FORMAT OF CERTIFICATES (CANDIDATES MAY EITHER USE THESE FORMATS DIRECTLY OR TAKE PHOTOCOPIES FOR SUBMITTING NECESSARY CERTIFICATES ALONG WITH ADMISSION APPLICATION) FORM - A NATIONALITY CERTIFICATE Certified that Shri./Smt./Kumari .................................................................................. son/wife/daughter / ward of Shri./ Smt……………………………………………………………………… ..............

residing at

............................................................ is an Indian national.

Place :

Deputy Tahsildar / Tahsildar

Date

Name of the Officer: (Office Seal)

:

FORM - B CASTE CERTIFICATE Certificate to be produced by the applicant belonging to OBC / MBC / BCM / EBC / BT in support of his / her claim for the purpose of admission to educational institution and academic purpose I. This is to certify that Shri./Smt./ Kumari ............................................. son/ wife /daughter /ward of Shri./Smt ................................................................................................................... in the Union Territory of Puducherry belongs to ........................................................................................... community which is recognised as a Back ward Class in the Union Territory of Puducherry vide Serial No ............ as per the (i)

GO. Ms. No.9-2001 - Wei. (SW-II) dated 19-02-2001 and published in the official Gazette of Puducherry Vide Gazette No. 29 dated 22.02.2001. (ii) G.O.Ms. No. 13/2002 - Wei. (SW-II) dated 12.03.2002 and published in the official Gazette of Puducherry Vide Gazette No. 13 dated 26.03.2002. (iii) G.O. Ms. No. 26/2002 - Wei. {SW-II) dated 10.06.2002 and published in the official Gazette of Puducherry Vide Gazette No. 117 dated 26.06.2002. (iv) G.O. Ms. No. 56/2003 - Wei. (SW-II) dated 01.12.2003 and published in the official Gazette of Puducherry Vide Gazette No.......................................... dated ……………………….

of the welfare Secretariat, Government of Puducherry, drawn up the list of other Backward Class based on the recommendation of the state level commission for backward classes. Shri./ Smt./ Kumari ................................................................ and his/her family ordinarily reside(s) in the above mentioned place. Note ; For residents of Puducherry, the caste certificate should be obtained only from Puducherry Authorities. Place : Date :

State / Union Territory

Signature Name of the Officer Designation (Office Seal)

Certificate to be produced by the applicant belonging to SCHEDULED CASTE or SCHEDULED TRIBE in Support of his / her claim 1. This is to certify that Shri./Smt./Kumari ...................................................... son / daughter of Shri./Smt./ .......................................................................................... of Village/Town ................................................... the State/Union Territory ............................................... belongs to the ......................................... Scheduled Caste/ Scheduled Tribe under : The Constitution (Scheduled Castes) Order, 1950* The Constitution (Scheduled Tribes) Order, 1950* The Constitution (Scheduled Castes) (Union Territories| Order, 1951* The Constitution (Scheduled Tribes) (Union Territories) Order, 1951* As amended by the Scheduled Caste and Scheduled Tribes lists (modifications) order, 1956, the Bombay Re-organisation Act, 1960, the Punjab Re-organisation Act, 1966 the State of Himachal Pradesh Act, 1970 and the North Eastern Areas (Re-organisation) Act,1971 and the Scheduled Castes and Scheduled Tribes Order (Amendment) Act, 1976. The Constitution (Jammu and Kashmir) Scheduled Castes Order, 1956* The Constitution (Andaman and Nicobar Islands) Scheduled Tribes Order, 1959* The Constitution (Dadra and Nagar Haveii) Scheduled Castes Order, 1962* The Constitution (Dadra and Nagar Haveii) Scheduled Tribes Order, 1962* The Constitution (Puducherry) Scheduled Castes Order, 1964* The Constitution (Ultar Pradesh) Scheduled Tribes Order, 1967* The Constitution (Goa, Daman and Diu) Scheduled Castes Order, 1968* The Constitution (Goa, Daman and Diu) Scheduled Tribes Order, 1968* The Constitution (Nagaland) Scheduled Tribes Order, 1970* 2.

This certificate is issued on the basis of the Scheduled Caste / Scheduled Tribe Certificate

issued to Shri. / Smt ................................................................... father / mother of Shri. / Smt. / Kumari ................................................... of Village / Town …........................................................ in District / Division ................................................ of the State / Union Territory ........................................... who belongs to the ........................................ Caste / Tribe which is recognised as a Scheduled Caste / Scheduled Tribe in the State/ Union Territory........................................... issued by the……………………………..

(Name of the prescribed

authority) vide their No............................... dated ........................ Place

:

Date

:

State/Union Territory

Signature Designation (with seal of Office)

* Please quote specific Presidential Order.

FORM – C

FORMAT OF CERTIFICATES FOT UT OF PUDUCHERRY RESIDENTS QUOTA 1. Candidates seeking admission under UT of Puducherry residents' quota seats must furnish Permanent Integrated Certificate as per G.O. M.s. No.13, Dt.24.2.2007. of the Department of Revenue & Disaster Management, Puducherry or separate certificate in the prescribed format issued by the concerned Taluk Office. [ OR ] 2a.

Certified that Shri. / Smt. / Kumari............................,..........,........................has passed the S.S.L.C / Matric /

Higher Secondary / any other higher public examination in the year........................................and for that purpose undergone academic studies continuously for five successive classes in the following recognized institution(s) in UT of Puducherry. SI.No.

Name of the Institution (s)

Date(s) attended

1. 2 Place: Date:

Signature of the Head of the Institution last attended with office Seal

2b. Certified that the said Shri./Smt./Kumari...................................................................................................... has resided in the UT of Puducherry continuously for five years during the period of study mentioned in the certificate 2(a) above. Place: Date: Tahsildar/Deputy Tahsildar Name of the Officer: (Office Seal) [OR]

3a.

