KENDRIYA VIDYALAYA SANGATHANREGIONAL OFFICE. BHUBANESWAR

DETAILs oF OFFER OF AppolNTMEr`IT IssuED TO THE cANDIDATEs INDIFFERENT POSTS UP TO THE YEAR 2018 0N DIRECT RECRUITMENT (MAINPANEL)NOTE -Offer of Appointment are being issued.

1. Candidates have been directed to report at the place of posting i.e. Kendriya Vidyalayas (asdetailed below) latest by 27.03 2019 positively alongwith original certificates as instructed inthe Offer of Appointment.

2. The acceptance in the prescriibed format(as given below) must be sent immediately but notlater than 20.032019 through e-mail to admnrobbsn@rmail.com duly signed.

3. Service Agreementeum-Suriety Bond on non-judicial stamp paper of Rs.100/-Orupees Onehundred only) per page to be executed. Text of Service Agreement-cum-Suriety Bond isattached herewith for the purpose.

Sl.No. Roll No. Name Date of Birth Gender Post Subjet KV wherePosted

PGT OnNGLlsH)L 53006930 SUDHIR SAHU 12.06.1986 RILE POT ENGLISH NO.l'BALASORE

2. 54401 149 SAMYA MITRA 27.04.1979 VALE POT ENGLISH BERHAMPUR3. 51300348 ARUP PURKAYASTHA 26.01.1981 MALE PGT ENGLISH NO.2,BOLANGIR

4. 5441 1255 SUSANTA LAHA 16.07. 1990 MALE PGT ENGLISH NO.1,BOLANGIR

5. 51006547 MANISH KUMAR 06.01.1980 RILE PGT ENGLISH DEOGARH6. 52110376 SHARIKA S BABU 22.09.1983 FEMALE PGT ENGLISH INS, CHILKA7. 51200639 VASAMSETTI JYOTHIPRAKASH 24.04.1989 RILE PGT ENGLISH MALKANGIRI

8. 53006498 SUBHALAXMI SAH00 05.03.1994 FEMALE PGT ENGLISH PARADIPPORT

9. 53000505 ADITYA KUMAR 01.07.1982 MALE PGT ENGLISH SUNDARGARHPATEL

10. 5 1076761 JYOTI 03.12.1989 FERALE POT ENGLISH GOPALPURMS

11. 53806576 HEM LATA 28.06.1988 FEMALE PGT ENGLISH NTPC'KANIHA

PGT urlNDI)12. 53806403 YOGESH KUMAR 16.09.1986 MALE POT HINDI NO.6,

SINGH BHUBANESWAR

13. 5 I 074 I 06 ALOK VARSHNEY 16.01.1987 RILE PGT HINDI BOUDH14. 54113365 VIKAS SINGH 12.10.1992 MALE PGT HINDI CHARBATIA15. 53908505 RAKESH KUMARYADAV 01.07.1991 MALE PGT HINDI MALKANGIRl

16, 53232697 MADAN LAL 14.10.1990 MALE PGT HINDI KENDRAPARA

17 54300532 NARENDRA SINGH 15.05.1986 MALE PGT HINDI KEONJHAR18. 53200282 KAPOOR CHANDMEENA 15.12.1984 RILE POT HINDI PURI

PGT (ECONOMICS)19. 52702514 EKANATH 15.07.1980 RILE POT ECONOMI BHAWAN]PA

POKHARKAR CS TNA20. 53000796 BALARAM DAKUA 17. I I.1993 RILE PGT ECONOMICS BONDAMUNDA

21. 53301174 muKESH 05.03.1994 MALE POT ECONOMICS SUNDARGARH

Cont'd......P.2

\edevl

PGT fl'HYSICS)22. 53001172 NARENDRA KUMAR 16.08.1984 MALE POT PHYSICS BONDAhIND

JAYANTI A23. 53001005 SRIMANTA KUMARTRIPATHY 03.07.1986 RILE PGT PHYSICS BARGARH

24. 53001153 SWA STI RANJANNAYAK 12.05.1992 MALE PGT PHYSICS NO. I , ANGUL

25. 53001274 ASHOK KUMARPATNAIK. 14.05.1981 RILE PGT PHYSICS KANDHMAL

26. 53001083 RAJANIKANTA 16.07.1992 VALE PGT PHYSICS KENDRAPARBEHERA A

27. 51015447 NAVJOT RAUR 31.07.1985 FEMALE PGT PHYSICS GOPALPURMS

28. 54006077 SHABNAM SENAPATI 08.09.1992 FEMALE PGT PHYSICS NTPC'KANIHA

29. 53237374 AMIT BAINIWAL 01.02.1994 MALE PGT PHYSICS BOUDH30. 51015849 r\4AN]EET KUMAR 01.09.1986 RILE PGT PHYSICS DEOGARH31. 51015493 BHARAT SAVITA 15 .06.1981 RILE PGT PHYSICS KEONJHAR32. 53001254 POONAM PATEL 26.01.1993 FEMALE PGT PHYSICS PARADIPPORT

