1

SPEED POST/REGD.POST. A.D

OFFICE OF THE COMMISSIONER

, , -I

CENTRAL EXCISE, CUSTOMS AND SERVICE TAX, VADODARAI,

, , CENTRAL EXCISE BUILDING, RACE COURSE CIRCLE,

TELE: 0265-2330108* 273

/ VADODARA 390 007

F.No.II/3-12/2013-Estt

FAX: 0265-2339271
Vadodara, Dated: 29.11.2013

To,
The Candidate
Dear Candidate,
Sub:

Estt: Appointment to the grade of Inspector/Tax Assistant (Central Excise and Customs) in
the Central Excise and Customs, Vadodara Zone selected by the Staff Selection
Commission on the basis of result of Combined Graduate Level Exam-2012.

You have been nominated by the Staff Selection Commission for appointment as INSPECTOR/TAX
ASSISTANT under the Central Board of Excise & Customs, Dept. of Revenue and allocated to Central Excise &
Customs, Vadodara Zone, for appointment in the State of Gujarat.
2.

You are directed to remain present for the certificates/documents verification as well as for physical test /

medical test as per schedule given below.

Sr. No.
1

Test
Medical Test

2.

Physical Test
(only for
Inspectors )&
Document
verification (for
all candidates)

3.1.

Date/Time
.12.2013 at
8:30 AM Sharp.
As per Excel
List
.12.2013 at
10.30. A.M.
Sharp.
As per Excel
List

Venue
Civil Hospital, Near New High
Court, S.G. Highway Road, Sola,
Ahmedabad
Recreation Hall, Ground Floor,
Central Excise Building, Race
Course, Vadodara

Person to be contacted
Official representative -Shri M.P. Makwana,
who will facilitate you at
Hospital.
Shri M. D. Mehta,
Superintendent,
Establishment Section.

You are directed to bring following documents in original along with their attested copies (of one

each)

3.2.

1.

Secondary School Certificate (10th Standard) showing the date of birth.

2.

Degree Certificates

3.

Mark-Sheets of SSC/HSC/Degree.

4.

SC/ST/OBC/PH Certificate (in case of candidate belonging to

SC/ST/OBC/PH Category).

You are further directed to bring following documents:1.

Three passport size recent photographs.

2.

Duly filled in and attested Attestation Form in triplicate (Form enclosed)

3.

Duly filled form of Statement and declaration (form enclosed)

4.

Character certificate (to be obtained from 2 different Gazetted Officers and also attested by

the

District Magistrate) (form enclosed).

3.3.

The candidates are required to make their own arrangement of Bicycle for Cycling, which is a part of
Physical test.

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4.

The following physical tests/ physical standards are prescribed for the post of Inspectors

(Only for Inspectors)

For Male Candidates
(i)

For Female Candidates

Physical Test

(i)

(a) Walking 1600 metres in 15 min.

(b) Cycling 8 kms. In 30 min.
(ii)

Physical Standard (Minimum)

Hight 157.5 Cms.
Chest 81 Cms.
(Fully expanded with minimum expansion
of 5 cms.)
Hight relaxable by 5 Cms. in the case of
Garwalies, Assamese, Gorkhas and
Members of Schduled Tribes.

5.

Physical Test
(a) Walking 0 1 km. in 20 min.
(b) Cycling 3 kms. In 25 min.

(ii)

Physical Standard (Minimum)

Hight 152 Cms.
Weight 48 kgs.
Hight relaxable by 2.5 Cms. in the case of
Garwalies, Assamese, Gorkhas and
Members of Schduled Tribes.

No Traveling Allowance/ Daily Allowance will be paid in this regard. It is also further informed that

candidate will have to make their own arrangements regarding travel and stay in Ahmedabad/Vadodara.
6.

This letter is only for the purpose of consideration for appointment to the post of Inspector and shall not

confer any right for appointment to the said post. Appointment Orders shall be issued only after verification of the
documents in Para 3.1 above and if you qualify in the physical standard test and Medical Examination.
7.

Any request for change of the date mentioned above will not be entertained. No further extension will be

granted.
Encl.As above

(Dr.Ashir Tyagi)
Additional Commissioner (P&V),
Central Excise & Customs,
Vadodara-I

ATTESTATION FORM

:WARNING:
1.

The furnishing of false information or suppression of any factual

information in the Attestation form would be a disqualification and
is likely to render the candidate unfit for employment under the
Government.

2.

If detained, convicted, debarred, etc., subsequent to the

completion & submission of this form, the details should be
communicated immediately to the Union Public Service
Commission or the authority to whom the attestation form has been
sent earlier, as the case may be, failing which it will be deemed to
be a suppression of factual information.

