layXud % **x**

�01334&242331 01334&242332 01334&244143 01334&244566 01334&244282 (F)

vuqØekad --------------------------

mÙkjk[k.M yksd lsok vk;ksx] gfj}kj Website – www.gov.ua.nic.in/ukpsc

vkosnu&i= ¼vH;FkhZ uhps fn;s x;s LrEHkksa dks Lo;a Hkjsa½

foKkiu la[;k ___________________ foHkkx la[;k ______________________ vkosnu i= Lohdkj fd, tkus dh vfUre frfFk ________________________________

1&in ;k lsok dk uke ftlds fy, vH;FkhZ vkosnu ns jgk gSA

2&vH;FkhZ dk uke ¼d½ fgUnh esa ¼gkbZLdwy izek.k i= ds vuqlkj½ ¼[k½ vaxzsth esa ¼cM+s v{kjksa esa½

3&Mkd dk iwjk irk ftl ij vH;FkhZ ls i=&O;ogkj fd;k tk lds ¼irs esa fdlh ifjorZu dh lwpuk iath—r Mkd }kjk vk;ksx ds lEcfU/kr foHkkx dks HkstsaA½

4&xzke@uxj] ftyk rFkk jkT; dk uke tgka dk vH;FkhZ LFkk;h fuoklh gSA

5&tUe&frfFk ¼bZloh lu~ esa½ ¼gkbZLdwy izek.k i= ds vuqlkj½

6 vH;FkhZ ds firk@ifr dk & ¼d½ uke ¼[k½ tUe LFkku ¼x½ irk ¼;fn e`r gksa] rks vfUre irk½ ¼?k½ D;k mUgksaus dHkh viuh jk’Vªh;rk cnyh \

;fn gka] rks iwjk fooj.k nsaA

7&D;k vH;FkhZ rFkk@vFkok vH;FkhZ ds firk@ifr tUe rFkk@vFkok vf/kokl ls Hkkjrh; ukxfjd gSa \ ;fn ugha rks iwjk fooj.k nsa vkSj vko”;d izek.k&i= layXu djsaA

2 8&¼d½ D;k vH;FkhZ us foKkiu esa mfYyf[kr fdlh izdkj

dk vkj{k.k pkgk gSa \ mÙkj ^gka* ;k ^ugha* esa nhft,A ;fn gka rks tkfr@oxZ@Js.kh dk iwjk fooj.k nsa rFkk fu/kkZfjr izi= ij izek.k&i= layXu djsaA ¼vkj{k.k dk ykHk mRRkjk[k.M ewy@LFkk;h fuokfl;ksa dks gh vuqeU; gksxk½

¼[k½ D;k vH;FkhZ foKkiu esa mfYyf[kr fofHkUu

oxZ@tkfr@Js.kh dh vk;q lhekvksa esa ns; NwV dk ykHk pkgrk gS \ ;fn gka rks tkfr@oxZ@Js.kh dk iwjk fooj.k nsa vkSj fu/kkZfjr izi= ij izek.k layXu djsaA ¼vkj{k.k dk ykHk mRRkjk[k.M ewy@LFkk;h fuokfl;ksa dks gh vuqeU; gksxk½

¼d½ gka@ugha ¼[k½ gka@ugha

9&¼d½ D;k vH;FkhZ fookfgr gSa \ ¼[k½ ;fn gka rks D;k vH;FkhZ dh ,d ;k ,d ls vf/kd

thfor ifRu;ka gSa ¼iq#’k vH;fFkZ;ksa ds fy,½ vFkok D;k vH;FkhZ us ,sls iq#’k ls fookg fd;k gS ftldh ,d iRuh igys ls gh thfor gS ¼efgyk vH;fFkZ;ksa ds fy,½

¼d½ ¼[k½

10&lHkh “kSf{kd rFkk izkfof/kd ijh{kkvksa] ftuesa vH;FkhZ mÙkh.kZ gS] rFkk mu mikf/k;ksa dk iwjk fooj.k %&

ijh{kk ;k mikf/k fo’k; Js.kh o’kZ izfr”kr izkIr fof”k’Vrk dk fooj.k

iznÙk izek.k&i= la[;k

gkbZ Ldwy

b.VjehfM,V

Lukrd

LukrdksÙkj

vU; “kSf{kd@izkfof/kd vgZrkvksa@”kks/kdk;Z dk iwjk fooj.k

11&[ksydwn] “kkjhfjd O;k;ke esa izkIr izoh.krk rFkk@vFkok ikB~;srj dk;ksZa esa Hkkx ysus dk ;fn dksbZ izek.k gks] iwjk fooj.k nsa rFkk izek.k&i= layXu djsaA

