UTTAR PRADESH PUBLIC SERVICE COMMISSION

ADVT. NO : A-3/E-1/2015
Date : 21-07-2015

U.P. Judicial Service Civil Judge (Junior Division)

Examination-2015
Last Date for Receipt of Examination Fees in the Bank: 17-08-2015.
Last Date for Submission of Application: 21-08-2015.
"SPECIAL NOTICE :- (a) Applic ations will be ac c epted only when fee is deposited in the Bank upto prescribed last date for fee
deposition. If the fee is deposited in bank after the last date prescribed for fee deposition, the on-line application of the candidate will
not be ac cepted and the fee deposited in the bank will not be refunded in any condition. It will be responsibility of the candidates to
deposit fee in the bank upto last date presc ribed for Fee deposition and Submit the application upto last date prescribed for
submission of applic ations. It is also informed that less or more amount deposited in the form of examination fee shall not be refunded
in any c ondition.
(b) In Online Applic ation System, the c andidates have to provide their Mobile No. in prescribed column failing which their Basic
Registration shall not be completed. All relevant informations/instructions / OTP (one time password) shall be sent through sms on that
mobile.

NECESSARY INFORMATION TO APPLICANTS FILLING THEIR APPLICATIONS

THROUGH ON-LINE
This advertisement is also available on the Commission's website http://uppsc.up.nic.in. The On-line application system is applicable
for applying against this advertisement. Applic ations sent by any other mode shall not be entertained hence candidates are advised to
apply On-line only. In c onnec tion with On-line application, candidates are advised to go through thoroughly the Instructions given as
under and apply ac c ordingly:1. When the c andidate c lic ks "ALL NOTIFICATIONS/ADVERTISEMENTS" on the Commission's website http://uppsc.up.nic.in the Online advertisement shall be automatically displayed, wherein there shall be 3 parts given as below:
(i) User Instructions
(ii) View Advertisement
(iii) Apply
A list of all the advertisements will be displayed in which "On-line System" is applicable. The Instructions for filling "On-line form"
have been given in User Instruc tion. The Candidates desirous to see the advertisement will have to click before 'View Advertisement' to
whic h they are desirous to see, full advertisement will be displayed along with sample snapshots of ON-LINE Application Procedure.
Clic k on "Apply" for On-line Application.
On clic king Apply, Candidate Registration will be displayed.
On-line application w ill be completed in three stages :
First stage: Basic Registration form will be displayed on clicking the 'Candidate Registration' respective to Examination. After filling
the Basic Registration form on c licking the submit button, the registration of First stage shall be over. Thereafter Candidate
Registration Ac knowledgement shall be displayed which can be printed by Clicking the Print Button.
Second stage: There shall be two options for depositing the fees which are E-challan and
I-collect, which can be deposited in State
Bank of India or Punjab National Bank. The c andidates having Net Banking facility in any of these two Banks may deposit the fees
through I-c ollec t. After taking the option of E-Challan or I-Collect Examination fees payment details will be displayed. On selecting the
Bank to deposit the fees through E-challan, the E-c hallan of concerned Bank SBI/PNB will be displayed in which there shall be
Candidate's Registration No., Name, Date of Birth and Fee Amount. The candidates will have to go with E-challan (in the Bank whic h
is opted by the Candidate themselves) to any branc h of the Bank and deposit the fees and take one copy of E-Challan and keep with
them safely. On the c opy of the E-Challan given by the Bank transaction ID/Journal No. and date shall be mentioned which shall be

used at the time of filling the form at third stage.

