SELECTION CENTRE EAST, PRAYAGRAJ CALL UP LETTER FOR SSB
INTERVIEW JAG (MEN) 31
st
COURSE (OCT 2023) TO BE READ IN
CONJUNCTION WITH THE NOTIFICATION FOR JAG (MEN)
ENTRY SCHEME 31
st
COURSE OCT 2023
Dear Candidate,
1. Congratulations on being shortlisted to attend SSB interview at Selection Centre East,
Prayagraj.
2. Reception. Candidates are advised to report at 05:15 AM on scheduled date at MCO
(Movement Control Office), Platform No 1 Prayagraj Junction OR candidates can report directly
to Reception, Selection Centre East (Near Cariappa Gate, New Cantt, Near Paani Tanki
Chauraha, Kanpur Road, Prayagraj-211001) by 0600AM. Daily bus service is available from
railway station to Selection Centre East and back.
3.
COVID-19 ADVISORY.
(a) RTPCR Report/ Vaccination Certificate
.
(i) Candidates who have a vaccination certificate for two doses generated
from COWIN platform and are asymptomatic on arrival will be exempted
from carrying a negative RTPCR Report.
(ii) Service entry candidates who have a vaccination certificate issued by
MH for two doses and are asymptomatic on arrival will be exempted from
carrying a negative RTPCR report.
(iii)
Any candidate (incl Service Entry candidate) who does not possess the
vaccination certificate will be reqd to produce RTPCR negative report as in
vogue. The RTPCR test should have been conducted within 72 hrs of
reporting at the Selection Centre
.
(b) Candidates will ensure that all documents including mandatory affidavits for
wrong name or tattoos etc as stated in the call up instructions are brought along,
failing which candidature will stand
CANCELLED.
NO repeat NO representation will
be accepted thereafter.
(c) Medical assistance and Laundry facilities (on payment basis) are available.
(d)
Compensation. Government is not responsible for any compensation to the
candidates or to their guardians/ heirs for injuries sustained by them during the period
oftesting or while using military transport. Risk certificate as per Appendix A
(e) COVID- 19 NO RISK CERTIFICATE. All candidates will carry and submit a
COVID-19 No Risk Certificate’ during reception at Selection Centre East. In case of
minors, the same is to be signed by their parents/ natural guardians as per Appendix ‘B’
attached.
4. No changes will be made to the SSB dates, once selected/ allotted. Also, no absentee
batches have been scheduled.
5. Local Candidates.
(a) Withhold your move and contact us at the earliest in case you or your
parents or close relatives are serving in Selection Centre East, Prayagraj.
2
(b) Candidates, who are wards of serving persons who are posted to any defence
establishment in Prayagraj/Prayagraj Military Station should immediately info Selection
Centre East, Prayagraj.
(c) Further instructions regarding change of Centre will be intimated to you on receipt
of such confirmation from you.
(d) Withholding information or giving false information in this regard will render you
liable for cancellation of your candidature and disqualification of commission in case
detected subsequently.
Eligibility.
6. Please ensure that you fulfill all eligibility criteria strictly as per the Notification
published for JAG Entry Scheme 31
st
(Oct 2023) Course on our official website
www.joinindianarmy.nic.in. In case of shortcoming if any, candidates will be returned on
reporting for SSB. Following issues are highlighted :-
(a)
Age Limit. 21 to 27 years as on 01 Jul 2023 (Born not earlier than 02 Jul 1996
and not later than 01 Jul 2002, both dates inclusive).
(b)
Educational Qualification. Minimum 55 % aggregate marks in LLB (Three years
professional after graduation or five years after 10+2 examination). The
candidates should be eligible for registration as advocate with Bar Council of
India/ State. Candidates should be from a college/ University recognised by Bar
Council of India.
Note:- In addition, CLAT PG Score of preceding year is mandatory for all candidates
(including LLM qualified and LLM appearing candidates) who apply for courses
starting in a particular year.
Documents Required when Reporting for SSB Interview
7. Self attested copy of following documents alongwith their ORIGINAL are to be carried
to the Selection Centre by the candidates:-
(a) Matriculation/ Secondary School Examination Certificate or equivalent certificate
and Mark Sheet issued by the concerned Board of Education.
