ANNEXURE I 17.08.2005, Notification No.1/41/93-RCI/209 dated 24.02.2009 and Notification No.1/41/93-RCI/609 dated 24.10.2013. Date of Issuance Signature of Issuing Authority Designation:

95prospectus 2017-18

ANNEXURE I

CERTIFICATE FOR SCHEDULED CASTES/SCHEDULED TRIBES (SC/ST)

Despatch No. ______________ Date ___________________

1. ItiscertifiedthatShri/Smt./Kumari________________________________________________

son/daughter of Shri___________________________________________________________

of village/town________________________________________________________________

District/Divison____________________________________________________StateofPunjab

belongs to__________________________Castewhichhasbeen recognisedasScheduled

Caste as per

“TheConstitution (ScheduledCastes)Order, 1950”.

2. Shri/Smt./Kumari___________________________________andhis/her family lives invillage/

town______________________________District/Division of PunjabState.

Signature_____________________

Place _________________ Designation___________________

Date _________________ (with seal of office)

Authorities competent to issue SC/ST Certificate :(i) M.Ps. in respect of Scheduled Caste persons residing in their respective parliamentary

constituencies.

(ii) M.L.As. in respect of Scheduled Caste persons residing in their respective assemblyconstituencies.

(iii) All gazetted officers of theStateGovernment. (Declared as such vide letterNo. 460/WG/56/4799 dated 25-01-1956 and 1/19/94-RCI/6045

dated 15-07-1994).

(iv) Tehsildar/NaibTehsildar (InpartialmodificationofLetterNo.1/8/07-rs 1/1295dated2-11-10issued vide letter no. 1/8/2007-rs 1/1047 dated 16-12-2011

N.B. : In case the certificate is found to be false or incorrect, the candidate will render himself/herself liable for criminal prosecution.

96 punjab agricultural university

ANNEXURE IIInstructions/Guidelines from Punjab Government, Welfare Department (Reservation Cell)

RegardingCERTIFICATE TO BE PRODUCED BY THE CANDIDATE IN SUPPORT OF CLAIM OF

BELONGING TO OTHER BACKWARD CLASS (OBC) & BACKWARD CLASS (BC)

;/tk fty/

oki d/ ;w{j ftGkrK d/ w[yh,

ofi;Noko, gzikp ns/ jfonkDk jkJh e]oN,

oki d/ ;w{j vthiaBK d/ efw;aBo,

oki d/ ;w{j fvgNh efw;aNoi,

oki d/ ;w{j T[g wzvb w?fi;No/N.

fwsh, uzvhrVQL 26-04-2016

ft;akL j]o gZSVh ;a/qDh (OBC) ns/ gZSVh ;aq/Dh (BC) dk ;oNhfce/N iakoh eoB ;w/A eoB ;w/A

eohwh b/no ;N/N; t/yD ;pzXh.

******************

T[go]es ft;/a d/ ;pzX ftZu dZf;nk iKdk j? fe j]o gZSVhnK ;q/DhnK (OBC) d/ ;pzX ftZu Gkos

;oeko d/ O.MNo.36012/22/93-Estt.(SCT) fwsh 08H09H1993 nB[;ko T[es gZso d/ nB[bZr ftZu doia

column 3 j/m nkT[Ad/ ftneshnK d/ ruleofexclusion bkr{ j[zdk j? ns/ T[j j]o gZSVh ;a/QDh(OBC) dk bkG

BjhA b? ;ed/ jB. fJ; gZso d/ nB[bZr ftZu 06 soQK dh e?Nkrohia fbyhnK rJhnK jB. e?Nkroh BzL 1 ;zftX-

kfBe gd j]bv eoB tkfbnK d/ ;pzX ftZu j?. e?Nkroh BzL 2 i’ fe ;oekoh eowukohnK Bkb ;pzXs j?, ftZu e/

Ado ;oeko iK oki ;oeko iK ghHn?;H:{ d/ ftZu roZ[g J/$ebk; 1 ns/ roZ[g ph$ ebk; 2 d/ fijV/ w[bkiawK d/

gZ[soK$gZ[sohnK s/ fJj ruleofexclusion bkr{ j[zdk j?, T[j fby/ rJ/ jB. e?Nkroh BzL 3 i] fe ;a;soXkoh ;?Bk

Bkb ;pzXs j?, ftZu ;?Bk d/ fijV/ nca;oK d/ gZ[soK$gZ[sohnK s/ fJj ruleofexclusionbkr{ j[zdk j”?, T[j fby/

rJ/ jB. e?Nkroh BzL 4 g/;aktokBk ebk;, ns/ fijV/ tgko ns/ T[d:]r Bkb ;pzX oZyD tkfbnK Bkb ;pzXs j?

ns/ e?Nkroh BzL 5 ikfJdkd wkfbeK Bkb ;pzXs j?. e?Nkroh BzL 6 ftZu income/wealthTestfbfynk frnk

j?. Gkos ;oeko tZb]A fJ; O.M ftZu O.MNo.36033/3/2004-Estt.(Res)datedthe9.3.2004,O.MNo.36033/3/2004-Estt.(Res.)dated14.10.2008 ns/ OMNo.36033/1/2013-Estt.(Res.)dated27.05.2013 okjhA ;]X ehsh rJh j? e?Nkroh Bzpo 6 income/wealthtest ftZu j[D ;kbkBk fJBew

fbfwN dh jZd tXk e/ 6 bZy ehsh rJh j?. e?Nkrohia fJj ;w{j w?w]ozvw B?;aBb efw;aB cko p?etkov ebk;ia

dh t?p;kJhN http://www.ncbc.nic.in/User_Panel/UserView.aspx?Type ID=1172 s]A vkT[Bb]

v ehshnK ik ;edhnK jB. fJ;/ dh soia s/ gzikp ;oeko tZb]A gZSVhnK ;aq/DhnK (BC) d/ ;pzX ftZu gZso BzL