Third stage: After depositing the fee in the Bank, the candidate two day after, on the working day (after 2.00 pm) shall enter
information On-line in the format, available on Commission's website by clicking "Submit Application Form". The photo and
signature, duly sc anned shall be uploaded also. The candidate should scan his photograph and signature in the prescribed size (the
size will be mentioned at the spec ified spot in the On-line application). This should also be kept in notice that the photo must be latest
passport size. In c ase the photo and signature, scanned in the prescribed size, are not uploaded, then the On-line system will not
ac cept it. The proc edure related for scanning of the photo and signature is laid down in the Appendix-1. After filling in all entries in
the format, the c andidates may c lic k "View application form" to see for themselves that all entries and informations are correctly
entered and after satisfying themselves should c lic k "Submit" button to forward the same to the Commission. It is essential that the
candidate should fill all informations On-line c orrec tly according to the instructions given and click the 'Submit' button by the last date
prescribed for submission of the application form. If the candidate does not click the "Submit" button, the application shall not be
completed finally and the c andidate shall be acc ountable for this. After clicking the 'Submit' button, the candidate may take a printout
of the applic ation to preserve it with them. In the event of any discrepancies, the candidate will be required to submit the said print-out
in the offic e of the Commission, otherwise his/her request shall not be entertained.
2. The Applic ation once submitted, will not be allowed to be modified.
3. Application Fee: After filling in the 'Candidate's Registration' format of the On-line application, the candidate shall procure the
print-out of the E-c hallan in duplic ate. The E-Challan will be used to deposit the fee in any of the branches of State Bank of India or
Punjab National Bank by the candidate ac c ording to his/her category. The fee will not be allowed to be deposited by any other mode
exc ept E-Challan. The above fee, for Preliminary Examination according to the category, is as under:1. Unreserved (General)-

Exam fee ` 100/- + On-line processing fee ` 25/- Total = ` 125/-

2. Other Bac kward Class-

Exam fee ` 100/- + On-line processing fee ` 25/- Total = ` 125/-

3. Scheduled Caste

4. Scheduled Tribe -

Exam fee ` 40/- + On-line processing fee ` 25/- Total = ` 65/-

5. Handic apped

Exam fee ` 40/- + On-line processing fee ` 25/- Total = ` 65/-

Exam fee NIL + On-line processing fee ` 25/- Total = ` 25/-

Physic ally Handicapped candidates are eligible for U.P. Judicial Service on the basis of their merit against unreserved posts only
ac cording to Govt. Letter dt. 27.12.2012 provided that they must pass any medical examination under Rule-14 of U.P. Judicial Servic e
Rules-2001.
6. Dependents of the -

Ac c ording to the original category mentioned from Sl. Nos. 1 to 4.

Freedom Fighters
7. Ex-Serviceman

Ac cording to the original category mentioned from Sl. Nos. 1 to 4.

8. Women

Ac cording to the original category mentioned from Sl. Nos. 1 to 4.

4. The Basic Registration of such candidates will not be accepted who have been debarred from U.P. Public Service Commission and
their period of debar has not been c ompleted. In addition to above, the applications submitted without requisite informations regarding
debar, if it is found at any stage in future that the applications have been submitted concealing this fact, his/her candidature will be
rejec ted at any stage and the Commission will c onsider to debar from all future examinations/selections including extension of debar
period. In this regard if the c laims of the c andidates made in their applications are not found true, they can be debarred not only from
the examination in question but from all the future examinations and selections made by the commission also including other
appropriate penalties.
5. If the candidates want some c orrec tion or c hange in their submitted applications, they can submit another fresh complete
application ON-LINE with desired c orrec tions along with prescribed fee within the last notified dates of the advertisement. The
application fee deposited with the prior applic ation will neither be returned nor adjusted in any condition. In the condition of more
than one applic ations submitted by a c andidate, only last submitted application will be treated as final.
6. The U.P. Public Servic e Commission shall hold a Preliminary Examination at various Centres of the Districts mentioned in
Appendix-2 of this advertisement for selec ting suitable candidates for admission to the U.P. Judicial Service Civil Judge (Junior
Division) Main (Written) Examination, 2015. The selec tion will be made on the basis of total marks obtained by the candidates in Main
(written) examination and Interview. The Centre of Examination, decided by the Commission, will be intimated to the candidates by
means of their e-Admission Certificate. The no. of Districts/centres may be increased/decreased according to final number of

applications received in the offic e of the Commission.

