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RECRUITMENTINSPECTORS2006FORDISPLAY

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					                               GOVERNMENT OF INDIA
                               MINISTRY OF FINANCE
                             DEPARTMENT OF REVENUE
        OFFICE OF THE CHIEF COMMISSIONER OF CENTRAL EXCISE, CHENNAI ZONE
          26/1, MAHATHMA GANDHI ROAD, NUNGAMBAKKAM, CHENNAI – 600 034

 Telephone No : 044-28331144                                          Email   : cexmds@vsnl.com
 Fax No : 044-28331159                                    Visit us at : www.kalalchennai.tn.nic.in
C.No.II/3/10/2009-CCA (Estt.)                                                    Dated:14.08.2009

To

List of candidates (Please see Annexure-I)

Madam / Sir,

               Sub:    CCA (Estt.) – Candidates qualified in the Graduate Level Examination,
                       2006 conducted by the SSC to the posts of Inspector (Central Excise)
                       in the Central Board of Excise and Customs – Call letter for Physical
                       Endurance / Test, Certificate verification and Medical examination – Reg.

                                             **********

             Your candidature has been recommended by the Staff Selection Commission for
appointment to the post of Inspector, Central Excise and you have been allocated to the
combined Central Excise Zones of Chennai, Coimbatore and Customs (Preventive) (Tamil Nadu
State).

              For the purpose of future necessary procedure, you are directed to report on
(Please see – Annexure-II) to

               The Additional Commissioner (P&V),
               III Floor, Central Excise Building (Near Ayakar Bhavan),
               26/1, Nungambakkam High Road (Mahathma Gandhi Road),
               Nungambakkam,
               Chennai – 600 034.

                The procedure will require verification of original documents / antecedent
verification / medical examinations and physical endurance test which includes walking and
cycling. You are therefore advised to bring original documents / certificates at the time of
reporting.

                Further, you may find enclosed herewith “Attestation Form” in triplicate, the same
should be filled up and a recent photograph pasted in the place provided for. A copy of the
letter addressed to the Superintendent of police of your District is also enclosed in duplicate.
You are required to submit the said letter along with attestation form in triplicate (duly filled) to
the Office of the Superintendent of Police and obtain acknowledgement on the second copy of
the letter and triplicate copy of the attestation form and submit the acknowledgement at the time
of reporting.
              Also enclosed is the letter addressed to the Civil Surgeon / Medical
Superintendent of the Government Hospital / Medical College of the District for conducting
medical examination. You should present yourself before the Civil surgeon / Medical
Superintendent for medical examination. You should also bring along the medical report given
by the Medical Authority and submit the same at the time of reporting.

               Also enclosed is the format of identification and character Certificate which is
required to be submitted duly certified in the prescribed form at the time of reporting.

               You are also advised to come prepared to stay atleast for 3 days for completion
of the required formalities. Please note that your have to make your own arrangements for
boarding and lodging during the stay. In case of any assistance at Chennai, you may please
contact PRO, Chennai – I Phone No.24331033.


                                                             Yours faithfully,



                                                          (P.VENKAT)
                                                ADDITIONAL COMMISSIONER (P&V)


Encl:   1) Attestation Form (in triplicate)
        2) Letter to the Superintendent of Police (in duplicate)
        3) Letter to the Civil Surgeon / Medical Superintendent
        4) Identity Certificate
        5) Character Certificate.
                    ANNEXURE - I


          Rank              Name            Date of
SL. No.
           No.         S/Shri/Smt./Kum.      Birth
  1       397    GOBI S                   29/11/1980
  2       418    LOGESHWARI C             25/07/1981
  3       491    SUDHAGAR K               02/12/1980
  4       684    SUBHAYAN DUTTA           09/01/1982
  5       750    SUBHADEEP BERA           10/01/1982
   6       776   SUBHABRATA CHAKRABORTY   03/12/1984
   7      1070   VIDYA DEVI S             24/08/1982
   8      1104   SRINIVASAN S             22/10/1975
   9      1131   GIRISH KUMAR SHARMA      26/01/1982
  10      1148   NALINA SOFIA T           16/10/1977
  11      1160   ROHIT RAWAT              19/05/1982
  12      1169   KAVITA UPPAL             09/09/1986
  13      1171   MUKESH KUMAR             24/02/1981
  14      1174   SATYA PRAKASH            29/09/1980
  15      1178   NITIN GUPTA              15/02/1984
  16      1185   VISHAL GAUTAM            15/12/1986
  17      1186   SANDEEP DALAL            14/09/1984
  18      1188   SAMLENDU PATHAK          01/03/1981
  19      1190   SANDEEP PODAR            02/09/1986
  20      1191   ATUL SINGH               16/10/1981
  21      1193   ABHISHEK GUPTA           23/02/1986
  22      1194   SUBHAJIT DAS             11/05/1984
  23      1196   AMIT RANJAN KAR          23/11/1983
  24      1201   RAKESH MISHRA            02/01/1986
  25      1202   ANISH KUMAR              14/01/1982
  26      1203   ANITA                    05/03/1984
  27      1204   RAKESH MANOCHA           18/09/1980
  28      1207   JITENDER KUMAR           15/07/1983
  29      1208   ANJESH KUMAR             18/12/1981
  30      1210   BHANU PRATAP SHARMA      07/07/1984
  31      1211   KUMAR NAROTTAM           10/10/1982
  32      1212   SARIKA CHOUBEY           22/06/1983
  33      1214   RAM KUMAR SINGH          25/12/1984
  34      1216   VIRENDRA KUMAR PARIHAR   27/09/1976
  35      1220   PURUSHOTTAM KUMAR        30/11/1975
  36      1224   ASHUTOSH NARAYAN         01/03/1983
  37      1228   SATENDER NAUTIYAL        01/11/1980
  38      1231   UMESH LAL SHAW           16/07/1982
                 ASHUTOSH NARAYAN
  39      1232                            01/03/1982
                 PRATIHAST
  40      1233   SOUVIK MUKHERJEE         05/07/1984
  41      1234   AMOD KUMAR MISHRA        12/06/1983
  42      1237   AVINASH SHRIVASTAVA      08/04/1982
  43      1238   MUKESH RANJAN            05/07/1981
                 BHAGAWATI SHARAN
  44      1239                            01/03/1982
                 UPADHYAY
  45      1240   ARGHO MUKHERJEE          11/02/1983
  46      1241   PAWAR VINOD LALASAHEB    19/02/1981
  47      1242   KAPIL DEO TRIPATHI       11/10/1981
48    1243   DIVYA GUPTA                22/09/1983
49    1249   MD K SHAH KHADIR           07/08/1982
50    1250   AMANDEEP KAUR              27/07/1987
51    1251   LALIT SAJWAN               17/10/1982
52    1254   SUMIT MITRA                16/01/1985
53    1255   RAKESH KUMAR               24/09/1980
54    1257   PAWAN KUMAR KHAJURIA       10/12/1977
55    1258   VIVEK KUMAR                26/12/1983
56    1260   BHUSHAN LAL KARNA          14/12/1982
57    1261   RANJEET KUMAR RAMAN        26/09/1984
58    1262   MADHU MANGALAM             05/02/1983
59    1263   NISHIT NATH                01/03/1976
60    1265   ASHUTOSH KUMAR JHA         01/03/1979
61    1266   SAMAR CHAKRAVARTY          15/02/1983
62    1268   ARDHENDU KARATI            04/05/1985
63    1269   PREM KUMAR                 20/01/1981
64    1270   SUDHIR KUMAR               08/08/1983
65    1272   JAYANT KUMAR JHA           07/07/1976
66    1276   HEMANT KUMAR               04/02/1982
67    1277   RUPAM BISWAS               09/09/1981
68    1279   SUDHANSHU GANDHI           08/08/1975
69    1280   ANUBHAV GAUTAM             20/12/1984
70    1284   RAVI KIRAN                 18/10/1981
71    1285   AMRESH KUMAR PATHAK        18/11/1981
72    1292   SANDEEP SIDDHARTHA         13/07/1976
 73   1293   SHWETA AGNIHOTRI           21/08/1985
 74   1294   MANOJ KUMAR                07/10/1982
 75   1298   SHUVAJIT GARAI             23/09/1981
 76   1299   SAPTAMITA SAHA             17/10/1980
 77   1301   RITESH KUMAR               25/12/1982
 78   1303   CHANDRAJIT CHATTERJEE      28/10/1985
 79   1305   PANKAJ SHARMA              06/07/1984
 80   1309   KHYATI TIWARI              05/06/1983
 81   1310   SUNIL KUMAR THAKUR         05/05/1985
 82   1311   NIBEDITA SIL               16/04/1982
 83   1314   MUKESH KUMAR               19/07/1980
 84   1321   MUKESH KUMAR SINGH         01/02/1982
 85   1326   PRADEEP KUMAR              01/03/1981
 86   1328   SUMIT BHANDARI             30/07/1984
 87   1331   NEERAJ KUMAR GUPTA         30/03/1981
 88   1332   VISHAL GUPTA               30/12/1979
 89   1333   SWATI                      23/10/1985
 90   1334   RITESH KUMAR               07/11/1977
 91   1338   YOGESHVAR KUMAR TRIPATHI   01/08/1983
 92   1339   SUMIT BANIK                21/12/1984
 93   1340   RAJEEV RANJAN              25/03/1981
 94   1342   AVIJIT CHAKRABORTY         21/07/1984
 95   1343   PAWAN SINGH                27/11/1980
 96   1344   ANAND RANJAN               16/09/1984
 97   1346   RAJESH KUMAR               03/02/1982
 98   1350   NIVEDITA                   18/09/1985
 99   1351   PRAVESH KUMAR BHADANI      10/02/1982
100   1353   SAURABH SANDHU             08/11/1983
101   1355   DEEPAK CHAUHAN             30/12/1982
102   1356   SHIVAM SYAL               27/11/1984
103   1357   VIVEKANAND MISHRA         22/09/1980
104   1358   SUNIL MEHLA               08/01/1982
105   1361   RAJESH KUMAR              05/11/1980
106   1363   SHAM SUNDER               02/10/1985
107   1368   SUNIL KUMAR               19/12/1980
108   1369   AMAR GUPTA                24/09/1980
109   1372   KOTTIKALAPUDI S LAKSHMI   23/06/1986
110   1373   DIPANKAR BERA             25/07/1981
111   1375   MOHAN LAL SHARMA          15/03/1982
112   1377   ANAND KUMAR PATHAK        11/01/1978
113   1378   SHAILESH RAJAN            15/12/1980
114   1379   GAURAV CHAUHAN            15/08/1982
115   1380   RITESH KUMAR              03/05/1981
116   1382   RAVI PRAKASH GUPTA        08/09/1983
117   1383   RITESH KUMAR SHARAN       01/03/1982
118   1386   ANAND BHUSHAN             15/06/1986
119   1387   ADITYA BAJPAI             25/10/1982
120   1389   HARISH MEHANDIRATTA       02/10/1983
121   1390   DEEPAK KUMAR              11/12/1984
122   1396   BRIJESH PANDEY            19/03/1983
123   1397   NAVEEN CHANDRA KANDPAL    05/12/1983
             PRASHANT KUMAR
124   1400                             18/10/1980
             CHOUDHARY
125   1402   BHUPENDER SINGH JAMJYAL   25/07/1985
             KRISHNA CHANDRA MANI
126   1403                             05/03/1982
             TRIPATHI
127   1405   PREETI SRIVASTAVA         17/07/1983
128   1406   PANKAJ KUMAR              12/08/1980
129   1407   ABHIK CHAKRABORTY         22/10/1983
130   1409   GAGAN MITTAL              25/07/1986
131   1410   AYATULLAH KHAN            04/03/1981
132   1411   RAHUL KUMAR               23/09/1983
133   1414   ATUL KUMAR GUPTA          07/02/1983
134   1415   PIYUSH KUMAR              15/02/1982
135   1416   MANISH                    08/07/1982
136   1419   VINEET KUMAR SRIVASTAV    01/03/1984
137   1425   VIJAY GOYAL               21/06/1981
138   1429   CHANDAN KUMAR             14/09/1982
139   1430   PRAMOD KUMAR PANDEY       30/07/1982
140   1435   ABHISHEK SHUKLA           13/07/1982
141   1439   MANISH RANJAN             31/07/1983
142   1441   MANISH KUMAR TIWARI       19/12/1980
143   1442   RAJ SRIVASTAVA            10/04/1987
144   1447   MADHUP SARASWAT           26/06/1982
145   1452   ROHIT SINGH               09/04/1983
146   1454   VINAY KUMAR AMBESTA       12/06/1984
147   1455   BHASKAR DEY               02/12/1982
148   1458   LALIT GAUR                28/08/1982
149   1457   GURPAL SINGH              24/03/1981
150   1461   SHWETA SHRIVASTAVA        12/08/1983
151   1464   HARSH SRIVASTAVA          24/02/1984
152   1465   LOKESH KUMAR SINGH        29/051985
153   1468   PRABHAT GUPTA             30/10/1985
154   1469   SANJEET SINGH                15/06/1982
155   1470   ANUJ KUMAR                   01/01/1976
156   1471   ASHWANI KUMAR                30/05/1978
157   1484   ANURADHA P                   22/07/1982
158   1511   DEBAJYOTI SARKAR             06/03/1984
159   1577   ASHOK KUMAR N                03/02/1980
160   1725   RINKA NATH                   25/10/1983
161   1745   RANJIT DAS                   07/07/1982
162   1804   THANAPATHI S                 01/02/1983
163   1817   MITHU SADHUKHAN              20/03/1981
164   1862   SURESH KUMAR G               20/06/1983
165   1896   VIKASH KUMAR CHANDAN         24/02/1983
             RAJ KUMAR DHIRENSANA
166   1910                                01/03/1981
             SINGH
167   1962   ATUL VERMA                   28/10/1982
168   1988   SANTOSH KUMAR                05/02/1981
169   2024   DHARMENDRA KUMAR             05/06/1983
170   2025   SURJEET SINGH RAJPUT         01/07/1983
171   2027   BINOD KUMAR GUPTA            01/08/1981
172   2030   RAKESH KUMAR SINHA           12/12/1978
173   2033   SUSHANT SETHIA               22/12/1982
174   2034   SOUMAYA KARMAKAR             24/05/1983
175   2035   OMPRAKASH NAYAK              27/11/1977
176   2036   RAJESH KUMAR                 01/08/1984
177   2037   PURNIMA YADAV                26/05/1983
178   2041   ARVIND KUMAR                 08/03/1983
179   2042   ANIL KUMAR                   15/10/1982
180   2045   SUBHASH YADAV                11/12/1979
181   2047   ASHUTOSH KUMAR               01/03/1986
182   2051   RAM KUMAR GUPTA              01/01/1979
183   2052   SHAILESH ANAND               25/01/1981
184   2057   PRASHANT VISHWAKARMA         19/06/1985
185   2059   SANTOSH KUMAR JAISWAL        15/06/1980
186   2069   KUNDAN KUMAR                 01/02/1979
187   2070   KUMAR HARSH WARDHAN          19/12/1979
188   2072   SURESH VERMA                 07/08/1980
189   2078   DAYA SHANKAR SINGH           25/08/1978
190   2080   ANIMESH KUMAR                28/11/1984
191   2082   TRILOK CHANDRA SAH           05/11/1983
192   2083   SANTOSH KUMAR SINGH          07/02/1983
193   2084   VINAY PRATAP BAHADUR SINGH   16/04/1983
194   2087   SHRAVAN KUMAR                02/06/1982
             JADHAV BHAGYASHRI
195   2089                                14/04/1982
             PANDHARINATH
196   2091   SUJEET KUMAR                 02/02/1984
197   2093   RAJEEV KUMAR                 15/01/1982
198   2094   MANISH KUMAR                 25/12/1986
199   2095   CHINTA RAJA RAMESH           30/11/1978
200   2096   RAJESH KUMAR ARYA            17/09/1981
201   2097   ARVIND KUMAR                 05/01/1980
202   2098   SUDIPTA SEAL                 02/10/1972
203   2099   SANTOSH KUMAR                03/11/1983
204   2101   PAWAN KUMAR                  25/12/1979
205   2103   KISHOR KUMAR              04/06/1980
206   2104   NIRMAL KATYAR             22/07/1985
207   2106   SANJAY KUMAR SAHU         05/02/1980
208   2109   BISWARUP KUNDU            24/01/1982
209   2110   MANOJ KUMAR               27/06/1980
210   2112   AHMAD FAIZ                01/03/1978
211   2113   ARAMBAM DHANESHOR SINGH   01/07/1984
212   2117   KUMAR KUNAL               22/09/1985
             DHARMVEER KUMAR
213   2119                             02/01/1981
             RATNAKAR
214   2124   CHANDRAMOHAN. V           25/03/1978
215   2128   VIJAYA NAGA CHANDRIKA D   13/08/1981
216   2131   ANAND KUMAR SHARMA        17/11/1978
217   2136   KEDAR PRASAD PRAJAPAT     06/11/1985
218   2137   ANIL KUMAR                05/01/1980
219   2140   MUKTI PADA PAL            25/04/1978
220   2143   ASHOK KUMAR DEHURY        23/12/1978
221   2144   PRAVEEN KUMAR YADAV       31/03/1979
222   2147   MD.MUMTAZ                 26/02/1986
223   2154   RABISH CHANDRA            01/01/1979
224   2160   ABHISHEK KUMAR            01/01/1979
225   2162   MANOJ KUMAR               01/01/1982
226   2169   SURENDRA MAHTO            27/06/1978
227   2170   SIMRAN PAL SINGH          19/10/1984
228   2171   SHASHI BHUSHAN            12/02/1981
229   2174   KOPPISETTI RAMAKUMAR      22/06/1983
230   2175   SUBIR KUMAR               01/03/1980
231   2176   ATUL KUMAR                02/07/1982
             PHIRANGE SACHIN
232   2180                             25/05/1980
             RAGHUNATH
233   2181   KRISHNA VENI P            19/09/1981
234   2182   DEBJYOTI DAS              18/01/1978
235   2183   RANJAN KUMAR              20/10/1978
236   2184   ARPANA KUMARI             05/09/1979
237   2197   CHANDRAJIT SING PRADHAN   02/06/1982
238   2202   SANJAY KUMAR AZAD         01/13/1978
239   2214   MOHAMMAD AKIL             20/04/1982
240   2221   PAWAN KUMAR               19/10/1980
241   2231   ANAND JAISWAL             15/01/1987
242   2239   SANDIP PAUL               26/07/1981
243   2243   PANKAJ MAHTO              07/10/1982
244   2251   SUGANYA M                 29/07/1981
245   2252   OM PRAKASH                26/01/1974
246   2258   DHEERAJ VERMA             06/12/1984
247   2259   ANAND KUMAR               04/10/1980
248   2271   SOUMEN KUMAR DAS          21/12/1974
249   2272   SHRAVAN KUMAR KUSHWAHA    14/11/1979
250   2280   SUBODH KUMAR              16/11/1979
251   2298   SIVA PRASAD SAHOO         13/03/1980
252   2301   DIVYA. G. V.              14/05/1981
253   2319   AKHILESH KUMAR HARIJAN    05/07/1986
254   2320   AMIT SENGAR               01/07/1978
255   2323   PRANAB SAHA               06/12/1976
256   2324   ANAND PRAKASH             01/05/1982
257   2327   JAGSIR SINGH           28/12/1982
258   2328   KUMAR RAVI             31/07/1981
259   2330   KAMLESH KUMAR          19/11/1980
260   2331   RAJKUMAR               24/11/1984
261   2332   PRASANT KUMAR          11/10/1984
262   2333   KAJAL BISWAS           02/03/1976
263   2335   VIPAN KUMAR            05/11/1981
264   2337   SHIB SANKAR BARAI      25/10/1980
265   2338   SANKAR NASKAR          12/12/1980
266   2339   PANKAJ VOHRA           12/02/1980
267   2340   PRADEESH. T            11/04/1984
268   2346   DHARAMBIR              16/03/1981
269   2348   VIJAY BHUSHAN          14/05/1974
270   2350   SUBHASH KUMAR          01/03/1979
             MANMOHAN SAMBHAJI
271   2352                          02/10/1985
             WAYADANDE
272   2353   INJATI SOUJANYA        31/03/1986
             CHAUHAN DHARAMKUMAR
273   2355                          18/12/1982
             BHAGVANBHAI
274   2357   BANWARI LAL BAIRWA     01/07/1982
275   2370   P T LOVENSON VAIPHEI   08/12/1979
276   2381   HARISH KAPUR           13/09/1983
277   2382   LALBENLIEL PULAMTE     25/03/1976
278   2383   JAGDISH PRASAD MEENA   11/07/1980
279   2384   KAMLESH KUMAR SAMADH   01/05/1979
280   2388   SUNIL KUMAR BECK       10/04/1977
281   2389   MAMANG LHOUVUM         01/07/1981
282   2390   ASHOK KUMAR            29/03/1979
283   2391   GANPATH SINGH MEENA    07/06/1983
284   2392   AMAR JEET              21/04/1981
285   2395   KISHORE CHAKMA         15/05/1976
286   2396   CHANDRAWATI            18/07/1981
287   2397   RAM NARESH MEENA       30/07/1977
288   2400   JITENDRA KUMAR MEENA   30/05/1983
289   2402   JAYA                   05/05/1983
290   2403   E.SRINIVAS NAIK        01/12/1981
291   2404   JAYAPADMA.P.N          28/07/1978
292   2405   VISHWAS SINGH MEENA    05/10/1987
293   2406   HILARIUS LAKRA         02/01/1978
294   2407   S. AARON               30/03/1984
295   2408   LOLIA                  16/09/1983
             LALNUTLUANGA
296   2410                          20/11/1980
             VANCHHAWNG
297   2412   KHEM RAJ MEENA         01/07/1984
298   2413   LUNTINLEN LUPHENG      05/01/1980
                         ANNEXURE - II


VERIFICATION OF DOCUMENTS / PHYSICAL / ENDURANCE TESTS




         For Sl. Nos. in Annexure - I
  Sl.
                                           Date       Time
  No.
           From                To


   1         2                  3           4           5


   1         1                 50        24/08/09   10.00 a.m.


   2        51                 100       25/08/09   10.00 a.m.


   3        101                150       26/08/09   10.00 a.m.


   4        151                200       27/08/09   10.00 a.m.


   5        201                250       28/08/09   10.00 a.m.


   6        251                298       31/08/09   10.00 a.m.
                                                          ATTESTATION FORM
                                 WARNING

                         1. The furnishing of false information or suppression
 Affix a signed             of any factual information in the Attestation Form
 Passport size              would be a disqualification and is likely to render
 (5cms X 7 cms              the candidate unfit for employment under the
                            Government.
 approximately)
 copy of recent          2. If detained, arrested, prosecuted, bound down,
 photograph here            fined, convicted, debarred, acquitted, etc.,
 without defacing           subsequent to the completion and submission of
                            this form, the details should be communicated
 the identity               immediately to the authorities to whom the
                            attestation form has been sent early, failing
                            which it will be deemed to be a suppression of
                            factual information.

                         3. If the fact that false information has been
                            furnished or there has been suppression of any
                            factual information in the attestation form comes
                            to notice at a time during the service of a
                            person, his/her services would be liable to be
                            terminated.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1.    Name in full (IN BLOCK
      CAPITALS) with alias, if any.
      (Please indicate if you have
      added or dropped in any
      stage any part of your name
      or surname)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2.    Present address in full
      (i.e. Village / Thana /
      District or House No./
      Lane / Street / Road / Town
      and name of District Hqrs.)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3.    (a) Home address in full
      (i.e. Village / Thana /
      District or House No./
      Lane / Street / Road / Town
      and name of District Hqrs.)

      (b) If originally a resident of
      Pakistan, the address in
      that country and the date
      of migration to Indian Union
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                                                                …………2/-
                                                 -: 2 :-

4.      Particulars of places (with period of residence) where you have resided for more than
one year at a time during the preceeding five years. In case of stay abroad (including Pakistan)
particulars of all places where you have resided for more than one year after attaining the age of
21 years should be given.

    Sl.        From          To        Residential address in full      Name of the Hqrs. of the
    No.                              (i.e. Village / Thana / District   places mentioned in the
                                     or Door No. / Lane / Street /         preceeding column
                                            Road and Town)




  Members            Name          Nationality      Place of   Occupation (if    Present postal
  of family      (with alias, if                      Birth     employed,         address and
                      any)                                        giving        permanent Home
                                                                designation         address
                                                                and Office
                                                                 address
                       1               2                   3         4                  5
   Father


   Mother


   Wife /
  Husband


 Brother (s)



  Sister (s)




                                                                                        …………3/-
                                                -: 3 :-

5.     Information to be furnished with regard to son(s) and daughter(s) in case they are
studying / living in a foreign country.

Name                       Nationality  Place       of Country in which Date from which
                           (By birth or birth          studying/living with studying in the
                           Domicile)                   full address         country mentioned
                                                                            in previous column




6.     Nationality (by birth or Domicile)                 :

7.     (a) Date of birth                                  :

       (b) Present age                                    :

       (c) Age at Matriculation                           :


8.     (a) Place of Birth/District & State in             :
           which situated

       (b) District & State to which you                  :
           presently belong

       (c) District & State to which your                 :
           father originally belonged


9.     (a) Your religion                                  :

       (b) Are you a member of                            :   SC / ST / OBC
           (strike out whichever not applicable)

       (c) Name of the Caste                              :

       (d) Category of candidature                        :   PH / EX-SM / Dependents of
           (strike out whichever not applicable)              EX-SM killed in action


                                                                                      ………4/-
                                            -: 4 :-

10.   Educational qualification showing places of education with years in School(s)
      and Colleges(s) since 15th year of age.


Name of School/ College Date of entrance       Date        of Examination(s) passed
with full address                              leaving




11.   (a)    Are you holding or have any time held an appointment under the Central or
             State Government or a Semi-Government or a Quasi-Government body or
             an Autonomous body or a public undertaking or a private firm or
             institution. If, so, give full particulars with dates of employment, up-to-
             date.


     period          Designations,      Full name and address of      Reasons for leaving
 From       To      Emoluments and             the employer            previous service
                       nature of
                     employment




      (b)    If the previous employment was under the Government of India / a State
             Government / an Undertaking owned by or controlled by the Government
             of India or a State Government / an autonomous body / University / local
             body.

             (state whether you had left service on giving a month’s notice under Rule 5
             of Central Civil Services (Temporary Service ) Rules, 1965, or any similar
             corresponding rules where any disciplinary proceedings framed against
             you, or had you been called upon to explain you conduct in any matter at
             the time you have been served with notice of termination of service, or at a
             subsequent date, before your services were actually terminated).

                                                                                      ……….5/-
                                                -: 5 :-

12.    (a)     Have you ever been arrested?                   :      Yes / No

       (b)     Have you ever been prosecuted?                 :      Yes / No

       (c)     Have you ever been kept under                  :      Yes / No
               detention?

       (d)     Have you ever been bound down?                 :      Yes / No

       (e)     Have you ever been fined by a Court            :      Yes / No
               of Law?

       (f)     Have you ever been convicted by a              :      Yes / No
               Court of Law for any offence?

       (g)     Have you ever been debarred from any           :      Yes / No
               examination or restricted by any
               University or any other educational
               Authority / Institution?

       (h)     Have you ever been debarred /                  :      Yes / No
               disqualified by any Public Service
               Commission/Staff Selection Commission
               for any of its examinations / selections?

       (i)     Is any case pending against you in any         :      Yes / No
               University or any other Educational
               Authority / Institution at the time of
               filling up this Attestation Form?

       (j)     Is any case pending against you in             :      Yes / No
               any Court of law at the time of filling
               up this Attestation Form?

       (k)     Whether discharged/expelled/                   :      Yes / No
               withdrawn from any training institution
               under the Govt. or otherwise?

                If the answer to any of the above mentioned questions is “Yes”, give full
particulars of the case Viz. arrest/detention/fine/conviction/sentence/punishment, etc., and the
nature of the case pending in the Court/University/Educational authority, etc. at the time of filling
up of this form.

NOTE           :       (i)     Please also see the „WARNING‟ at the top of this form.
                       (ii)    Specific answers to each of the questions should be given
                               by striking out “Yes” or “No” as the case may be.




                                                                                          ……….6/-
                                           -: 6 :-

13.    Name and addresses of two responsible persons of your locality or two references
       to whom you are known.


(1)




(2)




              I CERTIFY THAT THE FOREGOING INFORMATION IS CORRECT AND


COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I AM NOT AWARE OF ANY


CIRCUMSTANCES WHICH MIGHT IMPAIR MY FITNESS FOR EMPLOYMENT UNDER THE


GOVERNMENT OF INDIA.




Date   :

Place :                                              Signature of the candidate
                                    IDENTITY CERTIFICATE

              Certified that I have known Shri / Smt./ Kum.___________________________


Son / Daughter of    Shri ________________________ for the last ______________ years


________________ months and to the best of my knowledge and belief, the particulars


furnished by him/her are correct.




Date   :                                                     Signature:

Place :                                                      Designation / Status and
                                                             Address with seal



NOTE :        THIS CERTIFICATE IS TO BE SIGNED BY ANY ONE OF THE FOLLOWING.

              1.      Gazetted Officers of Central or State Government.

              2.      Members of Parliament or State Legislature belonging to the
                      Constituency where the candidate or his parent /guardian is
                      Originally a resident

              3.      Sub-Divisional Magistrate / Officers

              4.      Tahsildars / Deputy Tahsildars authorized to exercise Magisterial
                      powers

              5.      Principal / Head Master of the recognized School(s) / College(s) /
                      Institution where the candidate studied last

              6.      Block Development Officers

              7.      Post Masters

              8.      Panchayat Inspectors
                                 I. CHARACTER CERTIFICATE


                 Certified that I have known Shri / Smt. / Kum. ________________________
Son / Daughter of Shri __________________________________ for the last           __________
years ___________________ months and to the best of my knowledge and belief, he / she
bears reputable character and has no antecedents which render him / her unsuitable for
Government employment.


2.               Shri / Smt. Kum. _________________________________________ is not
related to me.



Date :                                             Signature     :
Place :                                            Designation   :
                                                   Seal          :



                                II. CHARACTER CERTIFICATE


                 Certified that I have known Shri / Smt. / Kum. _________________________
Son / Daughter of Shri __________________________________ for the last           __________
years ___________________ months and to the best of my knowledge and belief, he / she
bears reputable character and has no antecedents which render him / her unsuitable for
Government employment.


2.               Shri / Smt. Kum. _________________________________________ is not
related to me.

Date :                                             Signature     :
Place :                                            Designation   :
                                                   Seal          :

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                               GOVERNMENT OF INDIA
                               MINISTRY OF FINANCE
                             DEPARTMENT OF REVENUE
        OFFICE OF THE CHIEF COMMISSIONER OF CENTRAL EXCISE, CHENNAI ZONE
          26/1, MAHATHMA GANDHI ROAD, NUNGAMBAKKAM, CHENNAI – 600 034

 Telephone No : 044-28331144                                        Email   : cexmds@vsnl.com
 Fax No : 044-28331159                                  Visit us at : www.kalalchennai.tn.nic.in
C.No.II/3/10/2009-CCA (Estt.)                                                     Dated: .08.2009



                                    ANNEXURE
                       COVERING LETTER FOR ATTESTATION FORM

To

The Superintendent of Police,



Sir,

               Sub:    Verification of Character and antecedents of candidates
                       for the post of Inspector of Central Excise – Regarding.
                                              **********

                I am directed to say that Shri/Smt.Kum._____________________________
whose particulars are entered in the enclosed Attestation form is a candidate for the post of
Inspector of Central Excise. To enable this office to determine the suitability of the candidate for
Government service, I am to request you to kindly to certify on the basis of the information
available in your records whether he has come to adverse notice or not and whether there are
any facts about him on record which would render him unsuitable for employment under
Government. It may be specifically indicated whether or not the candidate is suitable for
Government service and if he is considered unsuitable, a brief statement of the grounds for the
opinion expressed may be added. The result of the scrutiny may be communicated directly to
this office as expeditiously as possible.

(2)             Steps may kindly be taken to establish the candidate’s identity and, after this is
done, a certificate may please be recorded to this effect along with your report on the suitability
of the candidate.

                                                                  Yours faithfully,



                                                               (P.VENKAT)
                                                      ADDITIONAL COMMISSIONER (P&V)
                               GOVERNMENT OF INDIA
                               MINISTRY OF FINANCE
                             DEPARTMENT OF REVENUE
        OFFICE OF THE CHIEF COMMISSIONER OF CENTRAL EXCISE, CHENNAI ZONE
          26/1, MAHATHMA GANDHI ROAD, NUNGAMBAKKAM, CHENNAI – 600 034

 Telephone No : 044-28331144                                        Email   : cexmds@vsnl.com
 Fax No : 044-28331159                                  Visit us at : www.kalalchennai.tn.nic.in
C.No.II/3/10/2009-CCA (Estt.)                                                   Dated: .08.2009


To
The Medical Officer,
Government Hospital,



Sir,

                       Sub:    Medical Examination of Shri/Smt./Kum                           –
                               Regarding.
                                            *********

                       The following candidate who has been sponsored for appointment in the
Central Excise Department for the post of Inspector of Central Excise may please be subjected
to usual medical examination and a certificate in the prescribed format may please be handed
over to the candidate in a sealed cover for presentation to this office. The particulars in respect
of the candidate are furnished below.

Name                                  :
Address                               :
Date of Birth                         :
Employment for the post of            :      Inspector of Central Excise




                                                                     Yours faithfully,



                                                                  (P.VENKAT)
                                                        ADDITIONAL COMMISSIONER (P&V)

				
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