Certified

that

Shri./Smt. ……………………………………………………… Father

/ Mother

of

Shri./Smt./Kumari ………………………………………….………............... was a Puducherry government employee/Central Government Employee/Employee of ………………………………………………………… which is a Public Sector Undertaking run wholly/substantially by the Central Government/Puducherry Administration and he /she is presently posted and serving

in

UT

of

Puducherry

since …….............

……………………………………… (Continuous THREE years is mandatory) (Please indicate the date from which he/she has been serving in UT of Puducherry).

Place: Date:

Name Designation of Head of the Office (Office Seal)

3b. Certified that Shri. / Kumari .........................,..................................... has passed the

Higher Secondary

(Qualifying Examination) in any of the Schools in UT of Puducherry in the year........................................and for that purpose undergone academic studies continuously for two successive classes in the following recognized institution(s) in the Regions of Karaikal / Mane / Yanam of UT of Puducherry. Name of the Institution (s)

Year(s) of Study

Place: Date: Signature of the Head of the Institution last attended with office Seal

[OR]

4. Certified that Shri/Smt. ………………………………………….. Designation ………………………….………. ……………………….. Father / Mother of Shri./Smt./Kumari. ……………………………………………………. was a Defence Personnel / Central Paramilitary Force and was killed / disabled in action during the year ……………………………………………… (Enclose separately document to prove that you have declared any place in UT of Puducherry as their home towns).

Place: Date:

Name Designation of Head of the Office/OC of Unit (Office Seal)

CERTIFICATE TO CLAIM SEATS UNDER SPECIAL REGIONAL ALLOCATIONS KARAIKAL, MAHE & YANAM. (a) Certified that Shri. / Smt. / Kumari................................................................ has passed the S.S.L.C / Matric / Brevet / Higher Secondary / any other higher public examination in the year........................................ and has for

that

purpose undergone academic studies continuously for three successive classes in the following

recognized institution(s) in the Regions of Karaikal / Mahe / Yanam of UT of Puducherry. S.I No

Name of the Institution (s)

Date(s) attended

1 2 3 Place: Date:

Signature of the Head of the Institution last attended with office seal

(b) Certified that Shri./Smt/Kumari...................................................................... son/daughter of Shrri/Smt..........................................is

having

continuous

residence

for

the

last

five

years

at..........................................................................................which comes under Karaikal / Mahe / Yanam Region of Puducherry UT. Place: Date: Tahsiidar/Deputy Tahsildar Name of the Officer: (Office Seal)

Counter Signed by RAO / CEO

Foreign and NRI students sponsor’s undertaking I, ……………………………………………………………….. S/o. ……………………………………………………………………… aged ……………………………… years residing at ……………………………………………………………………………………………. declare and solemnly affirm as follows. 1.

I am working as ……………………………………………………………………………………………………….…………….. in

………………………………………………………………………………………………….…….………………. and my annual income is ………………………………………………………………………………….. 2.

I am sponsoring Mr./Miss ………………………………….………………………………………………………………………

S/o. ………………………………………………………………. Residing at …………………………………………………………………… ………………………………………………………………………… as a relative ………………………………………………………………… for studying B.Sc.(Agri.) degree at Pandit Jawaharlal Nehru College of Agriculture and Research Institute (PAJANCOA&RI), KARAIKAL-609 603, U.T. of Puducherry, India. 3. I understand that the tuition fees payable is 2000 US dollars per semester of 15500 US dollars for the entire course of four years duration (one time payment) along with the admission fee of 300 US dollar per students, and is to be paid at the beginning of each semester for a period of four years exclusive of living and other expenses. 4. I am also aware of the academic rules and regulations of the B.Sc.(Agri.) degree programme of the college. 5. I hereby guarantee to provide full financial support for Mr./Miss …………………………………………… to meet the educational cost and living expenses as required for studying B.Sc.(Agri.) degree programme at PAJANCOA&RI Karaikal starting from the academic year …………………………….. 6. Further, I realize that I am fully responsible for and will be held accountable for maintaining the terms and conditions of this declaration. Place : Date :

Signature of the Sponsorer

Witnesses: 1. Signature : Name and address :

2. Signature Name and address

: :

PANDIT JAWAHARLAL NEHRU COLLEGE OF AGRICULTURE & RESEARCH INSTITUTE, KARAIKAL-609 603 PROFORMA FOR SPORTS CERIFICATE FOR THE PERIOD JUNE 2011 TO MAY 2016 (Please see The Gazette of Puducherry No.40 dt.29th May 2012 and No.17/2016)

Name of the candidate :

Registration No. : (To be filled by the Institute)

Sl. No.

2

3

Month and year (From June 2010 to May 2015)

Name of the Games and Sports

International / National / State / Division

1

June 2011 to May 2012*

2

June 2012 to May 2013*

3

June 2013 to May 2014*

4

June 2014 to May 2015*

5

June 2015 to May 2016*

(For Office use only)

Relevant form / Certificate I/II/III/IV (Yes/No)

* As per the norms only one Highest Level of achievement shall be mentioned for the year.

6

5 (For Office use only)

4

1

Gold (First)

Silver (Second)

Bronze (Third)

(For Office use only)

Participation

Points

Total Marks/points

DECLARATION The information furnished above and all the enclosures submitted by me are true. Should it however be found that any information therein is untrue with respect to Sports details, I realize that I am liable for criminal prosecution and I also agree to the forfeiture of my seat under Sports quota Place Date

: :

Signature of the Applicant

For Office use