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APPLICATION FORM
For post of Constable in Unit Band Staff in Himachal Pradesh Police Department during the year 2015
(To be filled in by the candidate)
To
The Commandant,
2nd India Reserve Battalion,
Sakoh, District Kangra at Dharamshala.
Read instruction below before filling:- Contact/Mobile No.
1. Full name of applicant
2. Father’s name of applicant
3. Date of birth (in figure):
(in words):
4. Sex Male
5. Mark of identification:
6. Present address: Vill./H.No
P.O
Teh.
District
7.Permanent address Vill./H.No
P.O
Teh.
District
8. Address as per Bonafide Himachal Certificate: Vill./H.No
P.O.
Teh District
9. Tick correct Category/
Sub category: (a)
Category
General
SC
ST
OBC
(b)
Sub-category
IRDP
[
Home Guard
Gorkhas
Attested by:
10.Name of Employment Exchange where name is registered:
Registration No. Date of
Registration
11. Detail of Middle Pass Certificate (Name of Board/School)
Certificate No.
Date of Issue
Passport size
latest
Photograph of
the candidate
12. Professional Qualification (a) (Name of Instrument)
(b) Diploma/Course on above Instrument Yes No
(c) If Yes, Duration of
Diploma/Course
& name of
Institute
13. Have you ever been arrested/named in a criminal case? If yes, gives details:
14. Bank Draft/IPO No. Amount (Rs)
Date Name of issuing Bank/Post Office
CANDIDATE SHOULD NOTE THAT CATEGORIES AS CLAIMED IN SERIAL NO 9 ON THE DATE OF FILLING
UP OF THIS RECRUITMENT FORM SHALL BE TREATED AS FINAL SUBJECT TO VERIFICATION AT THE TIME OF
PHYSICAL EFFICIENCY TEST ( GROUND TEST) ANY STAGE OF RECRUITMENT PROCESS AND WILL NOT BE
CHANGED UNDER ANY CIRCUMSTANCE DURING THE RECRUITMENT PROCESS.
(i) I certify that I have read the instructions for filling the form. (ii) I certify that information given above is true and to the best of my knowledge and belief. I understand
that willful misrepresentation of any fact will lead to rejection of my candidate for the post of constable in HP Police Department at any stage.
Date:
Place: Signature of the Candidate
General Instructions:- 1. Name and Father’s name must be filled up in block letters. 2. The candidates must write his name and date of birth behind the photograph to be pasted on the
Recruitment Form. 3. Category/Sub categories certificate must be valid as on last date notified for the receipt of application
form. 4. Candidate must have valid registration in the Employment Exchange of HP on the last date notified for
receipt of application form. He must be Himachali bonafide as per record. 5. The candidate must bring their original certificates and self attested photocopies of certificates at the
time of Personal Interview. 6. Candidate must ensure that their application form reaches the O/O Commandant 2nd India Reserve
Battalion, Sakoh before 09-10-2015 upto 5:00PM by any modes including by post. The cut off date for calculation of upper and lower age and reserved category certification limit is 01-09-2015.
7. The application must be accompanied by a crossed Bank Draft of IPO amounting to Rs. 120/-(Rs. One hundred twenty) only in respect of candidates from General category and Rs. 30/-(Rs. Thirty) only from candidates belonging to SC/ST/OBC/IRDP categories to be drawn in favour of HP RECRUITMENT BOARD SHIMLA-171002. Any application not accompanied by the requisite processing fee or not received by the last date for receipt of application will not beentertained.
8. Applicant must write his name & date of Birth on the back side of the Bank Draft/IPO. 9. Application received after 5:00PM on the last date of receipt of application i.e. on 09- 10-2015 will not
be entertained. 10. Processing fee would not be returned if the application form is rejected.