7. Vacancies: No. of Vac anc ies are 197, these Posts are temporary but likely to be continued.
Vertical

Horizontal

General-99

DFF-04

OBC-53

Women-39

SC-41

ST-04
Note: (1) The Candidates c laiming the benefit of reservation / age relaxation must obtain, in support of their category a certificate
issued by the competent authority on the proforma available on the Website & in this detailed advertisement (Appendix-3) and shall
submit the same to the Commission when asked for (2) All Reserve candidates of U.P. Must mention their Category / Sub Category in
the Applic ation Form. (3) Candidates claiming reservation / age relaxation in more than one categories will be entitled to only one
conc ession whic hever is more beneficial to them. (4) The Scheduled Caste, Scheduled Tribes, Other Backward Class and Dependents
of Freedom Fighters and women candidates who are not the permanent resident of U.P. shall not be given the benefit of reservation.
Suc h c andidates shall be treated as the candidates of the General Category. In case of women candidates the c aste
certificate/domicile c ertific ate issued from Father side only be treated valid. It is mandatory for the candidates to enclose self attested
copies of all marksheets and c ertific ates alongwith the application forms of Main (Written) Examination in support of the claims made
by them in their application forms of Preliminary Examination regarding eligibility and category/sub-category for the benefit of
reservation failing whic h their c laim as a reserve c ategory candidate shall not be entertained.
8. Scale of Pay: 27700-770-35090-920-40450-1080-44770
9. Educ ational Qualific ation: (A) Till Last Date for submitting the application the Candidate must be a Bachelor of Laws of a University
established by Law in U.P. or any other University of India recognised for this purpose by the Governor, Or (B) Must be an Advocate
enrolled under the provisions of the Advocate Act 1961 or a Barrister of England or Northern Ireland or a Member Faculty of Advoc ates
in Scotland and is entitled to practic e in the Court or Courts subordinate thereto; (C) Must possess a thorough Knowledge of Hindi in
Devnagri Sc ript.
10. Age Limit: A c andidate for direc t recruitment to the service must have attained the age of 22 years and must not have attained the
age more than 35 years on the first day of July next following the year i.e. 01.07.2016. They must not have born after 1st July, 1994
and not before 2nd July, 1981.
Provided that the upper age limit shall be higher by five years in the case of Candidates belonging to Scheduled Castes, Scheduled
Tribes, OBC, Skilled players of U.P. i.e. they must not have born before 02.07.1976. The upper age limit shall also be greater by 5
years for
E x-servic eman/Emergency Commissioned Officers/Short Service Commissioned Officers/ Commissioned Officers of U.P. who
have rendered atleast 5 years servic e in Army, but there shall be no reservation. No relaxation is admissible in upper age limit for D.F.F.
Candidates. The upper age limit shall be greater by Fifteen years for Physically Handicapped candidates according to GO Dated
03.02.2008. i.e. they must not have born before 02.07.1966. Provided further that where a candidate was eligible in age to appear at
the examination in the year 2014 he shall be deemed eligible in age as per provision of the U.P. Judicial Service (Amendment), Rules
2003.
Provided also that the maximum number of c hanc es a candidate is permitted to take will be four. ''The Hon'ble Court has not
adopted the (U.P. Recruitment to Servic e (Age Limit) (Tenth Amendment) Rules, 2012 issued by Govt. of U.P. with regard to increase
in the upper age limit from 35 years to 40 years.
11. Important Instructions: (1) Inc omplete applic ation and application without signature even if within time shall be rejected
summarily (2) Emergenc y Commissioned/Short Servic e Commissioned Officers who have not been released from Army but whose
period of Army Service have been extended for rehabilitation, may also apply for this examination on the following condition in
ac cordanc e with G.O.No.22/10/1976-Karmik-2/1985 dated 30-01-85 (A) Applicant will have to submit a certificate in this respect from
the competent authority of Army, Navy, Air Force, that their period of Service has been extended for rehabilitation and no disciplinary
ac tion is pending against them. (B) Applic ants will have to submit a written undertaking with their application that in case they are
selected for the post applied for, they will get themselves released immediately from the Army Service. The above facilities will not be
admissible to Short Servic e Commissioned/Emergenc y Commissioned Officer If: (a) he gets permanent Commission in the Army or (b)
Has been released from the Army on tendering resignation or (c) Has been released from the Army on grounds of misconduct. (3)
Character: The Character of a c andidate for rec ruitment to the service must be such as to render him suitable in opinion of the

Governor in all respec ts for employment in the servic e. Persons dismissed from the service by the Union Government or a State Govt. or
debarred from prac tic e as an Advoc ate by the Bar Council of India or a State or convicted and sentenced for imprisonment on any
offence under the Indian Penal Code or any other Law for the time being in force involving moral turpitude shall not be eligible for
appointment to the Servic e. (4) Marital Status: A Male candidate who has more than one wife living or a female candidate who has
married a man already having a wife living shall not be eligible for appointment to a post in the Service. (5) Physical Fitness: No
Candidate shall be appointed to a post in the servic e unless he/she be in good mental and bodily health and free from any physic al
defec t likely to interfere with the effic ient performanc e of his duties. Before a candidate is finally approved for appointment shall be
required to pass an Examination by a Medic al Board. (6) Only those candidates will be called for Main Examination (Written
Examination) who obtain suc h minimum marks as may be fixed by the Commission for the purpose on the basis of preliminary exam.
They will be required to fill up requisite form etc . determined by the Commission for main examination and will have to deposit fee
also for main exam. Examination Fees for General, OBC of UP Exam Fee Rs. 200/-+ Online Processing Fee Rs. 25/- = Rs. 225/- only