1$41$93-o;1$459, fwsh 17H01H1994 iakoh ehsk frnk j?. fJj gZso pknd ftZu gZso Bzpo 1$41$93-

o;1$1597 fwsh 17H08H2005, fwsh 1$41$93-o;1$209, fwsh 4H02H2009 ns/ gZso Bzpo 1$41$93-

o;1$609 fwsh 24H10H2013 Bkb ;]fXnk frnk j?. GbkJh ftGkr dhnK fJj ;w{j jdkfJsK gzikp ;oeko

BzL1$02$2016-o;1$740131$1

gzikp ;oeko

GbkJh ftGkr

(foiaot/;aB ;?Zb)


dh t?p;kJhN http://punjab.gov.in/s]A vkT{Bb]v ehshnK ik ;edhnK jB. nB[;{fus ikshnK ns/ gZSVhnK

;/aqDhnK GbkJh ftGkr, gzikp dhnK foiaot/;aB ;pzXh jdkfJsK http://welfarepunjab.gov.in/s]A th gqkgs

ehshnK ik ;edhnK jB.

2H j]o gZSVhnK ;/aDhnK (OBC) ;oNhfce/N pDkT[D ;w/A fJj :ehBh pDkfJnk ikt/ fe T[whdtko, Gkos

;oeko d/ OMNo.36012/22/93-Estt.(SCT) fwsh 08H09H1993 d/ nB[bZr ftZu doia column 3 nXhB

Bk nkT[Adk j]t/. fJ;/ soQK gZSVhnK ;/aqDhnK (BC) dk ;oNhfce/N pDkT[Ad/ ;w/A fJj :ehBh pDkfJnk ikt/ fe

T[whdtko, gzikp ;oeko d/ gZso BzL1$41$93-o;1$459, fwsh 17H01H1994 d/ column 3 nXhB Bk nkT[Adk

j]t/.

3H e?Nkroh BzL 6L income/WealthTest ftZu fJj ;g;aNheoB fdZsk frnk j? fe fe;/ T[whdtko d/ wksk-

fgsk dh fJBew ftZu T[BQK dh ;?boh fJBew ns/ y/shpkVh fJBew Bz{ BjhA i]fVnk ikDk j? (Gkt i/eo wksk- fgsk

dh ;?boh fJBew$y/shpkVh fJBew 6 bZy o[gJ/ s]A tZX j]t/ gozs{ j]o t;hfbnK s]A fJBew 6 bZy s]A xZN j]t/ sK

income/wealthtest nXhB T[whdtko Bz{ eohwh b/no nXhB BjhA frfDnk ikDk j?.

4H tZy-tZy c?vo/;aBK ns/ T[whdtkoK d/ wkfgnK tZb]A GbkJh ftGkr d/ fXnkB ftZu fbnKdk frnk j? fe j]o

gZSVh ;/a/qDh (OBC) ns/ gZSVh ;a/qDh (BC) dk ;oNhfce/N iakoh eoB tkb/$fJBew s;dhe eoB tkb/ nfXekoh

T[whdtko d/ wkfgnK dh fJBew i]Vd/ j]J/ T[BQK dh ;?boh fJBew Bz{ th i]Vd/ jB ns/ e?Nkroh BzL 6L income/wealthtest nXhB T[whdtko dk ;oNhfce/N pDkT[D s]A wBQK eo fdzd/ jB. nfijk eoBk Gkos ;oeko ns/

gzikp ;oeko dhnK jdkfJsK d/ ftoZ[X j? ns/ nfijk Bk ehsk ikt/.

fJj gZso dh gjz[u o;hd G/ih ikt/.

;eZso GbkJh

T[go]es dk fJZe T[skok fBwBfbys Bz{ ;{uBK ns/ nrb/oh :]r ekotkJh fjZs G/fink iKdk j?L-

1H oki d/ ;w{j ftZsh efw;aBoia,

2H oki d/ ;w{j gqwZ[y ;eZso ns/

3H oki d/ ;w{j gqpzXeh ;eZso.

;eZso GbkJh

nzHftHgZHBzL 1$02$2016-o;1$740131$2 fwsh, uzvhrVQL26-04-2016

fgZmHnzHBzL 1$02$2016-o;1$740131$3 fwsh, uzvhrVQL26-04-2016

T[go]es dk fJZe T[skok w?po ;eZso, gzikp oki gZSVhnK ;a/qDhnK efw;aB Bz{ ;{uBK fjZs G/fink iKdk j?.

;eZso GbkJh


Gosh$dkyab/ ;w/A bJ/ ikD tkb/ gZSVh ;aq/Dh Bkb ;pzXs ftnesh s]A bJ/ ikD tkb/ ;t?-x];aDk

gZso dk g]qckowK

1H w?A_____________________gZ[so$gZ[soh ;aqh ________________tk;h____________

fgzv $ e;pk ;afjo________________fibQk__________________x];aDk eodk jK $eodh jK fe

w?A____________________ iksh Bkb ;pzX oZydk $oZydh jK s/ fJj iksh gzikp ;oeko tZb]A gZso

BzL__________________fwsh ________________okjhA gZSVh ;aq/Dh eoko fdZsh rJh j?.

