The text for the hand written declaration follows procedure

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Abbreviations stand for: GEN -General Category; SC·Scheduled Caste; ST-Scheduled Tribe; OBC-Other Backward Classes, PWD- Person with Disability,

	Category	Upper Age Relaxation

Page 3 of 27

entertained.

These guidelines	are subject	to change in terms of GOI guidelinesl	clarifications,	if any, from time to time.

SC/ST/OBC	candidates	who wish to avail the benefit of pre-examination	training may register their names and other details with the

result on or before the date of registration of application form, has to be submitted.

2.	No request for change of centre/venue/date/session	for Examination shall be entertained.

16	30		Bhopal, Gwalior. Indore, Jabalpur, Salna,
	31	Maharashtra	Jalgaon, Kolhapur. Latur, MumbaifThane/Navi Mumbai, Nagpur, Nanded, Nasik, Pune, Ratnagiri, Satara.
	36
22	37	Puduche~	Puduche~
	39	Rajasthan	Ajmer. Alwar, Bikaner, Jaipur, Jodhpur, Kola.
	39	Rajasthan	Ajmer. Alwar, Bikaner, Jaipur, Jodhpur, Kola.
24	42	Telangana	Hyderabad, Karimnagar, Khammam, Warangal

Bank Transaction charges, if applicable, have to be borne by the candidate.

ii.	Signature in CAPITAL LETTERS will NOT be accepted.	fG ~ ~f~~1 t«~">R;oe ~	ft1fi:t26, ~,

	The Name of the candidate and his/her Fatherl Husband etc. should be spelt correctly in the application as it appears in the Certificatesl Mark sheets. Any change/alteration found may disqualify the candidature. Validate your details and Save your application by clicking the 'VALIDATE YOUR DETAILS' and 'SAVE & NEXT' button.

2.

	There is facility to print application form containing fee details after payment of fees.

contents of the testis) or any information therein in whole or part thereof in any form or by any means, verbal or written, electronically or mechanically for any purpose or

u.To be debarred, either permanently or for a specified period, from any examination conducted by The New India Assurance Co. Ltd.

			District	State __	hereby declare that I belong to

v. Instances for providing incorrect information and/or process violation by a candidate detected at any stage of the selection process

viii.	Company does not assume any responsibility for the candidates not being able to submit their applications within the last date on account of any reason Whatsoever.

CORRESPONDENCE WILL BE ENTERTAINED BY THE COMPANY IN THIS REGARD.	NO REPRESENTATION	OR

including ban from future examinations.

District I Division*	of the State I Union Territory*	belongs to the

This certificate	is issued on the basis of the Scheduled	Castes / Scheduled	Tribes* Certificate	issued to Shri / Smt /

IWith seal of Otftcer]

4. Sub-Divisional Officers of the area where the candidate and / or his family normally resides.

Note: - The term "Ordinarily" 1950.	used here will have the same meaning as in Section 20 of the Representation of the people Act,

Certificate			AUTHORITY	ISSUING THE CERTIFICATE)
Certificate	No. :		AUTHORITY	ISSUING THE CERTIFICATE)

Sr.		Affected Part of		Permanent	physical

16,	Parkinson's

(Please strike out the disabilities which are not applicable.)