Note 1. Matriculation/ Secondary School Examination Certificate or equivalent
certificate issued by the concerned Board of Education will only be accepted as
proof of date of birth, candidate’s name and parent’s name (father & mother). No
other document like Admit card/ Mark Sheet/ Transfer certificate etc are
acceptable.
Note 2. In case parent’s name (father & mother) is not mentioned in
Matriculation/Secondary School Examination certificate or equivalent certificate,
the candidate is required to produce any document issued by Govt of India or
States Govt such as PAN card, Aadhaar card, Passport, Driving licence etc for
verification. However, candidate’s name and their parent’s name filled in online
application must match exactly with those mentioned in the produced document.
3
(b) 12
th
Class Certificate & Marks sheet.
(c) Graduation Degree/ Provisional Degree (in case of three years LLB after
graduation) issued by a recognized university. Provisional Degree should not be more
than six months old at the time of the candidate joining the academy.
(d) LLB Degree/ Provisional Degree issued by recognized university. Provisional
Degree should not be more than six months old at the time of the candidate joining the
academy.
(e) Marks sheets of all years/ Semesters.
(f) Registration with Bar Council of India/ State OR Certificate from College/
University that the LLB Course in the said institution is recognized by Bar Council of
India.
(g) Valid Proof of Identity with photograph- Aadhaar Card/PAN Card/Voter ID
Card/Passport.
(h) One copy of Online Application duly signed and affixed with self attested
photograph.
(j) Certificate for Not Having Duplicate Profiles/Registration IDs. A declaration
to this effect as per format attached at Appendix - ‘C.
(k) In Case Original Documents Submitted for Pursuing Higher Studies.
Candidates are required to bring a Bonafide cum Custodian Certificate as per
Appendix -D.’ On original letter head duly signed by the Principal/Head of institution
where the documents have been submitted.
(l) Certificate of Previous Candidature/SSB Attempt. Format is attached
as Appendix - E.
(m) For Candidates from Universities Following CGPA/Grades System
Conversion Certificate. Certificate issued by Controller or Examination/Registrar /Dean
of the concerned University regarding formula for conversion of CGPA/Grades to
percentages, as followed by the University. Format of certificate required enclosed as
Appendix ‘F.
(n) Undertaking Certificate by Candidate Prior to Undergoing SSB. Format is
attached as Appendix - G.
(o) Candidate serving in the Armed Forces are required to inform their
Commanding Officer in written that they have applied for this examination. Application of
candidates serving in the Armed Forces, duly countersigned by the Commanding Officer
should be taken alongwith all other document as stated above to the SSB as and when
for the same.
(p) CLAT PG Score Card.
(q) Candidates are also required to bring all certificates in original. Failing which will
render cancellation of candidature. Originals will be returned after verification at the
Service Selection Board ITSELF.
4
(q) Proof of Identity. Proof of identity with photograph such as voter ID (or) PAN
card (or) driving license (or) passport or Aadhar Card in ORIGINAL along with two self
attested copies.
Note 1. Any ambiguity/ false information/ concealment of information detected in the
certificates/ documents/ online application will result in cancellation of the candidature
at any stage of selection and thereafter.
8. Change of Interview Date/ Centre. Request for change of SSB Interview Date/ Centre
will NOT be entertained or replied.
9. Body Tattoo (s) Please refer detailed Policy on permanent body tattoo available at web-
link http:/www.joinindianarmy.nic.in/writereaddata/portal/Images/pdf/tattopolicy2015.pdf
(Available under ‘Policies’ ‘Officers Selection’).
Instruction for Candidates
10. Procedure. The SSB interview will be conducted in two stages, stage I & stage II.
Candidates will be administered the stage I screening of the selection procedure on the same
day of their arrival. Candidates failing to qualify in the first stage will be sent back on the same
day. Candidates recommended for stage II will be retained for further testing for another four
days or even longer for medicals. Boarding & lodging during the stay at the SSB centre will be
provided by Selection Center East, Prayagraj.
11. Travelling Allowance (TA). AC 3 tier fare by shortest route is admissible in case you
are attending for the first time for the commission on production of hard copy of train ticket. If
travel is by air/ bus, original boarding pass and hard copy of Air/ bus ticket is mandatory for
claiming fare. Photo copy of first page of Bank Passbook or Cheque Book leaf reflecting the
Name, A/c No & IFSC details is required. To claim TA if applicable, candidates must submit TA
Form (Format attached as Appendix ‘H)
12. Use of Concession Form. Utilisation of any concession from (Defence or any other
department) will make candidates ineligible for TA.