2H w?A fJj th x];aDk eodk jK $eodh jK fe w?A gzikp ;oeko tZb]A iakoh jdkfJsK BzL 1$41$93-o;1$459,

fwsh 17H01H1994, fi; Bz{ pknd ftZu gZso BzL 1$41$93-o;1$1597 fwsh 17H08H2005, BzL 1$41$93-

o;1$209, fwsh 04H02H2009 ns/ gZso BzL 1$41$93-o;1$609 fwsh 24H10H2013 Bkb ;]fXnk frnk j?, dh

nB[;{fus ftZu doia ekbw 3 s/ nXhB BjhA nkT[Adk$nkT[Adh.

;EkBL x];aDk eosk

fwshL

t?ohfce/;aBL-

w?A fJZE/ fJj x];aDk eodk jK$eodh jK fe T[go]es fdZsh rJh ikDekoh w/oh ;wM nB[;ko

;jh tk do[;s j? ns/ fJ; ftZu e[M th S[gkfJnk BjhA frnk j?. w?A fJBQK sZEK s]A ikD{ jK fe i/eo w/oh e]Jh th

fdZsh ;{uBK rbs fBebdh j? sK w?A ekBz{B ftZu doi ;iak dk jZedko j]tKrk$ j]tKrh ns/ gqkoEh Bz{ fJ; ;{uBK

d/ nkXko s/ fdZs/ rJ/ bkG tkfg; b? bJ/ ikDr/.

;EkBL

fwshL x];aDk eosk

ANNEXURE II (Form A)


ANNEXURE II (Form B)Government of Punjab

Office of the __________________ District ___________

Certificate of Backward Class

CertificateNo.__________

This is to certify that Shri/Smt./Kumari ________________________

Son/Daughter of Shri ________________________

Village ________________________

District/Division ________________________

In theState ofPunjab belongs to the _____________ communitywhich is recognized as backwardclass under theGovernment of Punjab, Department ofWelfare of SCs and BCs vide NotificationNo._______________ dated ________ .

Shri/Smt./Kumari____________and/orhis/herfamilyordinarilyresidesinthe____________District/Division of theState of Punjab.

Thisisalsotocertifythathe/shedoesnotbelongtothepersons/sections(CreamyLayer)mentionedinColumn3of theSchedule to theGovernmentofPunjab,DepartmentofWelfareofSCsandBCsNotificationNo.1/41/93-RCI/459dated17.01.1994,asamendedvideNotificationNo.1/41/93-RCI/1597dated 17.08.2005, Notification No.1/41/93-RCI/209 dated 24.02.2009 andNotification No.1/41/93-RCI/609 dated 24.10.2013.

Date of Issuance Signature of IssuingAuthority

Designation:

Date:

Place:

Note:-The term “Ordinarily” usedherewill have samemeaningas inSection20ofRepresentationof PeopleAct, 1950.

IssuedVideNo.1/02/2016/rs1/90-91dt:2/8/16PunjabGovt.,WelfareDepartment(Reservationcell)

Spacefor

Photograph


ANNEXURE III

CERTIFICATE TO BE FURNISHED BY THE CHILDREN/GRAND CHILDREN OF FREEDOM FIGHTER (F/F)

CertifiedthatShri/Smt./Kumari___________________________________________anapplicant

foradmissiontoundergraduate/postgraduateprogrammeatPunjabAgriculturalUniversity,Ludhiana

isason/daughter/son’sson/son’sdaughterordaughter’sson/daughter’sdaughter(deletewhicheveris

notapplicable)ofShri________________________________who isa freedomfighter/TamraPatra

holder and/or drawing pension from _____________________ treasury as per PunjabGovt. Rules/

Instructions.

Place _____________ Signature __________________

Date _____________ Designation ________________ (with seal of office)

Authorities competent to issue F/F Certificate : DistrictMagistrate

N.B.: In case the certificate is found to be false or incorrect, the candidate will render himself/herself liable for criminal prosecution.


ANNEXURE IVCERTIFICATE TO BE FURNISHED BY THE CANDIDATE IN SUPPORT OF CLAIM OF BEING CHILD OF

INSERVICE/EX-SERVICE IN ARMED FORCES/C.R.P./B.S.F. OFFICERS/OFFICIALS (INCLUDING OFFICERS /OFFICIALS WHO DIED DURING THEIR SERVICE) CHILDREN//WIDOWS OF PARA-MILITARY FORCES

PERSONNEL, PUNJAB POLICE, PAP AND PUNJAB HOME GUARDS KILLED OR DISABLED IN ACTION TO THE EXTENT OF 50% OR MORE AND WARDS OF PUNJAB POLICEMEN DECORATED

WITH GALLANTRY MEDALS (A/F)

1.Certifiedthat________________________father/motherof____________________________isinregularserviceofArmedForces/CRP/BSFsince__________andpresentlyhe/sheisservinginthisunitas________________(designation).

2. It is certified that No.__________Rank_________Name________________________________ isa residentof_________________________Village/Town_____________Tehsil_______________District________________andhasservedin the IndianArmedForces from_______________________ to________________________andhasbeen released/retiredvideorderNo.___________Dated_________ordischargecertificateissuedby_______________________isanex-serviceman.Shri/Smt./Kumari _______________________________ son/daughter/wife of ______________________________ is residingwith him and iswholly dependent upon him.

3. Certified that ____________________ father/mother of ______________________ is/was in service ofArmedForces/CRP/BSF from______ to _____ as ________________________ (designation) and died during service.

This certificatehasbeen issued for admissionpurposeonly toShri/Smt./Kumari _____________________ toapplyfor (name of the class/course) __________________ in (name of the educational Institution) _________________________.

Place ______________ Signature of the_____________________Date ______________ AttestingAuthority___________________ (Seal or stamp of the officer signing the certificate must be affixed here)

Theabovecertificatemaybesignedby theHeadof theunit inwhich the father/motherof thecandidate isserving.In case of ex-serviceman, the certificatemay be signed by theSecretary,District Soldiers, Sailors andAirmenBoard.