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Application for Allotment of Permanent Account Number
Under Section 139A of the Income Tax Act, 1961(To avoid mistake(s), please follow the accompanying instructions and examples carefully before filling up the form) Only 'Individuals'
to affix recentphotograph (3.5
cm x 2.5 cm)
Sir,
I/We hereby request that a permanent account number be allotted to me/us.I/We give below necessary particulars :
Form No. ITS 49A
First Name
Middle Name
Last Name / Surname
Signature/ Left ThumbImpression
If yes, please give that other name(Full expanded name : initials are not permitted) Shri Smt. Kumari M/s
First Name
Middle Name
Last Name / Surname
3 Have you ever been known by any other name? Please Tick as applicable Yes No
4. Father's Name (Only 'Individual' applicants : Even married women should give father's name only)Last Name / Surname First Name
Middle Name
5. Address R. Residential Address Flat/Door/Block No.
Name of Premises / Building / Village
Road / Street / Lane / Post Office
Area / Locality / Taluka / Sub - Division
Town / City / District State / Union Territory
(Indicating PIN is mandatory) O. Office Address (Name of Office)
Flat/Door/Block No.
Name of Premises / Building / Village
Road / Street / Lane / Post Office
Area / Locality / Taluka / Sub - Division
Town / City / District State / Union Territory
Pin
Pin
(Indicating PIN is mandatory)
Ward/ Circle
Range
Commissioner
AreaCode
AOType
RangeCode
AONo.
ToThe Assessing Officer
6. Address for communication Please Tick as applicable R or O
1. Full Name (Full expanded name : initials are not permitted)
Please Tick as applicable Shri Smt. Kumari M/s
2 Name you would like printed on the card
Form No. 49A
13(a) Are you a salaried employee ? If yes, indicate Government Others
(b) If you are enganged in a business/ profession, indicate nature of business or profession and fill the relevant code
Name of the Organisation where working
(c) If you are not covered by (a) or (b) above, indicate sources of income, if any
Full Name(Full expanded name : initials are not permitted) Please tick as applicable Shri Smt. Kumari M/s
First Name
Middle Name
Last Name / Surname
Address
Name of Premises / Building / Village
Flat/Door/Block No.
Road / Street / Lane / Post Office
Area / Locality / Taluka / Sub - Division
Town / City / District PinState / Union Territory
(Indicating PIN is mandatory)
14. Full name, address of the Representative Assessee, who is assessable under the Income Tax Act in respect of the person, whose particularshave been given in column 1 to 13.
I/We , the applicant, do hereby declare thatwhat is stated above is true to the best of my/our information and belief.
Signature/ Left Thumb Impression ofApplicant (inside the box)
Verified today, theD D M M Y Y Y Y
7. Tel. No.
STD Code Tel. No.
email ID
8. Sex (For 'Individual' Applicants only) Please Tick as applicable Male Female√√
Individual P Firm F Body of Individuals
Hindu Undivided Family H Association of Person Local Authority
Company C Association of Persons (Trusts) Aritificial Juridical Person
10. Date of Birth / Incorporation / Agreement / Partnership or Trust Deed / Formation of Body of Individuals/ Associastions of Persons
A
T
B
L
J
D D M M Y Y Y Y
12. Whether citizen of India ? Please Tick as applicable Yes No√
11. Registration Number (In case of Firms, Companies etc.)
15. I/We have enclosed as proof of idenity and asproof of address
9. Status of the Applicant Please Tick as applicable
REGISTRATION FORM HIMACHAL PRADESH POLICE HALF MARATHON
On 28th June, 2015
1. First Name: _____________________________________________ 2. Last Name : _____________________________________________ 3. Father's Name: _____________________________________________ 4. Occupation:
A: Student If Yes then name of School/College/Institution: _____________________________
B: Self Employed C: Employed If Yes then name of the Department/Organization: __________________________
5. Date of Birth: __/__/____ Age as on 01/06/2015: __________________ 6. Category of the race in which participating (Only one category can be chosen)
A: Half Marathon (21.5 Kms): B: Mini Marathon (10 Kms) : C: Dream Marathon (3Kms):
7. Contact Number: ________________________( Ten Digit Mobile Number) 8. Age Category for the Dream Run(If applicable):
(Please Tick one) (i) 10-15 (ii) 16-30 (iii) 31-45 (iv) 46-60 (v) 61-74 (vi) 75&above
UNDERTAKING I agree to abide by the rules and regulations of the HP Police Half
Marathon -2015. The details furnished by me are correct and I and medically fit to participate in the marathon. I fully understand the risks involved and release and waive the organizers of the event against any damages, I may have against them.