3

12&vH;FkhZ viuh foxr rFkk orZeku fu;qfDr;ksa dk iw.kZ fooj.k uhps nsa %&

in dk uke ;k fu;qfDr dk Lo#i

fu;qfDr dk LFkku lsok;kstu dk uke rFkk iwjk fooj.k

izos”k frfFk NksM+us dh frfFk osru rFkk osru&Øe

13&vH;FkhZ foKkfir vfuok;Z rFkk vf/kekuh vgZrkvksa ls lEcfU/kr fuEu fooj.k nsa %&

vfuok;Z

¼Essential½ iznÙk izek.k&i= la[;k

vf/kekuh

¼Preferential½ iznÙk izek.k&i=

la[;k

1&

2&

3&

1&

2&

3&

14&D;k vH;FkhZ us & ¼1½ VsjhVksfj;y lsuk esa de ls de 2 o’kZ dh lsok dh

gS \

gka@ugha izek.k&i= la[;k

¼2½ ,u0lh0lh0 dk ^ch* lVhZfQdsV izkIr fd;k gS \ gka@ugha izek.k&i= la[;k

¼3½ ,u0,l0,l0 dk ^lh* izek.k&i= izkIr fd;k gS \ gka@ugha izek.k&i= la[;k

15&¼d½ D;k vH;FkhZ dks fdlh QkStnkjh U;k;ky; }kjk nf.Mr fd;k x;k gS \ ;fn gka rks iwjk&iwjk fooj.k nsaA

¼[k½ D;k vH;FkhZ dks dHkh la?k yksd lsok vk;ksx vFkok

fdlh jkT; yksd lsok vk;ksx }kjk izfrokfjr ¼Debar½ ?kksf’kr fd;k x;k gS \ ;fn gka rks fooj.k nsaA ¼x½ D;k vH;FkhZ dHkh jktdh; lsok ls inP;qr fd;k x;k gS vFkok gVk;k x;k gS vFkok vfuok;Zr% lsokfuo`Ùk fd;k x;k gS \ ;fn gka rks fooj.k nsaA

4

16&;fn vki vius vH;FkZu ds lEcU/k esa vk;ksx dks dksbZ fo”ks’k vgZrk@vuqHko nsuk pkgsa] tks Åij fn;s x;s LrEHkksa esa u vk;k gks] rks ;gka ,d vyx ls fooj.k nsa rFkk bl vk”k; dk izek.k&i= Hkh vius vkosnu&i= ds lkFk vo”; layXu djsaA

vH;FkhZ }kjk ?kks’k.kk %&

eSa bl ckr dh ?kks’k.kk *djrk@djrh gaw fd bl vkosnu&i= esa tks o.kZu gS] og esjs Kku ,oa fo”okl ds

vuqlkj lR; o iw.kZ gS vkSj ;fn mlesa dksbZ Hkh fyf[kr izfof’V vlR; ;k ftldh iqf’V u gks lds] rks eSa vik= Bgjk

*fn;k@nh tkÅa vkSj ;fn p;fur gks *x;k@gks xbZ gwa rks lsok ls gVk *fn;k@nh tkÅaA

vH;FkhZ dk gLrk{kj

iwjk uke

rFkk irk

nwjHkk’k

*tks ykxw u gks mls dkV fn;k tk;A

uksV % vk;ksx ifjlj esa eksckby Qksu] dSejk rFkk vU; bySDVªkWfud midj.k ykuk fuf’k) gSA

mÙkjk[k.M yksd lsok vk;ksx] gfj}kj izek.khdj.k izi=

ATTESTATION FORM psrkouh %& ¼1½ bl izi= esa dksbZ >wBh lwpuk nsuk ;k fdlh rF;iw.kZ lwpuk dks fNikuk vugZrk ¼Disqualification½ le>h tk;sxh vkSj blls mEehnokj

ljdkj ds v/khu ukSdjh ds fy, vuqi;qDr ¼unfit½ le>k tk ldrk gSA ¼2½ ;fn mEehnokj bl izi= dks Hkjus rFkk izLrqr djus ds ckn fu#) ¼Detained½ fl)nks”k ¼Convicted½] izfrokfjr ¼Debarred½ vkfn

fd;k tk;] rks mlds C;ksjs mÙkjk[k.M yksd lsok vk;ksx dks lwfpr fd;s tkus pkfg;sA ,slk u djus ij ;g le>k tk;sxk fd rF;iw.kZ lwpuk fNikbZ xbZ gSA