13. Administrative Instructions. Following administrative instructions are laid down for
Candidates guidance and strict compliance :-
(a) Cash and Valuables. Safe custody of cash and valuables will be the
responsibility of candidate.
(b) No out pass during the SSB is permitted.
(c) Candidates will strictly adhere to laid down timings at all places and will not visit
testing areas before/ after testing hours.
(d) Usage of mobile phones is strictly prohibited and will be deposited on arrival
during the stay at SCE.
(j) Items to be Brought. Following items will be required for the interview:-
5
Ser
No
Items
Quantity
Remarks
Ladies
(i)
Dark coloured trouser and
light coloured shirt, Brown/
Black shoes & Neck tie
(Optional) for interview.
1 Set
(ii)
Pure white shorts, T-shirt,
Sweater (for winter) and
Sports Shoes (Preferable
white) for GTO Test
1-2
Sets
@ 1-2
Sets
@ May wear Track
Suits / Appropriate
dress.
(iii)
Latest passport size
photograph in light
coloured dress and
white
background
40 copies
(Note :- Tie/blazers/ apparels bearing logos of school/ academies/institutes etc are
strictly prohibited)
(k) Any ambiguity/ false information/ concealment of information detected in the
certificate/ documents will result in cancellation of candidature at any stage of selection.
14. Change of Address. Change of address, if any after submission of application will
be intimated to “Dte Gen of Rtg (Rtg ‘A’), Adjutant General’s Branch, IHQ of MoD (Army), West
Block-III, RK Puram, New Delhi-110066’’. (Format Attached as Appendix -J).
15. Correspondence.
(a) Candidates must forward all queries/requests only through- ‘Feedback/Queries’
after logging in to their personal profile on www.joinindianarmy.nic.in
(b) Alternate modes of communication :-
(i)
Telephone - 0532-2424816 (Timings 8:30 AM to 2:00 PM)
(ii)
No action will be taken on requests received through any other channels.
16. Candidates who have Resided in Foreign Countries. Candidates who have resided
in foreign countries in the last five years are required to carry a copy of the passport and Visa
alongwith address of the place of stay. (NOC/ consent as per format at Appendix-K).
17. Court Case Pending. Candidates who is having any court case pending against him/
her, must carry a copy of FIR alongwith date of case, Police Station where FIR lodge, District
Headquarters of concerned districts, Court details where the case is pending , Section of CRPC
under which FIR lodged and Case No, date.
Sd/-x-x-x-x-x
Call Up Offr
Dated : Mar 2023 SCE, Allahabad
6
Exhibit- I
(Appx ‘A’ to DG Recruiting
Policy on Body Tattoo)
SELF CERTIFICATION (ONE FOR EACH TATTOO) BY CANDIDATES FROM TRIBAL
COMMUNITIES WITH PERMANENT BODY TATTOO(S)
1. I, (Name of Candidate), Son/Daughter of (Name of
Father/Mother/Guardian as applicable (Date of Birth) hereby give an
undertaking that I belong to body tattoo on my body/ I have on /two/ three/four/more than four
*permanent body tattoo(s) inked on my body as follows (one for each tattoo):-
(* Delete whichever is not applicable)
2. I am enclosing Certificate(s) as per Annexure V, in original, for permanent body
tattoo(s) on my, duly signed as per instructions.
3. I hereby declare that besides the tattoo(s) as referred in Para 1 of Annexure IV above, I
will not have any other permanent body tattoo(s) in future if I am selected to undergo pre-
commission training.
4. The above information given by me is true and correct to the best of my knowledge and
belief.
5. I understand that misrepresentation of any facts/concealment of any information
regarding body tattoo(s) will lead to cancellation of my candidature at any stage from
commencement of the selection process and I shall be solely responsible for the same.