Date: ___________________ Signature of applicant
P.T.O.
Route 1. Half Marathon (21.5 Kms) :
Ridge Oak Over Rajbhawan Forest Road St. Bede’s Chowk Sanjouli Chowk Sanjouli Bazar Tunnel Dhali Chowk Mashobhra bifurcation HIPPA Gate and back by the same route.
2. Mini Marathon (10 Kms) : Ridge Oak Over Rajbhawan Forest Road St. Bede’s Chowk Sanjouli Chowk and back by the same route.
3. Dream Run (3 Kms): Ridge Oak Over Rajbhawan and back by the same route.
RULES 1. The age of participant should be above 10 years. 2. Only single entry would be accepted from 1 person in case of multiple entries by a
person, all entries would be rejected. 3. The chest number provided by the organizers shall be worn by the participant
through out the event. 4. No change of race category would be allowed after registration. 5. Decision of the organizer will be final, in case of dispute. 6. If T-shirts/ Caps provided by the organizers are not worn, the participant may be
disqualified. 7. 27th June at 4:00 PM is the cut off time and date for close of the registration. 8. Distribution of the Caps and the T-shirts by AP&T along with entry forms will start
from 23rd June although registration will start from 20th June 2015. 9. If a participant is found not to have filled in the entry form as provided above , he
will be disqualified. 10. Any one formed using foul means will be disqualified. 11. Any complaint/dispute with regard to the race may be made to the Appeals
Committee in writing whose decision will be final. 12. Participants will take part at their own risk and there will be no reliability on the
Police department, If anything happens owing to medical condition or any other eventualities.
13. The registration fee will be as follow:- Half Marathon Rs. 50/- Mini Marathon Rs. 50/- Dream Run Rs. 10/-
14. Use of chest numbers /tokens/markers can be used to decide on the winners and successful completion of the race.
15. For reward money please check the website: www.hppolice.nic.in . 16. Any other rules may be devised by the organizing committee for smooth conduct of
the event.
H.P.T.R.-6
MEDICAL CHARGES REIMBURSEMENT FORM
1. Name and Designation ------------------------------------------------------------------------
2. Office in which Employed ------------------------------------------------------------------------
3. Basic Pay ------------------------------------------------------------------------
4. Name of Patient & relation
With the claimant ------------------------------------------------------------------------
5. Period of illness ------------------------------------------------------------------------
6. PARTICULARS OF TREATMENT:
I t e m N a m e s Charges Details of Cash-Memos etc. (i) Medicines (Names)
(ii) laboratory Tests/Ambulance/Consultancy/Indoor Room/Other (specify)
6. Total Claim Rs.------------------------------
7. Less-Advance drawn vide T/V
No------------------------------Dt. Rs.------------------------------
8. Net Amount Payable Rs.-------------------------------
I hereby declare that the statements in this application are true to the best of my knowledge
and belief and that the person for whom medical expenses were incurred is wholly depended on me.
Dated-------------------- (Signature of the Claimant)
VERIFICATION CERTIFICATE
I, Dr,---------------------------------------hereby certify that -------------------------------------------
suffering from--------------------------------and is/was under my treatment from--------------------------
to-------------and that the above mentioned medicines/tests were prescribed by me in this connection.
The claim is verified for Rs.--------------------------
Date-------------------------------- (Signature of Medical Officer) Designation & Seal Passed for Rs.-------------------------------(Rupees-------------------------------------------------------------)
And included in Bill No----------------------------------------Dated-------------------------------------------
(Signature of Controlling Officer) (Signature of the DDO)
I N S T R U C T I O N S
1. List all the medicines, tests etc individually. 2. Attach Cash-Memos duly verified. 3. Mention dates of admissions to the Hospital, stay etc.