and Scheduled Caste and Sc heduled Tribe Candidates of UP Exam Fee Rs. 80/- + Online processing Fee Rs. 25/- = Rs. 105/- The
Candidates under Horizontal Reservation shall deposit fees according to their main category but Physically Handicapped Candidates
will deposit only Rs. 25/- as on line proc essing fees. (7) The candidates will have to enclose self attested copies of marksheets,
certificates and degree alongwith the applic ation form of main examination in support of their claims of Educational Qualifications. If
they do not enc lose self attested certificates/doc uments in support of their claims, the applications shall be rejected. (8) All original
certificates shall be verified at the time of interview. Candidates will also be required to furnish four passport size photographs, two
unattested and two attested by their Head of Department or Head of the Institution where they have received education or by a
Gazetted Offic er at the time of Interview. (9) The c andidates working in Central or State Govt. will have to produce No objection
certificate from their Employer. (10) The Commission do not give any advice to the candidates regarding their eligibility. Therefore
they should go through the advertisement c arefully and apply for the post only when they are satisfied that they are eligible according
to the terms and conditions of advertisement. They should also go through the plan of Examination printed at Appendix-4 and the
syllabus of the Preliminary and Main (Written) examination printed as Appendix-5 of the advertisement. Fee will not be refunded in
case of c andidates being overage, underage, ineligible or rejected due to violation of rules or procedure. (11) The Commission may
allow any c andidate provisionally on summarily c hecking of application but in later stages if it is found that the candidate was not
eligible or his/her applic ation was not fit for admission or he/she should have been rejec ted at initial stage his/her candidature will be
canc elled and his/her rec ommendation shall be withdrawn even if he/she has been recommended for appointment. (12) Malprac tic es
i.e. c opying in the Examination Hall, Indisc ipline, Misbehavior or canvassing is prohibited. Candidature of such candidates can be
rejec ted by the Commission suo motto. (13) The candidates who qualify in the written examination shall have to appear compulsorily
in Personality Test (Viva-voc e) (14) In every c orrespondence with the Commission, the name of Examination. Advertisement No.
Registration No. Name of Candidate, Date of Birth & Roll No. (If communicated) Should be mentioned. (15) The candidates for the
main examination

shall be declared successful in the ratio of 1:10 according to order of Hon'ble

Supreme Court and for interview in the ratio of 1:3 (16) If a candidate gives such information which
can not be substantiated by any certificate, he/she can be debarred for the next five years. (17) No
change in category, sub-category, date of birth etc. is permissible after the receipt of application
forms in the office of commission. In this regard no application for error correction/modification
shall be acceptable. (18) The date of birth of the candidates shall be admissible as entered in High
School Certificate. The candidate will have to attach his/her High School or Equivalent
Examination Certificate with the application form of Main Examination. No other Certificate shall be
acceptable for Date of Birth and if it is not attached with the application, it shall be rejected. (19)
For the benefit of relaxation in upper age limit and exemption in exam fee, the Handicapped
persons must produce a certificate of being handicapped in that Sub category on the prescribed
4

proforma issued by prescribed Medical Officer/Specialist and counter signed by the Chief Medical
Officer according to Rule 2 of U.P. Public Service (Reservation for Physically Handicapped,
Dependent of Freedom Fighters and Ex-Serviceman (Amendment) Act. 1997 read with G.O. dated
03 Feb., 2008). The Ex-Army personnels must be discharged from Army up to the last date
prescribed for receipt of applications. (20) Date, time and venue etc. of examination along with Roll
No. will be communicated to the candidates through e-Admit Cards. Candidates will have to
appear at the centre/venue allotted to them by the Commission. No change in centre/venue is
permissible and no application shall be entertained in this regard. (21) The application/candidature
will be rejected/cancelled if the application is not submitted on prescribed form, date of birth is not
mentioned or wrong date of birth is mentioned, overage, under age, not fulfilling the minimum
educational qualifications, applications received after last date and no signature under declaration

