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ffi :# ii' f; ifl rf:ifl;it?ri,f :, iff* : :::: :: ; : :;: ::,::, :: :, ;tF;:l-*-

Ncr' 12011/1?r96-silc publi:;irert i' rhe {iftx*ile of inci* - f;<rracrdin*ry l,*o,1$a *{ricd i , uuo,_

',ffirt.o'ut'on No'12011/99is4'BCC puhlished in the cazene o{ rnrlia - Fxrrab'dirrary No.2i6 dered .r

i,h Dec3) orlti?'il'"-

i'lo'12011113197'Bcc puhi:slreil rn the Gazene of In.Jia - Exireardi'cry r.lo.?33 c,areJ J.jt' oufffillution

No'12011/121s6-BCc F';blishcri in tlic Gazeue of incria - Fxiraorclinary tJo.156 ciaicd 3,jt*' oufiE#ion

l"Jo 120 11/68193-BCC publ;sl,'ecj rn the c-r'z,:rte or t"r,;* - ri:!raordrr-r;r'. i!.r.r7i rj::*r.j rj,t]t "tfftSlution

No'1201i1681$s-Bcc pLrhlishctl in the Gaz-elte of,r4clia -- Hxtr*nrqrinary $rc.?41 $str.:d 3r,*,'ii' J _ Rcsolrrtiorr l.Jc. r20.i lri;gli:8.gttrj lrr,L:iDlc.1$gg. t;hsril in.liis Sateile"r:f lnciil * fixiranrr]ini:ry iar.i:; ,.{r:Le,:.i ti*

'.-u,j};'**,u.'*',,|jo^.lI2tt1l/3f/:$.F]{;ij1.ir,l,;li:,iir';iii;liil,;,i'i':rl'l{ilirfl'ltj];r_[.l:{lr}t:ir{.:jifi:

iwif inr hisi'hf...r " in$:ii:., *i*in;:ril5, i*si;:.*iri...^,.,,..,.,..,.,.t""Jix,t4iCl tri illi-i .-..tr*ishe" daes not b*long lo tfre prissilsi'

lJi*irici r,i iir.

: 1jl ::':.i :,' :4 11 i' L :: t'r r) .r-'-,

*'-,i, rnc.r i ;r c :J,.,;,r i :'i,r i,.,i,tr*ishe" daes not b*long to tfre prissil;rsilfinns iCrto th* Gor",el,rtn*r:t ci lnrjlrr,. Irr*ilrtltli:i i.-rf p,'i$nnri*]

$lsl*, -

$'r"snii; ffi:ill,l;il-.1'',ix''i"i-i,il':;i ,:,'i,nj-il:Tj,l"i::i :J't:l:'"::1:,:'1r*yg:,,,f r:'u'iii i 'l.titE$. ] da {s<t tr$.t}f .tSrJ4

Ir;r1iri, l)rgi,nrirnrr;t *f F*r**,n**i **rl fr*,*ing O;rilil_.r i-v L" l, La(.r\r aLU. J u(J tLi{.J ui:,t"j 11, JUUji ^gig elelsls ihry wr:rds ir,lrirh ari: nnl lllririii:ahi*

District li4egixirate/D5'. Currunissioner'*tu"{Wilii *enl 0t nltic{rl

G,ate

{-} Fie*pe delete tir6 wcrds which are fiot appiictlble

3" Ttte term-.or1iyr1rv. reside(n)" used rviil lrave the sarne meaning as in se*ir:* f$ ui *reRepresentaricn of the peoples Act,'1bS0.

b' w'{rer:e the certificates ar€ issued by Gazetiecl officers. of ll^ra union Gov*rnment or sraleGov$rnments, they should be in the sarne forrn but co*ntersis.leq by *r',n uulrtii]*ngislra{e $, nvffilffi ffii J3.f$Hir.jff^1y by Ga ee{ recr orricers

""J Jri*J # ;y-#ffi .

d*Hffid;#t- c- The p$g c,ertificsto fiom lhe authorities only witt be accepled:*

+:

!' :' Effi$ H*-fil:ifn'"i,:tr'' .?,illilo,Y'n3,'::',"Tlf::T/i?:t'lv, conrrnissioner/AtJdi,iqrrali* ". fi:b'$EiyH','trtffil3hlrulll3;;',:dfi*'i'f.il'#''$13,'*ffifvm'*#*m*3 Hi'ii,S?ffi#Sfi"ifry,f$g*$lf;jgfilf iencv Mosistrarerpresidency

r\rrasisrraro

.

