APPLICATION FORM FOR SPORTS GRADATION CERTIFICATE (To be submitted with two attested copies of passport size photograph) GAME DISCIPLINE: 1. Name of the applicant: ______________________________________ 2. Father's Name: ____________________________________________ 3. Date of Birth: _____________________________________________ (copy of matriculation certificate) 4. Academic Qualification: _________________________________________________ 5. (a)Present Address with Telephone No: ______________________________________ ______________________________________________________________________ (b) Permanent Address: ___________________________________________________ ____________________________________________________________________ ACHIEVEMENT Sr.No. Team Represented Venue Name Date(s) Position(s) Competition Year Secured 1. 2. 3. 4. 5. 6. ___________________________________________________________________________ GRADE: Affidavit in prescribed form is enclosed. Copies of the following documents are added:- 1. 2. 3. 4. 5. Place: Signature of the Applicant Date: CERTIFIED BY THE COACH I have today _______________(date) interviewed the applicant ________________(Name) whose particular are given on the reverse and from by:- (a) Personnel Knowledge as a Coach in the Chandigarh Union Territory and/or (b) The field test that I gave to the applicant and/or (c ) Authenticity of the certificate(s) submitted by the applicant that I Vouch. Confirm that the applicant is a right person to be issued necessary Sports Gradation Certificate according to his entitlement. Dated: __________________________ Name of Coach: __________________ CERTIFICATE BY THE SECRETARY OF THE ASSOCIATION I certified that the particular of the achievement given by the applicant On Page No. are correct and true to the best of my knowledge and belief in reference to the following stipulations:- (i) The state championships with seven teams/seven participants in the particular game/event. (ii) National participation/position where 10 teams are participated. (iii) International participations, where the 10 teams are participated. Signature of the Secretary of the Association (with stamp) CERTIFICATE BY THE HEAD OF THE INSTITUTION I certified that the particular of the achievement given by the applicant On Page No. are correct and true to the best of my knowledge and belief in reference to the following stipulations:- (i) Inter School/Inter College with seven teams/seven participants in individual events. (ii) National School Games/All India Inter University/Combine University/ Asian School Games. (iii) India/World Universities. Counter Signature Signature of the Head of Institution (With Stamp) 1. District Education Officer(Schools/Colleges) Chandigarh Administration: ______________ 2. Assistant Director/Deputy Director Sports Panjab University: ____________________ In case of minor the affidavit shall be filled by the Parent/Guardian with suitable amendments(in case of male 18 years and in case of female 18 years). (On non-Judicial Paper for Rs3/- duly attested by 1st class Magistrate) DRAFT AFFIDAVIT I __________________(name) Son/Daughter of ____________________(Father's name) born on _______________ resident of ____________________(address) Hereby solemnly declare and affirm as under: - (i) That as a sportsman/sportswomen in _____________________________(name of discipline).I have represented the team(s)at competitions(s) at place(s) on a date(s) as also obtained the position(s) as indicated in the table below:- P.T.O Sr.No. Team Represented Venue Name Date(s) Position(s) Competition Year Secured 1. 2. 3. 4. 5. 6. Certified that the information/documents supplied by me are fount to be false, incorrect or forget, I shall be also liable for criminal action in terms of the Provision in India Penal Code. (ii) That the certificate(s) mention below that are produced by me in support of the (iii) above are authentic: - 1. 2. 3. 4. 5. (iv) That there were seven or more then seven competitors in my event of _____________ and seven or more than seven teams in my game of ___________________________ DEPONENT VERIFICATION I, the above mentioned deponent do here by solemnly declare and affirm that the above contents are true to the best of my knowledge and nothing has been cancelled by therein. DEPONENT