DespatchNo................................. Dated.....................................

CERTIFICATE OF DEATH/INCAPACITATION OF PARA-MILITARY PERSONNEL Certified thatMr./Ms...........................................................................................anapplicant for admission to .........................................................................course in PunjabAgriculturalUniversity,Ludhiana is theson/daughter/spouseofMr./Ms.........................................................................whowaskilled/incapacitated to theextentof 50%ormore inactionordiedotherwise in service on/or incapacitated to the extent of 50%ormorewhile in service during peace time.

Dated.................................................... Signature of AuthorisedOfficerHeadquarter Official Seal

DespatchNo................................. Dated.....................................

CERTIFICATE OF GALLANTRY AWARD TO POLICE PERSONNEL Certified thatMr./Ms............................................................................................................anapplicant for admissionin.................................................................................................. course inPunjabAgriculturalUniversity, Ludhiana is the son/daughter/spouse of Shri...............................................................................who was awardedPresident’s PoliceMedal/PoliceMedal for gallantry.

Dated............................................ Official Seal Signature of InspectorGeneral of Police

N.B.: In case the certificate is found to be false or incorrect, the candidatewill render himself/herself liable for criminalprosecution.


ANNEXURE V

CERTIFICATE TO BE ISSUED BY THE SUB-DIVISIONAL OFFICER (CIVIL) IN RESPECT OF INNOCENT CIVILIANS KILLED/100% PHYSICALLY INJURED BY TERRORISTS/SECURITY FORCES

ACTING IN AID OF CIVIL POWER (T.A.) AND ALSO WHO AFFECTED IN NOVEMBER, 1984 RIOTS AND INTERNAL/EXTERNAL MIGRANTS.

1. It is certified thatMr/Mrs______________________________________________ son/daughter/wife ofMr./Ms___________________________________residentof______________________________________(Nameof village, tehsil (in case the deceased belonged to rural area) house number, name ofmohalla and area oftowntowhichhe/shebelongs)waskilled/100%physicallydisabledbytheterrorists/securityforcesactinginaidofcivilpoweron________________________________________________________________inVillage/Mohalla________________________________________Tehsil/Town____________________________________District________________________________.Hewas neither terrorist nor having any linkswith such elements.

2.It iscertifiedthatMr/Ms__________________________________________________son/daughter/wifeof

Mr/Ms.___________________________________whose father/motherwas killed/100% physically disabled inNovember,1984riotsat__________________________________________________(Nameofplace)orhis/her

familyhasmigrated from_________________________________(withinPunjaboranyotherstate in India)and

has settled at________________________.

3. It iscertified thatMr.___________________________CodeNo.________________________ofRegiment

__________________________fatherofMr/Ms___________________________whowaskilled/100%physically

disabledwhile deserting the IndianArmy.

4. This certificate is being issued for admissionpurposeonly toMr/Ms__________________________ toapply for admission toPAU.

Place _______________ Signature ____________________

Date _______________ Designation __________________ (with seal of office)

Authorities competent to issue T.A. Certificate : Sub-DivisionalOfficer (C)

N.B.: In case the certificate is found to be false or incorrect, the candidate will render himself/herself liable for criminal prosecution.


ANNEXURE VI(Form I toV)

Authorities Competent to issue Disabilty Certificate on behalf of the MEDICAL AUTHORITY.

Note:(i) For3typesofdisabilitycertificates,hospitalsasmentionedinCol3abovehavebeennotifiedasmedicalauthority.Intheeventofnon-

availabilityoftheconcernedspecialistinaparticularhealthinstitutionmentionedinCol3,theSMO/MOinchargeofthathealthinstitutionwouldrefertheapplicanttothenearesthigherhealthinstitutionswheresuchspecialists/facilitiesareavailable.

(ii) LikewiseifahospitalmentionedinCol3abovedoesnothavetherequisiteassessmentfacilitiesforvariousdisabilities,theheadofsuchhospitalmayutilizethefacilitiesavailableinthehospitaloftheHealthDepartmentinanearbyplaceinthedistrictorreferthecasetotheMedicalCollegesfortestingfacilities.TheMedicalCollegeswheresuchcasescanbereferredare:

S.N.

1

1.

2.

3

Type of Disability

2

Obvious Disability on Form-II (i)LocomotorDisabilitybywayonlyofamputationorcompletepermanent paralysis of limbs.(ii)Blindness

Multiple Disability on Form-III

SingleDisabilityonForm-IV(DisabilitiesnotmentionedatSN1&2above)

Hospital/Institution which is being specified as the “Medi-cal Authority” for the purpose of the disability mentioned in Col 2

3

AllDistrictHospitals,Sub-Di-visionalHospitals,CommunityHealthCentresandPrimaryHealthCentres

AllDistrictHospitalsandSub-Di-visionalHospitalshaving(a)Specialistsand(b)necessarymeasurement/assessment/evaluationfacilitiesinrelevantfields(eg.audiometric,optomet-ricandothertestingfacilities).

AllDistrictHospitalsSub-Divi-sionalHospitalsandCommunityHealthCentershavingspecial-istsandnecessarymeasure-mentassessment/evaluationfacilitiesinrelevantfields(eg.Audiometricoptometricandothertestingfacilities).

Medical Officer working in the Hospital/Institution mentioned in Col 3 who would be com-petent to issue certificate of disability

4

MedicalSuperintendent/SMOoraSeniorDoctorauthorizedbyanorderofMS/SMOofthehospital.SMOofCHC/SMOofPHC/MOinchargePHC.

