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gyrdlnmi unaflG[-&eufl& ooilglnrflosir rosErir flpiq uuflzuorfuenfldu snnSlu-rns q-dir6n

Gprlg SluLoan$$lfonditr ggflrfluLf Gp'iq arrrflu$$leir


oflrflo.lrorru-rnorni uerufluglL-riserfleir

gqplloflriuneoenrugloir, g$nr9L-@oir6'rr6unglt, glgle /g4rre 615l e-pdl9l GluErir / eup$l

uno5lGlL-&eufl& Lnpglti] Cun$lu5lurfr orirgnrflaffirfu ueruflqrfl$p / ueruflqrflqrir

ogmurenrrlupnryriooflrir GlunfluSludl LopErn Gunfltgludr g4riuonp ururi8rfloloeir Experience


Certificate-eir Glpn$ki: griu6 oeirofl Slru&gonryarb srniurs GLoGlzunrlu6 (Countersigned)

6f6lforgl Glpnuriuno, o5lefrrennriupnnrioeir g4eonnzulgrir Gleeireonr&g o'l$gt GLoGlnrnrlurir


GluEcunnp$ goglririgrn CIun1gi@, aflarurennrlupnryioofloir cue$l&ono, Glpn$ltil giu6 sri:afl

$tu6oorb gcrglrl Glgn$leir giuril oeiloSl Sluti;gprfleir orniuno, Experience Certificate-+ir


GLoGlnrnuuLb Glerircup$g S$SonnnL-cunE Loncuit-rfisoir onrflu.rno gr-61$tpnigril o-oiren u$gt
glldleorri Glunflufluf odugnrfloerflrir grpeilorrioeocnqri Regional Nodal Officer-s5nns
6lu.,,.6| pgt g$nD6r6r euprarsriui$leiren$.

6U. g4gornro$$cir Gluu.rf uruuflqrflqrir / uruuflqfl$p orirgpnfl ocir


creftr. gl6u,u!L6kl5&6rb r-onolr-drocir
1. Glpn$kfu griu& otirofl $lu-r&aerir, Gleeirooom, $O*uitEqf ri, oflqguqryb
Gls5ir6o6iff

5U. grdlrurri Glur$luSluS uruuflqlflrqrir / uruuflqtfl$p otilglrflocir


6r50il. o drqryfi ofl floi'r erfloryril g6u,rfi6l1q&grb r-onorir-riroeir
1. gprdlnnri GlunfluSluLf oo'ug1nrfl , Gonrurbq$glnri, $eudlfl , 6OnU'i
Gonurbq$gtmi.
2. gprdlnnri Glun$lu9lu:f oeirglnfl, Gen:6, gnLn6oeil, mGrrnGt
Gs26.
3. grrdlemri Glun$lu9uf ooirglnrfl , $llSGlprirGorafl, ociroflurnqgrnrfl,

$16CprirGcue6l. grnpgri;g+, oflqggpori


4. g4psriuri Gloigurnri glrdleinri rlrloprfpqfl.o, #lolenilcos, $geort,
Glunflufl u.rf ooirglrnfl , oncory&qgg qg1&GonLeor--

5. ppoinp Glurflumi grdlnmi GcrLgni, $grueuurennlrro5'Dil,


Glunfluflu.r$ ori:glnrfl , Ga.r gmi on@dlqryLb

6. gudlnnf Glun$lu9u4f oduEmfl , Sl6eipentrdltfl


uria'ri.
7. glrdlnmi Glun$lufluf ooirg2lnrfl, Gprfl
Gungpnu&ogtnri
8. gyl$lorri Glunflufluf ori: g1nrfl , FOLoqrfl
p(Droqrfl.

L gyldlorri Glunflu9u$ ooir glnrfl , p@eng5ri, pnoriuigeuni, $l15eunqgf,


pqfoen95f. ouzumi

10. gr$lenri Glunflufl ufr otirEnrfl , 6l6&dl, gqrfl ugnri oqgri, Gluryriruglmi,
urfrrruorir. $mur@d;orir
oflamrcuuriupnryriaeir, 2+O'I.2O2O grpdl 12.02.2020 orrorl J[Stat5Do Gcueoat pnL-aafldl

S$rioninL- ggoLeurnrfuo€DL6iT erbu$puuiL- g4gterLzuorir / ooirgnrfl&g& GloeirE

Experience Certificate-+il Gr-oGlonrluri Gsnrfl ofleuorermrluri Glorirgt GlonohdTrnlrnb.

Glsnfiurfhl orrcil6uurgu -Sor6uurfio6lflfir oflornit.

1 Request Letter
2. Experience Certificate prescribed by TRB - 3 Nos. (in Original)'
3. Original Service Certificate duly signed by the Principal &
Correspondent (or) Chairman.
4. Xerox copies of Pay Acquaintance duly attested by the Principal
in each page. (or)
ECS (griluro crLrardl seuor&dkfu oor$uLrb oLprareriuigtDppneil,
t r+gei:er rfl oir enoirGlpniupgJttin
s"gul Ban k Statem e nt.
5. Xerox copies of Attendance Register duly attested by the
Principal in each page. (or)
ar(Ddoo u$lGcu@ urynufl&orn-ooil, Bio-Metric g6tDp
urueiru@$priuL-g6$gn2, g4gnnnn& g$nr5lu@ otilgrrfl grpdrof
eiLpdrgilr eneirgl.
6. Affidavit in the prescribed format in the Bond Paper of Rs.20l-
with Signature of the Notary Public and two witnesses.
7. odgUfrflugkfu urynLnrfl &ouuiu ggcu nrurriro oir, Glorriremi (Fl ood) gfil5ug1
6 oflupgt (Fire Accident) Guneirp onrJoinrriroennoil
GeprnoorL-$$1151Bpnofu, ggt gdlpg cugcunfr$ gnnpu$lnn
glory6flLoir gqgeonn& 1qdnCIL@ grprirori eryrugrb enoirE.
8. Serv'rce Certificate u6ogtu Gp$unrir GtupdlO;i;png1i, Principal &
Correspondent (or) Chairman (or) Secretary eoaGlunfru$gL-eir
Gkrr&tqdr uL-o3!$|il clfrUrfi Glsneirenonrb.

^*ry'n
\X) t /-4-\

Glgn$lei:
y"
gtiu& seiro9l s|r,itgpOBsns

d9r".."
Lso-''
ry'
MODEL AFFIDAVIT

Certificate to the effect that l, was working as

Assistant Professor / Lecturer ...... in the


Department (Teaching Staff) in College,

which is a / Government Aided /


Government Self Financing
Engineering College for the period from .... to as per the
Experience Certificate issued by the institution signed by appropriate authority.

I hereby declare that the information furnished in the Experience Certificate is

bonafide one and tr.ue to the best of my knowledge. lf any discrepancies found later,

I am fully aware of the legal consequences and proceedings to be initiated against

me in case of falsification of records if any made by me and I will abide by the orders

issued by the Teachers Recruitment Board, which is the Recruiting Agency and in

such eventuality I know that my candidature shall be forfeited.

Signature of the Individual

I have verified with proof of records.

Signature of Notary Public

Witness 1:

Witness 2:
o.q{*
for Director of Technical Education

*"#'
r

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