Place:
Dated:
(Signature of the Candidate)
(Name, Entry & SSB Batch No
Significance of Tattoo
(If Applicable)
Details of Tattoo
Size of Tattoo
(In Cms)
Language
(If Applicable)
Photograph of Tattoo
(Post card size to be pasted here
duly signed by the candidate with
name please do not use staple
pins/clips)
7
Details of Tattoo
Size of Tattoo
(In Cms)
Language
(If Applicable)
Significance of Tattoo
(If Applicable)
Photograph of Tattoo
(Post card size to be pasted here
duly signed by the candidate and
official issuing this certificate with
their respective names. Please do
not use staple pins/clips)
Exhibit- II
(Appx ‘B’ to DG
Recruiting Policy on
Body Tattoo)
CERTIFICATE (ONE CERTIFICATE FOR EACH TATTOO) FOR PERMANENT
BODY TATTOO IN RESPECT OF CANDIDATES FROM TRIBAL
COMMUNITES
1. This is to certify that (Name of Candidate) whose date of birth is
is the Son/Daughter of (Name of Father/Mother/Guardian as
applicable) and belongs to (Name of the Tribe) Community of (Name of
the District) in the State of (Name of the State).
2. It is certified that the permanent body tattoo(s) inked at the following parts of the
body of (Name of the candidate) is as per existing customs
and traditions of) Tribe and is in practice as on date :-
(a)
(b)
(c)
a.
(Total No of Tattoos both in figures and words)
3. Post card size photograph of each of the tattoo as given in Paragraph 2 of Annexure
V above is correct and placed as under for any future reference / record hereafter :-
Note :- Each tattoo will have a separate photograph with details and will be
described separately in additional pages will be used for the purpose and each page will
attested separately.
Place:
(Signature with Name, Designation and Stamp
of DC/DM or SDM of the District / Tehsil) OR
(Signature with Name Designation if any and
Address of Chairman/Secretary or Senior
Member of the Tribe to which the candidate
belongs to with their Stamp)
8
Exhibit III
(Appx ‘D’’ to DG Recruiting policy on
Body Tattoo)
SELF CERTIFICATION (ONE FOR EACH TATTOO) UNDERTAKING BY CANDIDATES
(OTHER THAN THOSE FROM TRIBAL COMMUNITIES) WITH PERMANENT BODY
TATTOO (S) ON PERMISSIBLE BODY PART
1.
I, (Name of Candidate), Son / Daughter of
(Name of Father / Mother / Guardian as
applicable) (Date of birth) hereby give an undertaking that * I do not
have any permanent body tattoo on my body / * I have one / two / three / four / more than four
permanent body tattoo(s) as per details given and shown in the photograph(s) below (*strike
out whichever is not applicable) :-
Photograph of Tattoo
(Post card size to be pasted here duly
signed by he candidate with name please do
not use staple pins/clips)
Details of Tattoo
Size of Tattoo (In Cms)
Language
(If applicable)
Significance of Tattoo
(If Applicable)
2.
I hereby declare that besides the tattoos as declared by me in Paragraph 1 of Annexure
VI above. I will not have any other permanent body tattoo (s) in future if I am selected to
undergo pre-commission training.
3.
The above information given by me is true and correct to the best of my knowledge and
belief.
4.
I understand that misrepresentation of any facts/concealment of any information
regarding permanent body tattoo(s) will lead to cancellation of my candidature at any stage
from commencement of the selection process and I shall be solely responsible for the same.
Place : (Signature of Candidate)
Date : Name, Entry & SSB Batch No
Note 1. Each tattoo will have a separate photograph and will be described separately
additional pages will be used for the purpose and each gage will be signed by the candidate.
Note 2. Commandant Selection Centre or Commandants of a Pre-Commission Training
Academy are empowered to reject a candidate for non-permissible permanent body tattoo(s).
9
Appendix A
(Refers to Para 3 (d) of
Call Up Instructions)
RISK CERTIFICATE
I father / guardian of_____________________ who is a candidate of JAG-31
ST
Course (Oct 2023) in the Army, hereby certify that I fully understand that my son / ward
will, if required, attend Services Selection Board Interview with my full and free consent
and at my own risk and that I or my son / ward shall not be entitled to claim any
compensation or other relief from the Government in respect of any injury or disability
which my son / ward may sustain in the course of or as the result of any of the tests given
to him at the SSB interview, whether due to his own negligence or the negligence of any
other person or otherwise.
Place :
(Signature of father / guardian)
Date : Address :
Appendix ‘B’
(Refers to Para 3 (e) of Call Up
Instructions)
COVID-19 : NO RISK CERTIFICATE
I s/o who is a candidate for entry
in the Army/Navy, hereby certify that, I will not hold the Selection Centre responsible if I
contact COVID-19 during transit or during my stay with the Selection Centre. I am attending
the SSB at my own risk.