in the format. (22) The candidates who are appearing in the Examination of essential qualification
prescribed for the posts need not apply, because they are not eligible. (23) While filling the answer
sheets, the candidates must use Black Ball Point Pen Only. Use of any other pen or pencil is
strictly prohibited. (24) The candidates must fill up his/her all informations correctly in the answer
sheets with Black Ball Point Pen. The informations filled in the Answer sheets must not be erased
by whitener, blade or rubber etc.
GENERAL INSTRUCTIONS
1. In no circumstanc es, applic ations of any stage shall be accepted after the last prescribed date and time. Applications found without
requisite information and without photograph and signature, even when received in time, will be summarily rejected.
2. In the On-line system, the c andidates must ensure that all the requisite informations have been duly filled and must click the submit
Button by the Last presc ribed Date & Time. They must take the Print out and keep it safely. In any discrepancy, they will have to
produce the print out otherwise no request shall be entertained.
3. Those candidates, willing to take the benefit of the reservation/age relaxation must obtain a certificate, issued by the competent
authority, in support of the reserved category, in the prescribed format printed in this detailed advertisement (Appendix-3) and submit
the same to the Commission whenever required to do so. Those claiming more than one reservation/age relaxation will be given only
one suc h c onc ession, whic h will be more beneficial. The Candidates who are not originally domiciled of U.P. belonging to SC, ST,
O.B.C., dependents of freedom fighters, Ex-Army personnel, Skilled Players, P.H. and women are not entitled to benefit of
reservation/age relaxation. Suc h c andidates will be treated as general candidates. In case of the women candidates, the
domicile/c aste certific ate issued from father side will be treated valid.
4. The Commission do not advise to c andidates about their eligibility. Therefore, they should carefully read the advertisement and
when satisfied about their eligibility as per conditions of the advertisement, then only apply. The candidates must possess all the
requisite qualification till the last date for submitting the applications.
5. In the c ategory of dependents of the freedom fighters only sons, daughters, grandsons (Son's son/daughters son) and grand
daughters (son's daughter/daughters daughter, married/ unmarried) are covered. Only such relationships with the freedom fighters are
not adequate but the candidates should remain ac tually dependent of the freedom fighter. Drawing the attentions of the candidates
towards Govt. orders dated 22.01.1982, 08.03.1983 and Govt. Order No. 3014, Personnel-2, 1982 dated 18.10.1982 read with Govt.
Order No. 453/79-V-1-15-1(Ka)-14-2015, dated 07.4.2015, it is advised that now the candidates must obtain the reservation certificate
from the District Magistrate in terms of Govt. Order dated 07.4.2015 in the prescribed format and submit the same.

6. In the event of involvement of a c andidate in the c oncealment of any important information, pendency of any case/criminal c ase,
convic tion, more than a husband or wife being alive, submission of facts in a distorted manner, malpractice, canvassing for selec tion
etc, the Commission reserves the right to rejec t the candidature and debar from appearing in the examination in question and all
future other examinations and selec tions.
7. In c ase the candidates feel any problem in the "On-line Application" they may get their problem resolved by contacting over phone
or Website c lic king 'Contac t us'.
8. The name of Distric ts for Preliminary Examination are available in the advertisement in Appendix-2 and proformae for reservation
on Appendix-3. In the same way the plan of Examination is available on Appendix-4 and syllabus for Preliminary Examination and
Main Examination are available on Appendix-5.
Detailed Application Form:
At the top of the page, there is a Dec laration for the candidates they are advised to go through the content of the Declaration
carefully. Candidate has the option to either agree or disagree with the content of Declaration by clicking on 'I Agree or 'I do not agree'
buttons. In c ase the c andidate opts to disagree, the application will be dropped, and the procedure will be terminated. Accepting to
agree only will submit the c andidate's Online Applic ation.
Notification Details
This section shows information relevant to Notific ation
Personal Details
This sec tion shows Information about c andidate personal details i.e. Registration Number, candidate name, Father/Husband name,
Gender, DOB, UP domic ile, Category, Marital status, email and contact number.
Other Details of candidate
Other details of c andidate show the information about UP Freedom Fighter, Ex Army, service duration and physical deformity.
Education & Experience Details

It show educational and experienc e details of the c andidate.