1&iwjk uke] miukeksa ds lkFk] ;fn dksbZ gks 2&firk dk iwjk uke] miukeksa ds lkFk] ;fn dksbZ gks] rFkk lsok dk inuke] ;fn

dksbZ gks

3&fuEufyf[kr dh jk”Vªh;rk& firk ekrk ifr iRuh

fuEufyf[kr dk tUe LFkku ifr iRuh

4& LFkkbZ irk %& ¼vFkkZr~ xk¡o] Fkkuk] ftyk@lM+d] ekxZ ;k xyh] edku ua0 lfgr½

;fn ewyr % ikfdLrku dk fuoklh gks rks ml ns’k esa irk rFkk Hkkjr esa izoztu ¼Migration½ djus dh rkjh[k ;gk¡ nh tk;

5&orZeku irk %&

6&fiNys ik¡p o”kks± ds irs

7& vk;q rFkk tUe dh rkjh[k ¼gkbZ Ldwy ds izek.k i= ds vuqlkj½

8& ‘kSf{kd vgZrk;sa] ftuesa mEehnokj dh 15 o”kZ dh vk;q ls f’k{kk izkIr djus ds LFkku vkSj lkFk esa Ldwyksa rFkk dkWystksa esa O;rhr fd;s x;s o”kZ fn;s tk;sa %&

Ldwy@dkWyst@fo’o0fo0@laLFkk@laLFkku dk uke] iwjs irs ds lkFk

izos’k dk o”kZ mÙkh.kZ ijh{kk dk o”kZ mÙkh.kZ ijh{kk

Ñ0 i0m0 2

9&laLFkku dk ¼;fn dksbZ gks½ iw.kZ fooj.k rFkk irs] tgk¡ mEehnokj us igys dke fd;k gks ;k tgk¡ og bl le; dke dj jgk gks &

in dk uke] ftl ij dk;Z fd;k gks vFkok dj jgk gks dk;Z dk fooj.kA

vof/k dk;kZy;] ;k laLFkk dk iwjk irk

fiNyh ukSdjh NksMus dk dkj.k

dc ls dc rd

10& bykds ds ,sls nks ftEesnkj O;fDr;ksa ds uke ;k ,sls O;fDr;ksa dk gokyk tks mEehnokj dks tkurs gksa 1- 2- 11& ¼d½ D;k vki dHkh fdlh U;k;ky; }kjk fdlh vijk/k ds fy, fxj¶rkj] vfHk;ksftr ¼Prosecuted½] fu#) ¼Kept in

detention½] vFkok vkc) ¼Bound½] vFkZ&nafMr ¼Fined½ nks”kfl) fd;s x;s ;k fdlh yksd lsok vk;ksx }kjk ijh{kk@p;uksa esa lfEefyr gksus ds fy, izfrokfjr@ vugZ fd;s x;s ;k fdlh vU; f’k{kk izkf/kdkjh@laLFkk }kjk dksbZ ijh{kk nsus ds fy, izfrokfjr ;k cfg”Ñr ¼Rusticate½ fd;s x;s \

¼[k½ D;k bl izek.khdj.k izi= dks Hkjrs le; vkids f[kykQ U;k;ky;] fo’ofo|ky; ;k fdlh vU; f’k{kk

izkf/kdkjh@laLFkk ds le{k dksbZ okn fopkjk/khu gS \

;fn ¼d½ ;k ¼[k½ dk tokc gk¡ gS] rks okn] fxj¶rkjh] fujks/k] vFkZ& n.M] nks”kfl)] n.Mkns’k vkfn dk iwjk fooj.k rFkk bl izi= dks Hkjrs le; U;k;ky;@fo’ofo|ky;@f’k{kk izkf/kdkjh vkfn ds le{k fopkjk/khu okn dk izdkj fn;k tk; &