Place : ………………………….. Signature of Candidate/ Parents
or Natural Guardian
Date : …………………………… (In case of minor)
10
Appendix ‘C
(Refers to Para 7 (j) of Call Up
Instructions)
CERTIFICATE FOR NOT HAVING DUPLICATE PROFILES / REGISTRATION IDs
1. I, understand that creating duplicate profiles (registration Ids) on
www.joinindianarmy.nic.in is not allowed.
2. I hereby certify, that I have only one profile (registration ID) on
www.joinindianarmy.nic.in whose user name is .
OR
I have more than one profiles (registration Ids) on www.joinindianarmy.nic.in whose
user names are as under :-
(a)
(b)
(c)
3. For Candidates having more than one Profile/Registration ID Having
understood that I can maintain only one profile (Registration ID). I have already requested
the authority concerned at DG Recruiting by email / letter on to delete my profile(s)
(Registration Ids) with following user name (s) :-
(a)
(b)
(c)
4. In case the above information submitted by me is found to be false. I understand
that all my current application are liable to be cancelled at any stage of the selection
process.
Place : (Signature of the Candidate)
Date : Name
Course
Roll No
11
Appendix D
(Refers to Para 7 (k)
of Call Up
Instructions)
BONAFIDE CUM CUSTODIAN CERTIFICATE
(CERTIFICATE FOR CANDIDATES WHO HAVE SUBMITTED THEIR ORIGINAL
CERTIFICATES AND MARK SHEETS FOR PURSUING HIGHER STUDIES)
(this certificate is required on the original letter head)
1. Certified that Mr/ Miss_________________S/D/O Shri________________is a bonafide
student of____________________(Name of college / university) and presently studying in
(Name of course to be mentioned). The following certificates and mark sheets in respect
of the above individual have been deposited with this College / University / Institution in original for
verification purpose :-
(a)
(d)
(e)
2. It is further certified that Photostat copies of the above documents have been
verified and attested by the undersigned.
Place :
Date :
(Signature of Principal/Registrar of the
College / University where studying with stamp)
(College / University round stamp)
12
SSB interview for (Name of Entry) Course, Roll No hereby
declare that I have earlier attended the following SSBs Interview :-
2.
I hereby declare that to the best of my knowledge in belief the above information is correct and
understand that my candidature will be cancelled if found incorrect.
Place :
Date :
(Signature of the candidate)
Appendix E
(Refers to Para 7 (l) of
Call Up Instructions)
CERTIFICATE
DETAILS OF PREVIOUS SSBs INTERVIEW ATTEMPTS
1. I, Mr/ Miss S/D/O Shri appearing for
S No
Type of
Commission
/ Entry
SSB Centre
Batch No
& Chest No
Date of
Interview
Result
13
Appendix F
(Refers to Para 7 (m) of
Call Up Instructions)
CGPA RELATED UNDERTAKING CERTIFICATE
1 I____________________Roll No__________a candidate for JAG (MEN)-31
ST
(Oct 2023)
course hereby declare that my cumulative CGPA /SGPA /CPI of all semester is out of , and as
per the conversion formula provided by the university/ college the converted percentage of
marks of all semester is________________%, which is equal to/more than the minimum cut off
% age ________________ as required for the said course.
2 I, further undertake that I may be allowed to appear in this interview at my own risk and
my candidature for JAG (MEN)-31
st
(Oct 2023) course shall be cancelled in case the above
declaration is found to be false at any stage of selection.
3. The calculation is as under.
(a) Conversion Formula __________________________.
(b) CGPA/SGPA/CPI of all Semester ___________________________.
(c) Calculated percentage _______________________________.
Place : (Signature of Principal/Registrar of the
College / University where studying with stamp)
Date : (College / University round stamp)
14
Appendix ‘G
(Refers to Para 7 (n) of Call Up Instructions)
UNDERTAKING CERTIFICATE BY CANDIDATE PRIOR TO UNDERGOING SSB
1. I, Roll No_____________Name________________Son of________________am
appearing for SSB of Entry commencing from___________to___________I
undertake/ certify that all criteria/ eligibility conditions, as mentioned in the Course Notification
and Call Up letter are being fulfilled by me. There is no discrepancy in my school & college
marks sheets/ certificates, online application and all other documents as required. If any
discrepancy is found in any of my documents or eligibility conditions, at any stage, during or
after the SSB, I fully understand that my candidature will be cancelled.