Candidate address, photo & signature details
It shows c ommunication address and photo with signature of the candidate
Declaration segment
At the bottom of the page there is a 'Dec laration' for the candidate. Candidates are advised to go through the content of the
Dec laration carefully.
After filling all above partic ulars there is provision for preview candidates detail before final submission of application form on
clicking on ''Preview'' button.
Preview page will display all facts/partic ulars that the candidate have mentioned on entry time if they are sure with filled details
then click on ''Submit'' button to finally push data into server with successfully submission report that they can print.
Otherwise using ''Back'' button the details c an be Modified.
[CANDIDATES ARE ADVISED TO TAKE A PRINT OF THIS PAGE BY CLICKING ON THE ''Print'' OPTION AVAILABLE]
For other information c andidates are advised to select desired option in 'Home Page' of Commission's website http://uppsc.up.nic.in
CANDIDATE SEGMENT
CANDIDATE SEGMENT
All Notification / Advertisement
Candidate Registration (First Stage)
Generate E-Challan/I-Collect (Second Stage)
Submit Application Form (Third Stage)
View Application Status
List of Application Having photo related Objections
Download Forms for Eligibility Checking
Download Interview Letter
Duplicate Regi. Slip & Application form
Download Syllabus

LAST DATE FOR RECEIPT OF APPLICATIONS: On-line Application process must be completed (including filling up of Part-I, Part-II
and Part-III of the Form) before last date of form submission according to Advertisement after which the web-link will be disabled.

Appendix-1
The Procedure relating to upload Photo & Signature.
Guide Lines for Scanning Photograph w ith Signature
1. Paste the Photo on any white paper as per the above required dimensions. Sign in the Signature Space provided. Ensure that the
signature is within the box,.
2. Scan the above required size c ontaining photograph and signature. Please do not scan the complete page.
3. The entire image (of size 3.5 cm by 6.0 c m) c onsisting of the photo along with the signature is required to be scanned, and stored in
*.j pg, .j peg, .gif, .tif, .png format on loc al mac hine.
4. Ensure that the size of the scanned image is not more than 50 KB.
5. If the size of the file is more than 50KB, then adjust the settings of the scanner such as the DPI resolution, no. colours etc., during
the proc ess of sc anning.
6. The applicant has to sign in full in the box provided. Since
the signature is proof of identity, it must be genuine, and in full; initials are not sufficient. Signature in CAPITAL LETTERS is not
permitted.
7. The signature must be signed only by the applic ant and not by any other person.
8. The signature will be used to put on the Hall Tic ket and wherever necessary. If the Applicant's signature on answer script, at the time
of the examination, does not matc h the signature on the Hall Ticket, the applicant will be disqualified.
Sample Image & Signature:-

width = 3.5 cm

1.5 cm Height = 4.5 cm

Appendix-2
The names of the Distric ts where Preliminary Exam will be held is as followings :- Allahabad, Agra, Meerut, Lucknow and Varanasi.

Appendix-3

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vuqlwfpr tu tkfr;ksa rFkk vU; fiNM+s oxksZa ds fy;s vkj{k.k vfkfu;e] 1994
;Fkkla'kksfkr dh vuqlwph ,d ds vUrxZr ekU;rk izkIr gSA
;g Hkh izekf.kr fd;k tkrk gS fd Jh@Jherh@dqekjh --------------------------------------------------------------- iwoksZDr vfkfu;e] 1994 ;Fkkla'kksfkr dh vuqlwph&nks
tSlk fd mRrj izns'k yksd lsok vuqlwfpr tkfr;ksa] vuqlwfpr tu tkfr;ksa vkSj vU;
fiNM+s oxksZa ds fy;s vkj{k.k la'kksku vfkfu;e] 2001 }kjk izfrLFkkfir fd;k
x;k gS ,oa tks mRrj izns'k yksd lsok vuqlwfpr tkfr;ksa] vuqlwfpr tu tkfr;ksa vkSj
vU; fiNM+s oxksZa ds fy;s vkj{k.k la'kksku vfkfu;e] 2002 }kjk la'kksfkr dh
x;h gS] ls vkPNkfnr ugha gSA buds ekrk&firk dh fujarj rhu o"kZ dh vofk ds fy;s
ldy okf"kZd vk; vkB yk[k :i;s ;k blls vfkd ugha gS rFkk buds ikl kudj vfkfu;e]
1957 esa ;Fkk fofgr NwV lhek ls vfkd lEifRr Hkh ugha gSA
Jh@Jherh@dqekjh --------------------------------------------------------------------------------------rFkk@vFkok mudk ifjokj mRrj izns'k ds xzke ----------------------------------rglhy -------------------------------- uxj ------------------------------- ftyk ------------------------