AmedicalboardasmaybespecifiedbyaMedicalSuper-intendentorSeniorMedicalOfficeroftheDistrictHospital/Sub-DivisionalHospitalhead-edbyaSeniorSpecialistandconsistingofdoctorswithpostgraduatedegreeinthedisci-plinesdealingwithrelevantdisabilities.

AdoctorhavingaPGdegreeinthedisciplinesdealingwithrelevantdisabilitieswithamin-imumof3yearsofservicedulyauthorizedbytheHeadoftheInstitutioni.e.MS/SMO.

•Govt.MedicalCollege,Amritsar• Govt.MedicalCollege,Patiala• Govt.MedicalCollege,Faridkot• ChristianMedicalCollege,Ludhiana

• DayanandMedicalCollege,Ludhiana• ShriGuruRamDassMedicalCollege,Amritsar• GianSagarMedicalCollege,Banur• AdeshMedicalCollege,Bathinda• PunjabInstituteofMedicalSciences,Jalandhar

• GovtMedicalCollege,Sector–32,Chandi-garh

• PostGraduateInstituteofMedicalEducation&Research(PGIMER),Chandigarh

(iii) Explanation • PrimaryHealthCentremeansBlockPrimaryHealthCentreorPrimaryHealthCentrerunbyDepartmentofHealth&FamilyWelfare.• CommunityHealthCentremeansaCommunityHealthCentrenotifiedbytheStateGovernmentasCHCandrunbyPunjabHealthSystems

Corporation.• Sub-DivisionalHospitalmeansahospitalnotifiedbytheStateGovernmentasSDHandrunbyPunjabHealthSystemsCorporation.• DistrictHospitalmeansCivilHospitalsituatedatdistrictheadquarterandrunbyPunjabHealthSystemsCorporation.


ANNEXURE VI (Form-I)APPLICATION FOR OBTAINING DISABILITY CERTIFICATE BY PERSONS WITH DISABILITIES

(SeeRule3)

1. Name.................................................... ........................................... ........................................... (Surname) (Firstname) (Middlename)2. Father’sName....................................................... Mother’sName...............................................................3. DateofBirth:........../........../................ DD/MM/YYYY4. Ageatthetimeofapplication:.......................................years5. Sex: Male/Female6. Address:(a) Permanentaddress (b)(CurrentAddress(i.e.forcommunication) ........................................................................... ......................................................................... ........................................................................... ......................................................................... ........................................................................... ......................................................................... ........................................................................... ......................................................................... (c)Periodsincewhenresidingatcurrent address............................................................ .........................................................................7. EducationStatus(Pl.tickasapplicable) (I)PostGraduate/Graduate/Diploma (II)HigherSecondary/HighSchool/Middle (III)Primary/Illiterate8. Occupation......................................................................................................................................................................9. Identificationmarks(i)............................................................ (ii)...................................................................10.Natureofdisability:Visual/Hearing/Locomotor/Mental/others11.Periodsincewhendisabled:FromBirth/Sinceyear.......................................12.(i) Didyoueverapplyforissueofadisabilitycertificateinthepast?...............................YES/NO(ii) Ifyes,details: (a) Authoritytowhomanddistrictinwhichapplied.............................. (b) Resultofapplication...........................................................................13.Haveyoueverbeenissuedadisabilitycertificateinthepast?Ifyes,pleaseencloseatruecopyof CertificateNo. Date IssuedBy ............................................... ............/............./............... ..............................................

Declaration :Iherebydeclarethatallparticularsstatedabovearetruetothebestofmyknowledgeandbelief,andnomaterialinformationhasbeenconcealedormisstated.Ifurther,statethatifanyinaccuracyordetectedintheapplication.Ishallbeliabletoforfeitureofanybenefitsderivedandotheractionasperlaw.

...............................................................................(Signature or left thumb impression of personwithdisability, or of his/her legal guardian in case ofpersonswithmentalretardation,autism,cerebralpalsyandmultipledisabilities)

Date:................/................/...................Place:....................................................


ANNEXURE VI (Form-II)

DISABILITY CERTIFICATE (OBVIOUS DISABILITY)(In cases of amputation or complete permanent paralysis of limbs and in cases of blindness)

(See rule 4)(NAME AND ADDRESS OF THE HEALTH INSTITUTION)

CertificateNo. Date:

This is tocertifythatIhavecarefullyexaminedShri/Smt./Kum.....................................................................................

................................................son/wife/daughterofShri.....................................................DateofBirth............/......./.........

Age......................years,male/female.......................(DD/MM/YYYY)

RegistrationNo........................................permanentresidentofHouseNo.........................................Ward/Village

/Street.....................................PostOffice.........................District.......................................State.............................,whose

photographisaffixedabove,andamsatisfiedthat–

(A) he/sheisacaseof: • Locomotordisability • blindness (Pleasetickasapplicable)(B)thediagnosisinhis/hercaseis................................................Encl:1. Proofofresidence(Pleaseencloseacopyofoneofthefollowingdocuments) (a) rationcard (b) voteridentitycard (c) drivinglicense (d) bankpassbook (e) PANcard, (f) passport, (g) telephone,electricity,waterandanyotherutilitybillindicatingtheaddressoftheapplicant. (h) acertificateofresidenceissuedbyaPanchayat,municipality,cantonmentboard,andgazettedofficer

ortheconcernedPatwariorHeadMasterofaGovt.school. (i) incaseofaninmateofaresidentialinstitutionforpersonswithdisabilities,destitute,mentallyill,etc.,

acertificateofresidencefromtheheadofsuchinstitution.

2. Tworecentpassportsizephotographs..................................................................................................................................................................................... (Forofficeuseonly)

Date: SignatureofIssuingAuthorityPlace Stamp

Recent Passport

s i z e a t t e s t e d

p h o t o g r a p h

(showingfaceonly)

of the personwith

disability.