3.

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

---------------------------------------------------------------------------------------------------------------------------1.

Name in full (in Block Capitals) with

aliases, if any please indicate if you SURNAME
have added or dropped in any stage -----------------------------------------------------------any part of your name or surname.
NAME

---------------------------------------------------------------------------------------------------------------------------2. Present address in full (i.e. Village,

Thana & District, or House No.
Lane/Street/Road & Town and Name
of Distt. Hdqrs.)

---------------------------------------------------------------------------------------------------------------------------3 (a) Home address in full (i.e. Village,

Thana & District, or House No.
Lane/Street/Road & Town and
Name of Distt. Hdqrs)

---------------------------------------------------------------------------------------------------------------------------(b) If originally a resident of

Pakistan the address in that
country & the date of Migration
to India Union.

Contd.2/-

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4.
Particulars of places (with periods of residence) where you have resided for more than one year
at time during the preceding 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.
From

5 (a)

ii

To

Name

Residential Address in full (i.e. Name of the Distt. Hdqrs, of the

Village, Thana & Distt. Or place mentioned in the preceding
House No. Lane Street/Road & column.
Town.)

Nationality Place of
(by birth & Birth
or by
domicile)

Occupation
if employed
give
designation
& official
address

Present
postal
address if
dead give
last
Address

Permanent
Home
Address

Father
(Name
in full,
Aliases
if any)
Mother

iii

Wife/
Husband

iv

Brother
(s)

Sister (s)

5 (b). Information to be furnished with regard to son (s) & for daughter (s) in cases they are studying/
living in a foreign country:Name

Nationality (by Place of Birth

Birth & /or by
domicile)

Country
in
which studying
living with full
address.

Date
from
which studying
living in the
country
mentioned in
previous col.

5
Contd.3/-

6
6.

Nationality

7. (a)

Date of Birth

(b)

Present Age

(c)

Age of Matriculation

8. (a)

Place of Birth District & :

State in which situated

(b)

District & State to which :

you belong

(c)

Distt. & State to which :

your father originally
belong

9. (a)
(b)

Your religion

Are you member of a

Scheduled Caste/
Scheduled Tribe/
Other Backward Caste/
YES OR NO

10.
Educational qualification showing places of education with year in Schools & College since 15
years of age.
Name of School/College with full
Address

Date of
entering

Date of
leaving

Examination passed

11. (a) Are you holding or have any time hold an appointment under the Central or State Government
or Semi Govt., or a Quasi Govt. 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
From

To

Designation
Full name & Address Reasons for leaving
employments & nature of employer
previous service
of employment

Contd.4/-

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11. (b) If the previous employment was under the Govt. of India, a State Govt./ an Undertaking owned
or controlled by the Govt. of India or a State Govt./an autonomous body/University Local Body.
If you had left service on giving a Months notice under Rule 5 of the Central Civil Services
(Temporary Service) Rules, 1965, or any similar corresponding Rules were any disciplinary
proceedings framed against you, or had you been called upon to explain your conduct in any
matter at the time you gave notice of termination of service, or at a subsequent date, before
service actually terminated.

12. (a)
(b)
(c)
(d)
(e)
(f)
(g)

Have you ever been arrested?

YES / NO
Have you ever been prosecuted?
YES / NO
Have you ever been kept under detention?
YES / NO
Have you ever been fined by a Court of Law?
YES / NO
Have you ever been convicted by a court of law for any offence?
YES / NO
Have you ever been bound down?
YES / NO
Have you ever been debarred from any examination or educational
YES / NO
authority/institution?
(h) Have you ever been debarred /disqualified by any Public Service
YES / NO
Commission for any of its examination/selection?
(i) If any case pending against you in any University or any other educational YES / NO
authority/Institution at the time of filling up this Attestation Form?
(j) If any case pending against you in any court of Law at the time of filling up YES / NO
this Attestation Form?
(ii)
If the answer to any of the above mentioned question is YES gives full particulars of
the case/arrest/detention/fine conviction/sentence punishment etc. and/or the nature of the case
pending in Court/University/Educational Authority etc. at the time of filling up this Attestation
Form.

NOTE: i.
ii

Please also see the Warning at the top of this Attestation Form.
Specific answer to each of the question should be given by striking out YES or NO as
the case may be.

13. Name of two responsible persons of 1.

your locality or two references to
whom you are known (with full
address)
2.

14.

I certify that the foregoing information is correct and complete to the best of my knowledge &
belief. I am not aware of any circumstance which might impair my fitness for employment
under Government.

Date :
Signature of the Candidate.
Place :
Grade
Place of posting.

