NON JUDICIAL STAMP PAPER

Rs.10 Rs.10
1. I, Name SILAMBARASAN son of RAMAN while applying for
enrolment in Army Solemnly affirm & state the
Paste your
following my respect :-
photograph
(a) I belong to the following caste/Religion :- and self attest
Caste _______ Sub Caste _______ Religion Hindu the same
(b) My Residential Addresses are as under :-

(i) Permanent Home Address

Father Name RAMAN House No 90

Vill/Mohalla PUTHUR Tehsil Ariyalur

District ARIYALUR State TAMIL NADU

(ii) Postal Address

Father Name RAMAN House No 90

Vill/Mohalla PUTHUR Tehsil Ariyalur

District ARIYALUR State TAMIL NADU

(ii) I fully understand that if enrolled, a detailed verification of my character and antecedents will be carried
out by police and civil administration from my permanent address submitted above and also places where I
have resided in the last five years.

(iii) My places of residence in the last five years are as stated under :-

Residential address in full i.e., House Number,

I was involved in following cases but was acquitted :-

(i) ______________________

(ii) ______________________

OR

Following court cases / FIR are pending against me :-

(i) ______________________

(ii) ______________________
(e) Consent Certificate. I am below 18 years and my parents give their consent, for attending the Army
Recruitment Rally. (if applicable)

Signature of Father _______________

(f) I am authorized to attend UHQ rally because I am son/ brother of No ____________ Name
_____________ Regt ___________________.
(g) I hereby certify that I, son of No ______________ Name _________________ Regt ______________
am eligible for claiming bonus marks as none of my brothers have been enrolled in Army earlier/ I am not
eligible to claim bonus marks (Cut whichever is not applicable).
2. I am aware that there is only one recruitment rally conducted in a recruiting year (01 April to 31 March)
for every district and therefore I am entitled to attend only once every recruiting year from my home town
district based on my nativity/domicile certificate. I fully understand that if I attend another recruitment rally in
the same recruiting year, based on a different district Nativity/ Domicile certificate, my candidature will be
cancelled and if enrolled, I will be dismissed from service.
3. I am attending this recruitment rally based on the Nativity / Domicile certificate issued by _________
(mention the state government), details of which are as stated below :-

S/No. Cert No Date of Issue Validity Issuing authority

(a)
4. Details of nativity/domicile certificate held by me in past (if any) are as stated below :-

Present status
S/No. District Issued by Issuing date
(Valid/Expired)

(a)

(b)

(c)

5. I hereby certify that till date I have attended the following Army Recruitment Rallies :-

Nativity/
Army Month Category
Recruitment Domicile
S/No. Recruitment and Applied
Rally Venue Certificate
Office Year For
Address used

(a)

(b)

(c)
6. I give an undertaking that all documents submitted by me are correct. All documents issued by govt org
/ offices have been signed by authorized designated and govt officials. If any document at any stage is
found fake or wrong info is furnished by me, I am aware that I will be dismissed from service and FIR will be
lodged against me .

Signature of Notary Signature of Candidate