33. 53001245 JYOTIRMAYEE 22.03.1987 FEMALE PGT PHYSICS NO. I ,BEHERA BALASORE

34. 51081228 SUNIL KUMAR 01.01. 1991 RILE PGT PHYSICS SINABEDA,NAD

35. 51015892 SANDEEP KUMAR 06.09.1990 MALE PGT PHYSICS KORAPUT36. 52101906 RANJITH D G 16.03 .1992 MALE PGT PHYSICS BONDAMINDA

PGT (CHEMISTRY)37. 18240307 DEEPSHIKHA 17.07.1992 FEMALE PGT CHEMIST GOPALPUR

RY MS38. 18221607 PRIYA DUBE 13 .09.1979 FEMALE PGT CHEMISTRY NO.I, BBSR(ls'SHIFT)

39. 18016296 MANISH KUMAR SONI 23.03.1993 MALE PGT CHEMISTRY BONDAMIND.A

40. 18024176 SARAT CHANDRA DE 28.02.1985 VALE PGT CHEMISTRY NO. I , ANGUL

41. 18920173 ASHOK KUMAR 06.10. 1982 VALE PGT CHEMIST BERHAMPURLAXKAR RY

42. 18346894 POOJA MAHAJAN 22.10.1982 FEMALE PGT CHEMISTRY NO.2, BBSR

43. 18718461 RAJEEV SHARMA 11.06.1982 MALE , GT CHEMISTRY BHAWANIPATNA

44. 18880905 ADESH KUMAR 06.03 . 1995 VALE PGT CHEMISTRY DEOGARH

45. 18237748 GAURAV SHARMA 04.06.1989 MALE PGT CHEMISTRY KANDHMAL

46. 18079375 BALWINDER SINGH 11.05.1989 MALE PGT CHEMISTRY KENDRAPARA

47. 18270175 PARTHIBAN G 18.01.1989 MALE PGT CHEMISTRY PURI

48. 18166747 USHA RANI 05.10.1979 FEMALE PGT CHEMISTRY NTPC'KANIHA

49. 18299460 VANOJ KUMAR 15.08.1990 MALE PGT CHEMISTRY MALKANGIRI

50. 18025081 MUKUND LAL 27.03.1990 RILE POT CHEMISTRY RAYAGADA

Cont'd.......P.3

\qof

51. 18935708 MUKESH SONI 04.02.1988 MALE PGT CHEMISTRY NO.1,BOLANGIR

52. 18205345 SHALU SOLANKI 02.07.1991 FEMALE PGT CHEMISTRY KHURDAROAD

53. 18033379 RAHUL 05.07.1992 VALE PGT CHEMISTRY BOUDH

54. 18408409 JAGDISH CHAND 22.09. 1988 RILE PGT CHEMISTRY KEONJHAR

55. 18350590 VIKAS KUMAR 28.12.1991 MALE PGT CHEMIST SUNABEDASUMAN RY

56. 18434006 JAYALAXMI NAIK 02.07.1994 FEMALE POT CHEMISTRY NO. I , JAJPUR

PGT "ATHS)57. 53219133 GOPAL SINGH RAWAT 07.07.1994 VALE PGT MATHS BARGARH58. 52704768 ASHIF MUJAWAR 28.02.1985 MALE PGT MATHS NO. I ,BARIPADA

59. 52404795 K K BHARTI 22 .04.1991 FEMALE PGT MATHS CHAREATIA,ARC

PGT (COMMERCE)60. 53103905 NEHA TANDON 08.09.1993 FEMALE PGT COMMERCE NO.4, BBSR

61. 53220944 SURENDER SINGH 14.12.1981 RILE PGT COMRERCE BONDAMUNDA

62. 5 3 1 03 1 49 NEHA BAROTRA 03.03.1987 FEMALE PGT COMMERCE KHURDAROAD

PGT (BIOLOGY)63. 53006853 SADHANA MAYBESENAPATI 25.06.1994 FEMALE PGT BIOLOGY ROURKELA

64. 52 I 0449 I GUNDA VENKATASATYANARAYANA 05.03.1986 VALE PGT BIOLOGY VALKANGIRI

PGT (COMP. SC.)65. 53706834 GOLAK BIHARI DHAL 29.06.1993 MALE PGT COMP. SC SAMBALPURNo.I

66. 51043627 ANKITA AWASTHI 27.12. 1989 FEMALE PGT COMP. SC No. I , BBSR(2ndShift)