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::IDENTIFICATION FORM::
(Certificate to be signed by any of the following)
1. Gazetted Officers of Central or State Government.
2. Member of Parliament or State Legislative belonging to the constituency where the candidate or
his Parent/Guardian is ordinarily residents.
3. Sub-Divisional Magistrate/Officers.
4. Tehsildars or Naib/Deputy Tehsildars authorized to exercise Magisterial Powers.
5. Principals/Head Master of the recognized school/College/Institution where the candidate
studied last.
6. Block Development Officers.
7. Post Masters.
8. Panchayat Inspectors.
Certified

that

__________________

have

known

Son/Daughter

Shri/Smt./Kum.
of

Shri

________________________________
_______________________________

_____________________ for the last _______________ years ______________ months and that to the
best of my knowledge and belief the particulars furnished by him/her are correct.

Date :

Signature
with stamp

Place :
Designation or:
status and
Address.

TO BE FILLED BY THE OFFICE

i. Name, designation and full address of the appointing authority.

ii. Post for which the candidate is being considered.

CANDIDATES STATEMENT AND DECLARATION

The candidate must make the statement required below prior to his medical examination and
must sign the declaration appended thereto. His attention is specially directed to the warning contained
in the Note below:-

1.

State your name in full (in block letters) .

2.

State your age and place of birth

3.

(a) Have you ever had small-pox,

Intermittent or any other fever,
Enlargement or suppuration of
Glands, spitting of blood, Asthma,
Heart disease, lung disease, fainting
Attacks, rheumatism, appendicitis ? .

Or
(b) Any other disease or accident
Requiring confinement to bed and
Medical or surgical treatment ?

4.

When were you last vaccinated ?

5.

Have you or any of your near relations

Been afflicted with consumption, scrofula
gout, asthma, fits, epilepsy or insanity ? .

6.

Have you suffered from any form of

Nervousness due to overwork or any
Other cause ?

7.

Have you been examined and declared

Unfit for Government Service by a
Medical Officer / Medical Board, within
The last three years ?
.

8.

Furnish the following particulars concerning you family :-

Fathers age if
Living and state
Of health

Fathers age at death

and cause of death

No. of brothers
living, their ages
and state of health

No. of brothers dead,

their ages at death
and cause of death.

10
::2::

Mothers age if
Living and state
Of health

Mothers age at death No. of sisters

and cause of death
living, their ages
and state of health

No. of sisters dead,

their ages at death
and cause of death.

I declare all the above answers to be, to the best of my belief, true and correct.
I also solemnly affirm that I have not received disability certificate / pension on account of any
disease or other condition.
Candidates Signature ...
Signed in my presence
Signature of Medical Officer .
NOTE.The candidate shall be held responsible for the accuracy of the above statement. By willfully
suppressing any information he will incur the risk of losing the appointment and , if appointed, of
forfeiting all claim to superannuation allowance or gratuity.
[ G.I., M.H., O.M. No. F.5(11)-55-M-II, dated the 27th September, 1957.]

11

: CERTIFICATE OF CHARACTER:
Certified

that

have

known

Shri/Smt./Kum.

___________________________________________________

_____________

Son/Daughter

______________________________________________________________

for

of
the

Shri
last

__________ years and ________________ months and that 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.
Shri/Smt./Kum.________________________________________________

is

not

related to me.
Place :
Date :
* Signature
Name

:
:

Designation :
(* To be signed by the Gazetted Officer of Central or
State Government)

ATTESTED
Place :
Date :
@ Signature

Name

Designation :
(Attesting Authority)
(@ To be attested by Stipendiary Ist class Executive
Magistrate/District Magistrate or Sub-divisional Magistrate.)
NOTE: Two certificates to be signed by two different Gazetted Officers of the Central or State
Government attested by Stipendiary Ist class Executive Magistrate/District Magistrate
or Sub-Divisional Magistrate.

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APPENDIX 3
AUTHORITIES EMPOWERED TO ISSUE CASTE CERTIFICATES
[G.I., Dept. of Per. & Training O.M. No. 36012/6/88-Estt. (SCT), (SRD.III), dated 1-44-1990.]
The under mentioned authorities have been empowered to issue Caste Certificates of
verification
1. District Magistrate/Additional District Magistrate/Collector/Deputy Commissioner/Additional
Deputy Commissioner/Deputy Collector/1st Class stipendiary Magistrate/Sub-Divisional
Magistrate/Taluka Magistrate/Executive Magistrate/Extra Assistant Commissioner.
2. Chief Presidency Magistrate/Additional Chief Presidency Magistrate/Presidency Magistrate.
3. Revenue Officer not below the rank of Tehsildar,
4. Sub-Divisional Officer of the area where the candidate and/or his family normally resides.