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CERTIFICATE FOR PHYSICALLY HANDICAP OF U.P.
NAME & ADDRESS OF THE INSTITUTE/HOSPITAL
Certif icate No.........................................
DISABILITY CERTIFICATE
This is certif ied that Shri/Smt/Kum..................................................................................................
son/wif e/daughter of Shri ........................................................................................ age...................
sex............................. identif ication mark(S)................................................................. is suf f ering f rom permanent disability of f ollowing
category .
A. Locomotor or cerebral palsy :
(i) BL-Both legs af f ected but not arms.
(ii) BA-Both arms af f ected
(a) Impaired reach

(b) Weakness of grip

(iii) BLA-Both legs and both arms af f ected

(iv ) OL-One leg af f ected (right or lef t)
(a) Impaired reach

(b) Weakness of grip (c) Ataxic

(v ) OA-One arm af f ected

(a) Impaired reach

(b) Weakness of grip (c) Ataxic

(v i) BH-Stif f back and hips (Cannot sit or stoop)

(v ii) MW-Musculer weakness and limited phy sical endurance.
B. Blindness or Low Vision :
(i) B-Blind

(ii) PB-Partialy Blind

C. Hearing impairment :
(i) D-Deaf

(ii) PD-Partialy Deaf

(Delete tha category whichev er is not applicable)

2. This condition is progressiv e/non-progressiv e/likely to improv e/not likely to improv e.
Re-assessn of this case is not recommended/is recommended
af ter a period of ............................................................................... y ear................................................. months.
3. Percentage of disability in his/her case is ............................................ percent.
4. Sh./Smt./Kum...................................................... meets the f ollowing phy sical requirements discharge of his/her duties:
(i)F-can perf orm work by manipulating with f ingers.

Yes/No

(ii) PP- can perf orm work by pulling and pushing.

Yes/No

(iii) L-can perf orm work by lif ting.

(iv ) KC- can perf orm work by kneeling and crouching.

Yes/No
Yes/No

(v ) B-can perf orm work by bending.

Yes/No

(v i) S-can perf orm work by sitting.

Yes/No

(v ii) ST- can perf orm work by standing.

Yes/No

(v iii) W-can perf orm work by walking.

Yes/No

(ix) SE-can perf orm work by seeing.

(x) H-can perf orm work by hearing/speaking.
(xi) RW- can perf orm work by reading and writing.

Yes/No
Yes/No
Yes/No

(Dr......................)

(Dr......................)

Member

Member

Medical Board

(Dr......................)
Chairperson

Medical Board

Medical Board
Countersigned by the
Medical Superintendent/CMO/HQ

10

Hospital (with seal)

Strike out which is not applicable.

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vkSj HkwriwoZ lSfudksa ds fy, vkj{k.k vfkfu;e] 1993 ;Fkkla'kksfkr ds vuqlkj
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laxzke lsukfu;ksa ds vkfJrksa vkSj HkwriwoZ lSfudksa ds fy, vkj{k.k vfkfu;e]
1993 ds vuqlkj Lora=rk laxzke lsukuh gSa vkSj Jh@Jherh@dqekjh vkfJr---------------------------------------------------------------------------------------

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iq= dk iq= ;k iq=h dk iq= rFkk ikS=h iq= dh iq=h ;k iq=h dh iq=h fookfgr
vFkok vfookfgr mijkafdr vfkfu;e] 1993 ;Fkkla'kksfkr ds izkfokkuksa ds
vuqlkj m Jh@Jherh Lora=rk laxzke lsukuh-------------------------------------------------------------------- ds vkfJr gSaA
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11

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'kklukns'k la[;k&22@21@1983&dkfeZd&2 fnukad 28 uoEcj] 1985
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muds Vhe ds }kjk mDr fr;ksfxrk@VwukZesUV esa ----------------------------------------------------- LFkku kIr fd;k x;kA
;g ek.k&i= jk"Vh; QsMjs'ku@jk"Vh; ,slksfl,'ku@;gk laLFkk dk uke fn;k tk;s
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13