Place : (Signature of the Candidate)
Date :
15
Appendix ‘H’
(Refers to Para 11 of Call Up
Instructions)
TO BE FILLED BY THE CANDIDATE IN DUPLICATE (TWO COPIES) BEFORE REPORTING AT SSB
(PLEASE ALSO FILL DETAILS ON OPPOSITE SIDE)
(APPLICABLE ONLY FOR FIRST ATTEMPTS OF PERMANENT/ SHORT SERVICE COMMISSION)
(FILL ALL DETAILS IN CAPITAL LETTER)
Roll No TA help desk: scetadesk@gmail.com
0532-2420896
TRAVELLING ALLOWANCES FORM (PAYMENT THROUGH NEFT SYSTEM) PART I
1. Batch No* Stage I Chest No*
(Para No 1 as mentioned above to be filled after reporting at SSB)
2. Name of candidate as per Dossier
3. Email ID Mobile No
4. Banker’s details of the individual for making payment of TA through NEFT :-
(a) Details :-
(i) Name of the Candidate
(ii) Name of the Account Holder
(b) Account No and Type (saving/current account)
(c) IFSC Code
(d) Bank Name
(e) Branch with full address
5. Actual train fare (onward journey) :-
(a) From
(b) Class () Amount
To
(@) Train: PNR Original Ticket attached )
6. Actual Bus fare (onward journey) :-
(a) From
(b) Amount
To
(@) Original BusTicket attached
7. Grand total (5+6) Rs
(Return Journey ticket is not required as amount equal to onward journey will be paid)
CERTIFICATE
I have verified the above details and they are correct to the best of my knowledge. I will be
responsible if TA is not credited into my account because of wrong data/ incorrect banker’s detail. I will
not blame Selection Centre East, Prayagraj for the same.
Station : Prayagraj
Dated : (Signature of the Candidate)
Note 1: If any of the above bank details submitted by the candidate is incorrect
(including spelling of the bank holder’s name) then the amount will not be credited into the account and
I will be responsible for the same.
Note 2: Once the process is initiated, the undisbursed TA amount is re-imbursed into
Govt treasury and there is no provision to re-claim the same.
16
PART-III
(TO BE FILLED BY CANDIDATE BEFORE REPORTING FOR SSB)
DETAILS OF PREVIOUS SSBs INTERVIEW FOR WHICH
TRAVELLING ALLOWANCE CLAIMED
* Note : Additional sheet may please be attached as per above, in case more SSB attempts.
9. Auth Train fare :-
PART II
(TO BE FILLED BY THE ACCOUNTS
CLERK)
(a) From
(b) Class
(c) Amount
To
10. Admissible Train fare
(Para 5 or 9 whichever is less)
11. Admissible grand total paid 10x2 Rs
(Signature of Account Clerk)
Ser
No
Roll No
Batch No
Entry
SSB
Amount
Claimed
Signature of
Candidate
1
2
3
4
5
6
7.
8.
9.
10.
17
From,
Roll No :
Name :
Father’s Name :
Postal Address :
Appendix ‘J
(Refers to Para 14
of Call Up
Instructions)
Email :
Mob No :
To,
Dte Gen of Rtg (Rtg A)
Adjutant General’s Branch, IHQ of MoD
(Army), West Block III, RK Puram, New
Delhi 110066
APPLICATION FOR CHANGE OF ADDRESS
Sir,
1. I am a candidate for course.
2. My postal address has been changed. I request you to please update my postal
address in the application for further correspondence :-
Postal Address (as given in
the Application)
New Postal Address (To be
changed in the Application)
Thanking
You Yours
faithfully,
Date
(Signature of candidate)
Copy to
The Call Up Officer
Selection Centre
East Prayagraj (UP)
- 211001
18
Appendix ‘K
(Refers to Para 19 of
Call Up Instructions)
TO WHO-EVER IT MAY CONCERN
CONSENT
I Son/ Daughter of , Indian Passport No Hereby give
my consent that details of my stay in
During the period from to may be
verified to concerned Indian Authorities.
Signature Name Address
Place Date