* Fu$-{.,rrrslonal Officers of ths ares whei:€ ti}b etindidato ant}lor hls family rronna}}y r*sirles.

ilfllri"l ilt0

-qt:ql;it.*d

{Ns.$ts & Arl

tFfGsss &$E's$sf'ls

*i:$i:rtete lt$*

€w*urnicaltSrlnxh {R*pees Hip*Wo *,,rly *f

l. 5 e+res *i rJor,t*irlr.*i lpnej *hrve;{1. ResideniilI1. Res,ldenti

t Shrit$nriiffiElllc*$ *s x S edLlteci easrcl-

---.1-".-.....".."

G$verrrnlent *f;s u[ thc authority issuirrg tfi* rertific*te)

sY HStrfiIfis}r*ALLY

$*ts:

T S.ffiRTtst A]-ff T* 8g FR#nusEsflltrAKffR

V $ TOR THE YEAR

This ix ss,ft't{1d titat $h t./Ki:mali

Fu.xt *ffi**ansnt resid*rrt of * s*nfti*ugtrte,#wif *f

ni i*:*r G!*4re"*-d* - Til*=*-trffi ,,

*Y_nli *ryJ$:tre*r

::-*i,-I-i--il1hru*ru'j:,.*:-, $S:i?oby Ysrrits'qpholcgruph ir{,,rJsri $fr$t$grupfi tff aitee{ed i:e}ow b*fo,trgs tiihe gruss annuai incolne' of iristn*.r {f;ernirrr*,* ie r-^{-... n- Eirislher 'l*mrly"** is helsw Hs. dthe finanuiat year ,._.. ",:_ -

Hffilr ;ffii ddffiYtrJand abo,re;flnt *f t,S$S sq, ft"

FIot of iOS sq ;,aplot of 20S sq.

'16

*n* ab*ve i*l n*tified fflijrii*iFeril{ris ;ant* ahclr* ln ar.ess rlther tnailr tirs noiified,m*srici *li{ies.

%'*"- heloir$g tc 'the caste r4;lrtch ts nCItreduiei l'rii:c ;r*rr orher gi:i;kwa; riEnsses icenir"ai List)

$ignaiur* lvrtlr se*{ *lf {}Si**Nanr*

Wffis, *&i{ilq[b,ssi;

{$f, lltis r}rlfp$sf iritlrJds

Sy * "F*lsigy"' trrn*€W*aleiue.

1t'\firjcr i * ,r*ilrY.ie.slll: r*. l"ir.rs*iG{ffi fr ffi

arxd s$lif$rsn figffAr$iffii,f$ h*)}\ts{i} $f re*wrrcifit* hrsrhw.r $}**r.$$r{s u,rx$ r{s{hgu }**'twrrtu wgw

1,-.-

b*W{rerr* $r Siffss*$t sissrue/*rr** r'i,,v* s$*n i!!ut}b&ti &,&* a$sis{s*{u Mfi$ $s,** t4, :&. gff{..r*r***.^* .*

: 1,1

.11I,S f .

{_,i j SiJ.l"u11. ll,:!11,,"}f,S},

i"tr'c; lrs iler.titJ*el I.ri {lr* G*vqr"nrir*rrr n\rrrlur,.i....lc,1i,-,,,,. 2.d..., ., ,..s'u;;;il';fiilri:l::::''r f]ri'l t'lrt 1 ( i'i^:{r*'l:rJ I}t;r llgl1111

L crrIrrl;,SI;ttu I Ir:cJrc;rI .tr.;,r,i.*rjNanrc * f' rlir: {"tiirrri irl*tr:

l-at{rc:r Nnrire

,, ,;.' I { I.":\{ll":\_t.-.*4n*,q<uvt$

-{

{hr: },i;,uih *f, A ssis{:rnt

"l'raric & Nqnr aJ. \Vprk.r|*pll,iririt ;

I}rlnu itnen f Jr{enti fi catian

lliisl* tiJ bs*ttesle{i fry theC!vil Surg*unwlru rs gir:ir:grhe certificalewillr SigriplUrqanri 5*nl

ilarks

Standa rri qf Phvsical irfi;'