67. 541 10520 VIVEK VIKRAM SINGH 09.03 . 1990 RILE PGT COMP. SC BHAWANIPATNA

68. 52706240 HARI SHANKAR RAI 05.09.1981 VALE PGT COMP SC BOUDHNO.5,BBSRGAJPATI69. 52107129 SHWETA VERMA 14.09.1993 FEMALE POT COMP. SC70. 51048041 KASHISH GUPTA 27.12.1993 MALE •PGT corm sc71. 51062783 ASHISH KUMAR 07.05.1994 VALE FGT COMP. SC PARADIPPORT

72. 5300406552706668 CHANDRALEKHA 04.07.1977 FEMALE POT COMP. SC NO.1,BALASORE

73. DEEPIKA SHENDE 08.07.1994 FEMALE POT COMP. SC CHARBATIA,ARC

74. 54205980 SHAILENDRA KUMARVERMA 30.06.1988 RILE PGT COMP. SC DEOGARH

75. 52304811 PRIYANKAKALARIKKAL 27.07.1989 FEMALE PGT COMP. SC INS, CHILKA

76. 54205991 SAQUIB ALAM 29.09. 1994 MALE POT COMP. SC NO. I 'BALASORE

77. 53706060 SRINIVASA RAOGANTENAPALLI 30.08.1978 VALE PGT COMP. S DARGARH

78. 51804191 SHEFALIBENGHANTIYA 22 .10.1992 FEMALE POT COMP. SC JAJPUR NO. I

Cont'd.....P.4

\trf"

PRT (MUSIC)79. 43221150 RAJSHREE TANK 02 .10.1993 FEMALE PRT musIC SAMBALPURNO.2

80. 43908938 RICHA SAXENA 25 .10.1993 FEMALE PRT NISIC NO.4, BBSR81. 41094912 SHIVANI 12.03.1994 FEMALE PRT NISIC NO.2, ANGUL82. 44208629 KUMARI SHALINI 17.07.1995 FEMALE PRT MUSIC NO.2,BOLANGIR

83. 43806035 PARAMPARACHATURVEDI 10.08.1992 FEMALE PRT musIC NO. I , JAJPUR

84. 41094259 KARAMVEER SINGH 18.10.1996 RILE PRT NISIC BOUDH85. 41704735 LIKESHWAR PATEL 29.10.1990 RILE PRT qusIC RAIRANGPUR86. 42004160 PRIYA 09.01.1995 FEMALE PRT MUSIC NO.2,

PRIYADARSHINI BARIPADA87. 44005423 AKANKSHA YADAV 01.07.1993 FEMALE PRT NISIC SUNDARGARH

88. 42405683 NARENDRA KUMAR 20.1 I .1992 VALE PRT MUSIC KANDHMAL89. 44208256 SADHANA SONKAR 10.07.1996 FEMALE PRT AVSIC VYASNAGAR,JAJPUR

90. 43220840 PARAS RAM 23.06.1986 RILE PRT NISIC DIGAPAHANDI

91. 41704637 ANIL KUMAR 25.08.1993 RILE PRT MUSIC MALKANGIRITGT (AE)

.92. 44207600 NEHA MISHRA 10.07.1995 FEMALE TGT AE INS, CHILKA93. 44402888 SUBHANKARCHAKRABORTY 05.03.1989 MALE TGT AE BARGARH