ANNEXURE VI (Form-III)DISABILITY CERTIFICATE

(In case multiple disabilities)(NAME AND ADDRESS OF THE HEALTH INSTITUTION)

(See rule 4)


ThisistocertifythatwehavecarefullyexaminedShri/Smt./Km.....................................................................................son/wife/daughterofShri....................................................................DateofBirth................./................./..............Age,years,male/female...........................

(DD/MM/YYYY)RegistrationNo....................................................permanentresidentofHouseNo.............................................................Ward/Village/St

reet.....................................PostOffice............................................District...............................................State...........................................whosephotographisaffixedabove,andamsatisfiedthat:(A)He/SheisaCaseofMultipleDisability.His/herextentofpermanentphysicalimpairment/disabilityhasbeenevaluatedasperguidelines

notifiedbyMinistryofSocialJusticeandEmpowermentNo.16-18/97-NI.I,NewDelhidated1stJune,2001andamendmentfromtimetotimeforthedisabilitiestickedbelow,andshownagaintherelevantdisabilityinthetablebelow:

1. He/Shehas...................%(Infigure...........................................percent(inwords)permanentphysicalimpairment/blindnessinrelationtohis/her.....................(partofbody)asperguidelinesnotifiedbyMinistryofSocialJusticeandempowermentno.16-18/97-NII.NewDelhiDatedJune1,2001andamendedfromtimetotime

Signature/Thumbimpressionof the personwhose favourdisabilitycertificateisissued

2.Theapplicanthassubmittedthefollowingdocumentasproofofresidence:-

NatureofDocument DateofIssue DetailsofMedicalauthorityIssuingcertificate

Name:

Address:

Signature–

Seal–

Recent Passport


p h o t o g r a p h

(showingfaceonly)

of the personwith

disability.

No. Disability Affected Diagnosis Permanent physical Impairment / part of Body mental disability (In %)

1 Locomotordisability @ 2 Lowvision # 3 Blindness BothEyes 4 Hearingimpairment 5 Mentalretardation X 6 Mental-illness X

(B) Inthelightoftheabove,his/heroverallpermanentphysicalimpairmentasperguidelinesnotifiedbyMinistryofSocialJusticeandEmpowermentNo.16-18/97-NI-I,NewDelhidated1stJune,2001,isasfollows:-Infigures:-................................................................................percentInWords:-.............................................................................................................................................................percent2. Thisconditionisprogressive/non-progressive/likelytoimprove/notlikelytoimprove.3. Reassessmentofdisabilityis– (i)notnecessary, Or (ii)isrecommended/after...............years................months,andthereforethiscertificateshallbevalidtill............./............/................. (DD/MM/YYYY)[email protected]. Left / Right/ both arms / legs-#- e.g. Single eye / both eyes

- - e.g. Left / Right / both ears

h+


Theapplicanthassubmittedthefollowingdocumentasproofofresidence:-

Nature of Document Date of issue Details of authority issuing certificate

5. SignatureandsealoftheMedicalAuthority.

Nameandsealof Nameandsealof Nameandsealofthe Member Member Chairperson

Signature/ Thumb impression ofthepersonwhosefavourdisabilitycertificateisissued


ANNEXURE VI (Form-IV)DISABILITY CERTIFICATE (SINGLE DISABILITY)

(In case other than those mentioned in Forms II and III)(NAME AND ADDRESS OF THE HEALTH INSTITUTION)

(See rule 4)


This is to certifythatwehavecarefullyexaminedShri/Smt./Kum..................................................................son/wife/daughterofShri.......................................................DateofBirth.............../............./...............Age.....................years,male/female................................... (DD/MM/YYYY)

RegistrationNo............................................permanentresidentofHouseNo................................Ward/Villages/Street............................PostOffice...................................District...........................................State........................................whosephotographisaffixedabove,andamsatisfiedthathe/sheisacaseof..................................................disability.His/herextentofpercentagephysicalimpairment/disabilityhasbeenevaluatedasperguidelinesnotifiedbyMinistryofSocialJusticeandEmpowermentNo.16-18/97-NI.I,NewDelhidated1stJune,2001andamendedfromtimetotime

andisshownagainsttherelevantdisabilityinthetablebelow:-SerialNo.

Disability AffectedpartofBody Diagnosis PermanentphysicalImpairment/mentaldisability(In%)

1 Locomotordisability @

2 Lowvision #

3 Blindness BothEyes

4 Hearingimpairment

5 Mentalretardation X

6 Mental-illness X

(Pleasestrikeoutthedisabilitieswhicharenotapplicable.)

Recent Passport


p h o t o g r a p h

(showingfaceonly)

of the personwith

disability.

h+

2. Theaboveconditionisprogressive/non-progressive/likelytoimprove/notlikelytoimprove.3. Reassessmentofdisabilityis– (i)notnecessary, Or (ii)isrecommended/after...............years....................months,andthereforethiscertificateshallbevalidtill............./........../.............. DD/MM/[email protected]. Left / Right /both arms / legs-# - e.g. Single eye / both eyes-- e.g. Left / Right /both ears

4. Theapplicanthassubmittedthefollowingdocumentasproofofresidence:-

NatureofDocument Dateofissue DetailsofMedicalauthorityissuingcertificate

Name:

Address:

Signature– Seal–


ANNEXURE VI (Form-V)Intimation of Rejection of Application for Disability Certificate

(In cases other than those mentioned in Forms II and III

(See rule 4)

No:......................... Date: .....................................

To

(Nameandaddressofapplicant

forDisabilityCertificate)

Subject : Rejection of Application for Disability Certificate.