Standarcl cl. Visian i(A) visu;rl -.;;;

' "cancricratcs rra'irrg. r.ision irr orre e-\.e srr;rg crigibrct* u*dergpr apprenticcsirip trairiing cxcsFr irr rhe itlrlrrvingssvente*n traejes n*rnel;. :- (r) slectiician Air*ari 1l,) wat*h nrrICloek Merlranie g) Drive;;-;; fi**r {4} Sur"roe},or (,r} i}rocr:ssearxeranlan (d) sjrerar {?) Risger{fingg- * ctr*,n. l*dusrry) {s}$hortfire#srnsier{rvrn**i ip) frare {Mines} {10} Mecrr_ I{*cri* &li.adar Aircnaft (r'r) ceranii* irao*ui*r {r:j b;rr;-;; c*srer {r3}cerarnic l(irn opcrator (i+; cerar:ric p,J;r-bil"*,ri,5) cera'ricX:.f|:r f l6) C*rnmir Decorqto, trn Opricai wnrker.;;:.:.1i:, r I u/ L.frarilrf" rJecol4tor { t7) opticai v' ruDsrrtute vide csl{. 2? i date,d 2 I'r Apr.il 1 gg3.9) Colour vision : Not reqLrired.

.T,x),rd i {r-f-tl' " -li rrt-***t;iG *- ; f, a,F c *il$ gtrs i,,. r, rFa, o i;;

i f::i.:::iT"slrnutci n,:r t*;;{ibiil; rmnl ai}y ctiseasc *hi,.r., i.. {ir._,.",.-be aggra vnre{ bv se,', i c e .,.' i,-i,r.;,r',:'i#H,| ff i': JIi' ;i.';"X,:'J .T::lfflf.:,"",iii:,,.T:l:f...lf.rt," o*Lrl'.' r.{e sh*urcr arsi: he {iee l,r.nr"ny,',$xssl_ul:srssr:n!:_ssrfus.*&ffill,,Jjl" he rree I n*r

I I e i r^h t . W ei$ iiia n d (),Sft*' "'' :-*:'-''1 ..',i :- ill-!-(r'--

l':ll:l::i'::;t]ottl{ sarisf' tlre fcllr:r*ins *rininrum sNiirrri*rri{ *n*ri,r,, .I r *isrrr : r r ?*en ri,; ;;-; i,";; ;;il -,

lT,i'JlilJlLi,l,l,,l1il:il ;.ilnk;s,*u*J rr*r i* rc"ss tria* ;.s **,iiirr.,.:rli.o i,,",,*perrir,e n.f.siz* *1.che:r :Illu'"'itlg fltiit ti"'het'*;i crilrcjiclerte di:es rct.satisfi,tli* slrirJ nririirrrr,r*r*tiwelalrl* frut is celitiel irr u,r"irrrirj bll a ntrttir,*t i:rl.ii**,r.'ii$r hel{:rv ihe

;:*J::T,'iT'J:1j::,1,1;s-lj' t::'ffiy:'' i,i r,,L-il;',,r r,rr b,ing1j c,rsrrgeel iis an -f:,:,T:; i,,, oi ;il;;;,J,'il;,iiil,::iffi -i';|ilff[iI l-S{l.hq my.!* SISjigg.$_{$,,tngfi[g]rLqe in rh$r rracte.iE]nfilux -r:t'-:ji-ir-r" r'r'{" ''j shuuld [:r: no cvicle*er r.rr" arr1,

'rorhicJ r.ncriri*rr

'{, ciilrer r..r,r or th*

ll:t.::. eifhcr eye r.viricl., ,.,rr,r,. be li;ri:tr-: rr> ri.sk 1f. rggr.r,rc,oriri' *1,I re$ilx.rence"

Paru--rtearing lrysi be.'gcod in {:othggse,l:io hesrins

en1.s and tfuere shor.rld he no sign uff41ive di aid shall be pernrittecl.'l here should be9lr,gli$Jlcerarion.

nt er,idence of acute cl clironic skitr ciis*ase ot--G-'

*!%

-I T"*a e sr"Irdrr TTGr& I I Id "ryH"ryT'#4qS &sl **ff*.*

*3*

5. "l'ltr:r'u: shcruld bc rrr,r sutl;rr irr tirtr rrlirl*.{r, Clrnrlir-lules slrlrrld nut bu srrl'li:iir*.t fi.*irr f nir:rlllilJti.rii.l:;,ttttil tcstis:uxrl lru:l'riilr {rt'hul}r-}n{ri:;.1i,{}t.iritlrirr-r.r:clirlhvdr'*i:*le .