¼Ñi;k izek.khdj.k izi= ds ‘kh”kZd ij psrkouh Hkh ns[ksa½ ¼izek.k&i=] ftl ij mEehnokj }kjk gLrk{kj fd;s tk;saxs½

eSa izekf.kr djrk gw¡@ djrh gw¡ fd tgk¡ rd esjh tkudkjh vkSj fo’okl gS] Åij nh xbZ lwpuk lgh vkSj iw.kZ

gSA eSa ,slh fdUghsa ifjfLFkfr;ksa ls voxr ugha gw¡ tks ljdkj ds ekrgr fdlh ukSdjh ds fy;s esjh mi;qDrrk dks de dj ldrs gSaA

frfFk LFkku

mEehnokj ds gLrk{kj

mÙkjk[k.M yksd lsok vk;ksx

vk;ksx Hkou] xq#dqy dk¡xM+h] gfj}kj&249404

Website –www.gov.in/ukpsc vuqØekad &

izkIrkadksa ds fooj.k dk izi= ¼uksV&bl izi= dks Hkjdj vius vkosnu i= ds lkFk layXu djsa½

fofHkUu ijh{kkvksa ¼gkbZ Ldwy ls ysdj½ esa Jh@Jherh@dqekjh --------------------------------------------------------ds izkIrkadksa dk fooj.k

fo”k; ijh{kk dk uke ftlesa lfEefyr gq;s@gqbZ vU; ijh{kk] ;fn dksbZ gks

gkbZ Ldwy b.VjehfM,V Lukrd LukrdksÙkj

izkIrkad iw.kk±d izkIrkad iw.kk±d izkIrkad iw.kk±d izkIrkad iw.kk±d izkIrkad iw.kk±d

1 2 3 4 5 6 7 8 9 10 11 1- fgUnh 2- vaxzsth 3- 4- 5- 6- 7- 8- 9- 10- 11- 12- 13- 14- 15- 16- 17- 18- 19- 20- 21- 22- ;ksx Js.kh] ftlesa ijh{kk mÙkh.kZ dh

eSa ,rn~}kjk izekf.kr djrk gw¡@djrh gw¡ fd mi;qZDr izfof”V;k¡ esjh tkudkjh ,oa fo’okl ds vuqlkj lgh gSaA fnukad %------------------------------------- vH;FkhZ dk gLrk{kj ---------------------------------------------------

mRRkjk[k.M yksd lsok vk;ksx] gfj}kj

ns”kuk&i=d (Index Card)

¼uksV& bl i=d dks Hkjdj vius vkosnu i= ds lkFk layXu djsa½

foKkiu la0 % ------------------------------------------- vuqØekad foHkkx la0 % -------------------------------------------

1- lsok@in dk uke % --------------------------------------------------------------------------------------------------------------------------------

2- vH;FkhZ dk uke %

¼v½ ¼fgUnh esa½ Jh@Jherh@dq0@MkW0 ---------------------------------------------------------------------------------------------

¼c½ ¼vaxzsth esa½ ------------------------------------------------------------------------------------------------------------------------------------------

3- firk ;k ifr dk uke ¼;fn fookfgr L=h gks rks½ --------------------------------------------------------------------------

4- tUe frfFk % -----------------------------------------------------------------------------------------------------------------------------------------------

5- irk % ¼v½ LFkk;h % -------------------------------------------------------------------------------------------------------------------------------------------------------------

---------------------------------------------Qksu ua0@eksckby ua0 --------------------------------------------------

¼c½ i= O;ogkj dk % ---------------------------------------------------------------------------------------------------------------------------------------------------------

--------------------------------------------- Qksu ua0@eksckby ua0 ------------------------------------------------

6- vki mRRkjk[k.M ds fdl tkfr@oxZ ¼m0vuqlwfpr tkfr@m0vuqlwfpr tutkfr@m0vU; fiNM+k oxZ½

ds vH;FkhZ gSa \ -----------------------------------------------------------------------

7- vki {kSfrt vkj{k.k dh fdl Js.kh ¼mRRkjk[k.M efgyk@m0iwoZ lSfud@m0Lo0la0lsukuh@m0dq”ky

f[kykM+h@m0fu%”kDr O;fDr@m0 jkT; vkUnksyudkjh½ ls lEcfU/kr gSa \ -------------------------------------------------------

--------------------------------------

8- “kSf{kd rFkk@vFkok izkfof/kd ;ksX;rk,a % --------------------------------------------------------------------------------

¼—i;k i`’B ds nwljh vksj nsf[k;s½

2

9- mÙkh.kZ ijh{kkvksa dk fooj.k ¼gkbZLdwy vkSj mlls mPp ;ksX;rk,a½ %

ijh{kk fo’k; o’kZ Js.kh izek.k i= la0

10- foxr ,oa orZeku fu;qfDr;ksa dk fooj.k ¼;fn dksbZ gks½ %

frfFk;ka ftl in ij dke fd;k gks ;k dj jgs gksa mldk uke vFkok fu;qfDr dk Lo#i

osru&Øe rFkk osru

dc ls dc rd

fnukad % -------------------------------- vH;FkhZ ds gLrk{kj -------------------------------------------