Sir/Madam,

1. Pleaserefertoyourapplicationdated...............................forissueofaDisabilityCertificateforthefollowing

disability:

.....................................................................................................................................

2. Pursuant to the above application, dated youwere examined by the undersigned /Medical Board on

..................................andIregrettoinformthat,forthereasonsmentionedbelow,itisnotpossibletoissueadisability

certificateinyourfavour:

(i)

(ii)

(iii)

3. Incase,youareaggrievedbytherejectionofyourapplicationyoumayrepresentto........................................

................requestingforreviewofthisdecision.

Yoursfaithfully,

Signature-

Name-

Address-

Seal-


ANNEXURE VII

CERTIFICATE TO BE PRODUCED BY THE CANDIDATE IN SUPPORT OF CLAIM OF KASHMIRI MIGRANT (KM)

No. _______________ Date _______________

It is certified that Sh./Smt./Kumari ___________________________________ Son/Daughter

of_______________________________________Residentof_______________________________

Tehsil___________________________District_____________________________________isKashmiri

migrant.He/She is original resident of __________________________________________________

Tehsil __________________________District _____________________________________.

TheCertificateisbeingissuedtoSh./Smt./Kumari__________________toapplyforadmission

to ________________ programmeat PunjabAgriculturalUniversity, Ludhiana.

Signature ________________

Designation ______________ (with seal of office)

Authority competent to issue Kashmiri Migrant Certificate : DistrictMagistrate.

NB.: IncasetheCertificate isfoundfalseor incorrect, thecandidatewill renderhimself/herself liablefor criminal prosecution.


ANNEXURE VIII

CETIFICATE TO BE PRODUCED BY THE CANDIDATE IN SUPPORT OF CLAIM OF TSUNAMI AFFECTED (TSA)

No. __________________ Date __________________

It is certified that Shri/Smt./Kumari ___________________________________________

Son/Daughter of ________________________ Resident of __________________________

Tehsil _____________________District __________________________ is Tsunami affected. He/

She is resident of ______________________________ Tehsil ____________________________

District ____________________________.

Signature ____________________

Designation __________________

(with seal of office)

Authority competent to issue Tsunami affected Certificate :

DistrictMagistrate

NB : IncasetheCertificateisfoundfalseorincorrect,thecandidatewillrenderhimself/herselfliablefor criminal prosecution.


ANNEXURE IXResidence Certificate

**CERTIFICATE TO BE ISSUED BY THE PRINCIPAL/HEAD MASTER OF THE GOVERNMENT/RECOGNISED SCHOOL/COLLEGE CONCERNED IN CASE OF CATEGORY (b) (i) of Annexure-E

It is certified thatMiss/Mr. __________________________________________________________ D/o/S/oSh.__________________________________________hasbeenastudentofthisSchool/Collegeforaperiodof___________________years,from______________________to___________________.He/She left theSchool/College on _______________________________.

Dated ________________ Signature of Principal/HeadMaster of theSchool/College (with seal)

**CERTIFICATE TO BE ISSUED BY HEAD OF THE DEPARTMENT IN CASE OF CATEGORY (b) (ii) (a) of Annexure-E

Certified thatMr./Ms.________________________S/o/W/o Sh._____________________________ father/motherofMiss/Mr.____________________________________________(nameoftheChild/Ward)isanemployeeofthe________________________________(nameofOffice)ofPunjabGovernment.He/Sheisworkingas____________________________andispostedat__________________________He/She hasmore than three years service at his/her credit.

Date _________________ Head ofDeptt. (Seal)Place _________________

ORCertifiedthatMr./Mrs.___________________________S/o/W/oSh.__________________ is father/motherofMiss/Mr.________________________________isanemployeeofthe_________________of Punjab Government. He/She is working as ______________________________________ondeputationwiththe_________________________andispostedat______________________.He/She hasmore than three years service at his/her credit.

Place ______________ Head of theDepartmentDated ______________ (with seal)

** CERTIFICATE TO BE ISSUED BY THE RESPECTIVE HEAD OF THE DEPARTMENT IN THE CASE OF CATEGORY (b) (ii) (b) of Annexure-E

Certified thatMr./Mrs. ___________________________S/o/W/o/Sh. ______________________ isfather/motherofMiss/Mr.____________________________________isanemployeeofGovt.ofIndiaand he/she isworking as ___________________. He/She has been posted atChandigarh/Punjabin connectionwith the affairs of PunjabGovernment for the past three years.

Head of theDepartmentDated ______________ (with seal)


**CERTIFICATE TO BE ISSUED BY THE RESPECTIVE HEAD OF THE DEPARTMENT IN THE CASE OF CATEGORY (b) (ii) (c) of Annexure-E

Certified thatMr./Mrs._____________________________ S/o/W/o/ Sh. _____________________ isfather/motherofMiss/Mr.______________________isanemployeeof__________________(Institution/Undertaking) of theGovernment of Punjab and is working as _____________________________.He/ShehasbeenpostedatChandigarh/Punjab in connectionwith affairs ofPunjabGovernment forperiod of past three years.

Dated _________________ HeadoftheDepartment (with seal)

**CERTIFICATE TO BE ISSUED BY THE RESPECTIVE HEAD OF THE DEPARTMENT IN THE CASE OF CATEGORY (b) (ii) (d) of Annexure-E

CertifiedthatMr./Mrs.___________________________S/o/W/o/Sh.____________________isfather/motherofMiss/Mr._____________________________________________________isanemployeeof______________________.(nameofautonomousbody/company)_____________________________inwhichthePunjabGovernmenthas20%ormoreshare.He/Sheisworkingas________________________and ispostedat__________________ It isalsocertified thathe/shehas threeyearsservice in theabove said autonomous body/company.