fl i {.*Jtt}i0l_,t"tL"lrl,i\ l{.$"i:,I-t tiN "

( lv> nac"cn'- '---v

li:i,-il,lf(:r' lllrtl)I,.:,'rri i )t'

i. [']ltt*Ll ill'f:i\ilt'{: sJirrtrirj rr*t r"',',i:r:crl fij!. CltrrtJidatrs ri ilh lrrrv i;ilor} llr,*slirt.{r (i

r.iirt,rtrll ir: ;i rul j qll r.t :liirl i*,,c. :;.i,stllir: l:r:inil Illi)i :;itirr.r lti

.i

iI

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i

hc *'uie*tcd,

,: "l"lt-Ut flplllil 1,11". 11q _s!ir 1 t: l' 1113 1, 1li-d i () r.ii,\r u l i1

r 1

i i,;r; 1 sL:

llullllall) I t L$' -ti' t..Ii(-r:rilrJiilirL*s sJirrulrJ l:* ll ,:,,: ii'orrr rrli tiise;;cc** t;,1'rc:yrilatr,)r'\'::r.\,rilr.,n)Ihet'c slrr,itrlrl hu tir: ticfi:i'rnit,i' *l'i:irr:;t r',,Jritlr llrii_\.' crur* irrrilciiirlir:l:1

' 'J lrtr'c sltlrtlr.l l:r: r:,) ,'r.i.l..n,.r' ,,t ,,..rrilpr. trt,trtrr.,, rlirr.:ir,, rlt rrt,,. l:':l

:-i r,,t'rr,:tlit' ir,.1.,..,..-.-"r:,,I .t, lit/Illt;llil\

I I : ,\ Irl. I .l:.1_i\1. "S \_,;-l_1 .t Iiil i,\-liLLlrl)!1..5-):,i*1_L:i:l ;

r i I '{hc llllltiit}rl ri1'ltll litrtl;r,:iJtr:trlri hr ri'irlrirr ri,.rrrr;rl liirrils,j i J

" liri:r'r' ;iilirlrl Ir,: nr; ri,iilrrii:L ui' l;..,:t.iiirrs ilr:liriirrii., ll. llrr: lpirr;ii

j i r't.itt.illll? r.ri i,r j lltr: i:,rtr.r|r rili,,ts.i ^,- -'-

-i1l i r\l{$ilu-l,,s slvr'l.iti - -, "

i llict'cl sltor"r ir.i l.'tr tttl t-".'itJr.:nr:* iil"iiir.\ (iiricil:;fs rll il{:rJ.\j(t{tl, s.\r;i,,:rr irr rrl l

. ," j_.itlt nrtlntill cJrs*irs*. i

t: f !,_ti\i:rrJ'J,Ar{{Ursli$j i

, ,llll.i: :]]:l:11:,.]:- n{r,c!,iiJL,nr:r rl'liil:ui.r,ui*sir ,r. otl:.r. rii:iuri:;i: ,,,.ttr,, i

1',.t,ttitrjlrL:'..t.:rtt j,11'1,1,jr11- {jr,,,*.rt,j,,r.: J)r.j,i:ri,.],. .I+,j ,U-l_fi!\' {lir J,ili\{;.i ir + _j,,ulfll"l]t: i.ii,:rn

! i J !B J,fl-s- tl1:'-\jiLq l. ul,luuJiStltr

iil|i|j :i:::i:],J*ilffiiffi; i:l ll;lf:';::,1;"'i,;i:,:10,,,;::i j:, :j:: :

i::;f:::,;il:l:ii;i:_i :lli,:lli,,:.il;,,::l'i;;; li:,ll::,,:,,;

l: il.,,,:il ,i",li:, i::i'i ;::::,;t".iili.r.rI:stirLlJirJtrlterits,,,'.l",.tltc,,11;1lrctr|'...;,i..;;.;;;.,"|SIl{l()il|1(lt'|':'l

Siplral urc o f' fuiccj ical ( )l.ll c:cr.

Narrrc of Meciical OIficer.

.{nJxqu&

; i"l

il,:

tl'ts l I

i.,