Performa for reservation of accommodation in Himachal Bhawan /
Himachal Sadan, New Delhi / Himachal Bhawan, Chandigarh.
Dated:- 23-02-2013 Hari Singh Singta
Head Constable, State CID, HP Shimla-2
9. Reservation is subject to the availability. 10. Allotment is liable to be cancelled without any notice by the permit issuing authority
without/assigning any reason in the public interest.
11. The applications must be submitted at least two days in advance but under no circumstances after 12.00 Noon of the aforesaid day. No application will be entertained thereafter. 12 Reservation would not be made more than three days at a stretch reservation made for
more than one day and not occupied by the first day up to 11.30PM the reservation for the remaining days would be automatically cancelled. 13. Generally only permit holders in whose name permits are issued would be allowed to stay. The permit is non-transferable and a person other than the concerned person shall be
refused entry at Himachal Bhawan, Sadan New Delhi/Chandigarh/HPPWD Rest House. 14. Generally one room may be allotted subject to the availability to one officer/official
Dated:-26-02-2013 Hari Singh Singta
Head Constable, State CID, HP Shimla-2
1. Name Hari Singh Singta
2. Whether Govt. Servant Yes
3. Designation Head Constable
4. If not Govt. Servant Yes
5. Department HP Police
6 Nature of work
Official
Non official l/personal
7. Accommodation required (Pl. tick the relevant)
a. Himachal Bhawan Chandigarh
b. Himachal Bhawan, New Delhi.
c. Himachal Sadan, New Delhi.
d. Any of (ii) and (iii) above.
e. HPPWD Rest House Shimla
Himchal Bhawan, Delhi
8. Duration of stay from 27th & 28th February, 2013
Period ( Two days)
H.P.T.R. 7
TRAVELLING EXPENSES CLAIM FROM
1. Establishment : ………………………………………………………………….. Month : ……… ………….2013
2. Name & Designation : ……………………………………………………………………………………………………….
3. Basic Pay : ……………………………………………………Head Qrs. ……………………………………..
4. Purpose of Journey : ………………………………………………………………………………………………………
DEPARTURE ARRIVAL Km./ Mode
of Travel Rate/ Class of '1 ravel '
Actual Fare Paid
DAILY ALLOWANCE TOTAL OF
LINE Station Dale & Hour
Station Date & Hour
Hotel charges (if any)
No. of Days
Rate Admis-sible
Amount
1 2 3 4 5 6 7 8 9 1C! 11 12
** GRAND TOTAL** .
(DETAILS OF THE CLAIM)
1. Total of Column no. 12 (B.F.) Rs. ………………………………………..
2. Terminal Transportation Charges Rs. ………………………………………..
3. Local Transportation Allowance Rs. ………………………………………..
4. Transfer Grant Rs. ……………………………………….
5. Personal Effects
Wt. : Rate : Amount Rs. ………………………………………...
6. Conveyance Charges Rs. …………………………………………
7. Miscellaneous (Specify)..........................................-. ........ Rs. : ………………………………………..
8. G R O S S A M O U N T Rs. …………………………………………
(). Less Advance of TA/TTA drawn vide
T/VNo ...................................... Dt .................................... Rs. …………………………………………
10 . NET A M OUNT P AYA BLE Rs. …………………………………………
(Signature of Claimant)
Passed for Rs ................................................ (Rupees).
Signature of Controlling Officer Signature of DDO
(TO BE USED IN AUDIT OFFICE)
Admitted for Rs. : .....
Objected to Rs. :........
Reason for Objection
(Accounts Officer)
INSTRUCTIONS
1 . Tour Diary should invariably be attached with the claim. 2. !n case of Transfer claim, the details of members of the family with age along with details of personal effects be
given. 3 . The Receipt Nos. of Hotel and carnage charges bills be quoted against the relevant Column. 4. Ticket Nos. shoukl be quoted, when journeys are performed in a class higher than the ordinary class.
