unemployment claim

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					APPLICATION FORM FOR CLAIM OF UNEMPLOYMENT ALLOWANCE
    FOR EDUCATED HANDICAPPED PERSONS REGISTERED IN
                EMPLOYMENT EXCHANGE.

1.      Name of applicant ( Capital) ----------------------------------------------------------
2.      Father/husband name            ---------------------------------------------------------
3.      Temporary address              --------------------------------------------------------
4.      Permanent address             ---------------------------------------------------------
5.      Date of registration & date with Employment Exchange -------------------------
6.      Category of National Vocational Trade ----------------------------------------
7.      Educational qualification (Attached Certificates) ----------------------------------
8.      Three attested signatures of applicant by Gazetted officer ---------------------
        ( Separately attached)
9.      Attested domicile certificate duly attested by Gazetted Officer -------------------
10.     Category of disability( physically handicapped/blind, deaf & dumb or
        mentally retarded               ---------------------------------------------------------


                                                      Signature of applicant

I -----------------Son/D/W of Sh.-------------------- permanent resident of -----------------
The.------------------ Distt.--------------- hereby declare as under: -

1. That my name has been registered in Employment Exchange----------- as per
   particulars given above.
2. That I am not claiming any unemployment allowance from Govt.or any
   organization working under Govt.
3. That I am unemployed and I shall inform the Director, Social Justice &
   Empowerment Department, Haryana, Chandigarh on getting the job.
4. That I have not been dismissed from any Public Sector organization or semi Govt.
   & Local Bodies and neither convicted under any charge, also not receiving any
   pension from any source or Social Justice & Empowerment Department, Haryana.
5. That I am not getting education, training etc. from any recognized vocational
   institution.
6. That I am Haryana domicile and residing in Haryana for 6 months before the date
   of my registration.

                                 OR
   That I am Haryana domicile but temporary residing in Chandigarh for the last-----
   Months/years.
7. That contents of my application are true and I assured to inform the Director,
   Social Justice & Empowerment Department, Haryana upon any change.


                                                      DEPONENT
VERFICIATION

   It is certified that contents of above affidavit are correct & true as per my belief
and nothing has been concealed thereon.

                                                   DEPONENT

ATTESTION

( Signature & stamp of attesting authority)
Registration certificate of Employment Exchange.

Certified that Sh./Km./Smt.---------------------- Son/D/W/ of ---------------------------
Resident of -------------------------------------------------- has been registered in
Employment Exchange ----------------- under the registration no.--------------- dated----
---------- .

It is also certified that the applicant is unemployed and his name is registered in live
register of this Employment Exchange.

                      Signature employment Officer with stamp.