Dated _________________ HeadoftheDepartment (with seal)

**RESIDENCE CERTIFICATE TO BE ISSUED BY THE DC, ADC(R ), ADC (D), SDM, ASSTT. COMMMISSIONER GENERAL, DORG, DRO, EM, TEHSILDAR, COMMISSIONERS

OF MUNICIPAL CORPORATIONS OF AMRITSAR, JALANDHAR, PATIALA AND LUDHIANA IN CASE OF CATEGORIES (iv) of Annexure-E

Certified thatMr./Mrs. _______________________________________________________________ S/o/W/o Sh. _________________________________________________________ father/mother/guardian ofMr./Miss ____________________________ (name of theChild/Wardwith full address)has settled* in Punjab or has resided* in Punjab for a period of 5 years from ______________________________________ to _________________________.He/She isworking as _______________________________.

*Strike outwhichever is not applicable. (name of profession, designation and job). Dated _______________


**RESIDENCE CERTIFICATE TO BE ISSUED BY THE DC, ADC (R), ADC (D), SDM, ASSTT. COMMISSIONER GENERAL, DORG, DRO, EM, TEHSILDAR, COMMISSIONERS OF MUNICIPAL

CORPORATIONS OF AMRITSAR, JALANDHAR, PATIALA AND LUDHIANA IN CASE OF CATEGORY (v) of Annexure-E

CertifiedthatMr./Mrs.__________________________________________________________S/o/W/oSh. _____________________________________________________ father/mother/guardian ofMr./Miss.___________________________ (name of theChild/Wardwith full address) hold immovableproperty at (place& district) ____________________________________ in the state of Punjab forthe past ______________________ years.

Dated _______________

**RESIDENCE CERTIFICATE TO BE ISSUED BY THE DC, ADC (R), ADC (D), SDM, ASSTT. COMMISSIONER GENERAL, DORG, DRO, EM, TEHSILDAR, COMMISSIONERS

OF MUNICIPAL CORPORATIONS OF AMRITSAR, JALANDHAR, PATIALA AND LUDHIANA IN THE CASE OF CATEGORIES (vi) of Annexure-E

CertifiedthatMiss/Mr.______________________________S/o/D/o/Sh.____________________________resident of ________________________________was born inPunjab as per BirthCertificate.

Dated _______________

* This affidavit is to be givenby all candidates.** Any one of these certificates, as applicable to the candidate according to the PunjabGovt.

instructions, is to be given.


ANNEXURE - IX (‘D’)

d&qr qihsIldwr

rYzIfYNs srtIiPkyt

qsdIk kIqw jWdw hY ik SRI / SRImqI / kumwrI _______________________________

puqr/puqrI/pqnI SRI _________________________________, vwsI__________________

____________, qihsIl__________________ izlHw___________________________

pMjwb rwj dw G`to-G`t pMj swlW qoN vsnIk hY[

qihsIldwr

____________________

nM :_______________

imqI:______________

Office of Tehsildar

Residence Certificate

CertifiedthatSh/Smt/Ms________________________________________________________

S/o/D/o/W/oSh__________________________________,residentof__________________________

Tehsil_____________________________District ________________________________ has been

resident in theState of Punjab for at least five years.

Tehsildar_____________________

No. ____________________

Date: ___________________

ANNEXURE - IX (‘D’)


ANNEXURE - IX (‘E’)

d&qr qihsIldwr

rYzIfYNs srtIiPkyt



____________, qihsIl__________________ izlHw___________________________

dw jnm, jnm srtIiPkyt dy muqwibk, pMjwb rwj iv`c hoieAw[

qihsIldwr

____________________

nM :_______________

imqI:______________

Office of Tehsildar




Tehsil_____________________________District________________________________wasbornin

theState of Punjab as per BirthCertificate.

Tehsildar_____________________

No. ____________________

Date: ___________________

ANNEXURE - IX (‘E’)


ANNEXURE - IX (‘F’)

d&qr qihsIldwr

rYzIfYNs srtIiPkyt



____________, qihsIl__________________ izlHw___________________________

dI pMjwb rwj iv`c Ac`l sMp`qI hY[

qihsIldwr

____________________

nM :_______________

imqI:______________

Office of Tehsildar




Tehsil_____________________________ District ________________________________ holds

immovable property in theState of Punjab.

Tehsildar_____________________

No. ____________________

Date: ___________________

ANNEXURE - IX (‘F’)


ANNEXURE X

CERTIFICATE BY THE HEAD OF SECTION/DEPARTMENT/OFFICE FOR INSERVICE CANDIDATES OF THE PUNJAB AGRICULTURAL UNIVERSITY AND PUNJAB GOVT. AND UNION TERRITORY OF

CHANDIGARH ONLY

1. Certified that Shri/Smt./Kumari_______________________________________________is

employedintheofficeof_________________________________as________________________since

Alsocertifiedthathe/shesubmittedhis/herapplicationtothisofficeon_____________________for

onwardtransmissiontotheRegistrar,PunjabAgriculturalUniversity.

2.Certifiedthathis/herservicerecord,sofarasknowntome, isgoodandIamnotawareofany

circumstanceswhichmayrenderhim/herineligibleforadmissiontoPunjabAgriculturalUniversity.Certified

thathe/shehascompletedtheperiodofprobationofthepostheldbyhim/her.

No._________________________ Signature___________________________

Date________________________ Designation_________________________

Place_______________________ Section/Deptt./Office__________________

Documents

ANNEXURE I 17.08.2005, Notification No.1/41/93-RCI/209 dated 24.02.2009 and Notification No.1/41/93-RCI/609 dated 24.10.2013. Date of Issuance Signature of Issuing Authority Designation: