Appendix ‘A’
AFFIDAVIT
(To be submitted by Ex-Serviceman/ Widow)
1. I, Smt __________________________ Army No : ___________________ Rank :
___________ Name _______________________Resident of Village : _________________ PO :
___________________ Tehsil : ______________District : ______________________ (H.P) do
hereby solemnly declare and affirm that neither myself nor any or my ward (i.e Son/Daughter of
Wife) have been provided employment against the vacancies reserved for ex-servicemen under
the H.P Govt/Corporation/Board/Autonomous Body of H.P as well as Central and other
State/Union Territory Government of Public Sector Undertaking/Autonomous Body/Banks, etc
under the control of the said Central or other State/Union Territory Government.
2. That if my statement found false in future, I shall be solely responsible for legal action
against me.
Dated : _____________ Deponent
Place : _____________
Countersigned by Tehsildar/Sub-Divisional Officer (Civil) of the area
Appendix ‘B’
AFFIDAVIT
(To be submitted by Ward of Ex-Serviceman)
1. I, __________________________ Son/Daughter/Wife of Sh. _____________________
Ex-serviceman No : __________________ Rank : ___________, Resident of Village :
_________________ PO : ___________________ Tehsil : ______________, District :
______________________ (H.P) do hereby solemnly declare and affirm that neither myself nor
any or my ward (i.e Son/Daughter of Wife) have been provided employment against the vacancies
reserved for ex-servicemen under the H.P Govt/Corporation/Board/Autonomous Body of H.P as
well as Central and other State/Union Territory Government of Public Sector
Undertaking/Autonomous Body/Banks, etc under the control of the said Central or other
State/Union Territory Government.
2. That if my statement found false in future, I shall be solely responsible for legal action
against me.
Dated : _____________ Deponent
Place : _____________
Countersigned by Tehsildar/Sub-Divisional Officer (Civil) of the area
Annexure-‘A’
Form of certificate to be furnished by the sons/daughter or wife’s of ex-Servicemen
to be considered against the posts reserved for ex-Servicemen.
It is certified that Sh/Kumari/ Smt._______________________ resident of Village
____________ P.O.__________ Tehsil___________ District ___________(Himachal
Pradesh), is the dependent son/daughter or wife of Shri____________________. Ex-
Servicemen No._______________ Rank___________ who has not been rehabilitated
through employment against the post reserved for ex- Servicemen with the H.P. Govt.
/Corporation/ Board/ Autonomous Body of H.P. as well as Central and other State/Union
Territory Government or public Sector Undertaking/ Autonomous Body/ Banks, etc. Under
the control of the said Central or other State/Union Territory Government.
Dated : ____________ Patwari/Pradhan of Gram Panchayat/President
of Municipal Committtee or Notified Area
Place : ____________ Committee/ Executive Officer of the Municipal
Corporation of the area.
Countersigned by
Tehsildar/Sub-Divisional Officer (Civil) of the Area
Annexure- ‘B’
AFFIDAVIT
I,______________________ son/ daughter/ wife of shri _____________________ Ex-
servicemen No._________________ Rank________________resident of
Village_____________ P.O.______________ Tehsil______________
District________________(Himachal Pradesh), do hereby solemnly declare and affirm
that no other ward(i.e. son/daughter or wife) of my father/husband has been provided
employment against the vacancies reserved for ex-servicemen under the
[Link]./Corporation/ Board/ autonomous Body of [Link] well as central and other
state/Union Territory Government or Public Sector Undertaking/Autonomous Body/Banks
[Link] the control of the said central other State/Union Territory Government.
DEPONENT
Date:____________
Place_____________
Tehsildar/Sub-Divisional Officer(Civil) of the area