94. 41084620 RICHA RAWAT 31.10.1991 FEMALE TGT AE GOPALPURMS

95. 44107627 RAJESH KUMAR 16.07.1986 RILE TGT AE SINDARGARYADAV H

96. 44206967 ANURAG KUMAR 01.07.1989 MALE TGT AE NO.2,KASHYAP BOLANGIR

97. 44107737 NEETU SINGH 25.06.1992 FEMALE TGT AE JHARSUGUDA98. 44207618 SANTOSH KUMAR I I. I I.1990 MALE TGT AE RAIRANGPUR.99. 43907099 SURAJ KUMAR PATEL 15 .07.1993 VALE TGT AE DEOGARHloo. 43102304 RANJIT KAUR 23.09.1988 FEMALE TGT AE NTPC'KANIHA

lot 44207476 MAMTA KARVE 15.06.1989 FEMALE TGT AE PARADIPPORT

TGT ff&HE) ,102. 41703221 ASHWINI KUMAR 19.02.1994 VALE ` TGT P&HE KENDRAPAR

MAJHI A A103. 44500685 ANIRPAN ROY 16.01.1994 VALE TGT P&HE NO.I,BARIPADA

104. 44205469`SOUGAT MUKHERJEE

15 .12.1992 MALE TGT P&HE NoiBBSR (rLShift)

105. 44205038 SHANI SINGH 10.12.1995 MALE TGT P&HE KORAPUT106. 41074464 ARUN 06.05.1992 MALE TGT P&HE NO. I ,CUTACK

107. 4440151 1 BIPLAB PAUL 01.01.1989 MALE TOT P&HE CUTTACKNO.3

108. 44302358 RAHUL MAMGAIN 10.07.1993 MALE TGT P&HE NO.I,BALASORE

109. 43905832 GAGAN SINGH 22.09.1996 RILE TGT P&HE INS, CHILKA110. 41301364 ASHUTOSH SHARMA 05.04.1995 RILE TGT P&HE KHURDAROAD

tll. 44205257 SANTOSH KUMAR 06.05.1986 MALE TOT P&HE PARADIPPORT

Cont'd......P.5

\Qof",

112. 42502073 VISHWAJEET SINGH 29.1 1.1997 RILE TGT P&HE CHARBATIA,

YADAV ARCGOPALPURMS

113. 44004410 ABHISHEK YADAV 25.051987 RILE TGT P&HE

114.115.116 416127394240258342502418 GURDEEP SINGH 27.09.1993 RILE TOT P&RE BOUDH

MANOJ KUMAR SONI 20.06.1992 VALE TGT P&HE NO. I , ANGUL

UTSAV CHAWARE 31. 12.1996 RILE TGT P&HE SONEPUR

117. 43805056 MANINDER ANAND 14.07.1983 VALE TOT P&HE SUNDARGARH

118. 42501978 CHANDAN KUMARPASWAN 10.07.1992 VALE TOT P&HE DHENKANAL

119. 42502165 VILHUKHOTSO 27.04.1993 VALE TGT P&HE BHANJANAGAR

TGTOwET)120. 41093308 RADHESHYAM 22.05.1989 MALE TGT WETWET NO. I ,

MISHRA BALASOREBERHAMPUR

121 41089732 ANURAG SHARMA 01.02.1991 MALE TGT

122 43218935 ALTAF HUSAIN 15.07.1993 RILE TGT VET NO.2'BOLANGIR

123. 42706734 SANTOSH KUMARSHUKLA 16.12.1988 VALE TOT VmeT ASKA

124. 42601955 AMBUJ KUMARDUBEY 21.12.1991 RILE TOT WET BARGARH

125. 41085860 ANJANI NANDAN 16.11.1992 MALE TOT VET BHANJANAGAR

126 41507539 PREETY VATS 22.01.1993 FEMALE TGT WET CHILKA, INS

127. 41089770 BALMIKI SINGH 24.10.1988 RILE TOT VmaT KHURDAROAD

128.129 4340135541093016 RAKSHIT DADHICH 14.09.1991 MALE TOT VVET BOUDH

SATISH KUMAR 05.11.1989 VALE TGT VmeT DEOGARH

130. 42102007 NIRVAY KUMARNIRVAR 01.10.1989 MALE TOT WET HINJILICUT

131 41616899 SHASHANK KUMAR 27.06.1989 MALE TGT WET NO. I , JAJPUR

132. 41507429 HARISH KUMARCHAUHAN 25.10.1992 MALE TGT VET MALKANGIRI

133. 41507530 SUNIL KUMAR 10.10.1993 MALE TGT VET KENDRAPARA

134.135 4108856541091895 DINESH KUMAR 04.06.1990 VALE TOT VAT KHARIAR

MUKUL KUMAR 04.05.1992 MALE TGT VAT NAYAGARH

136. 441 10820 DEVENDRA PRATAPVERMA 10.04.1993 MALE ,, TGT VET RAIRANGPUR

137. 41093679 PR]YANKA MEENA 15.03 .1993 FEMALE TGT WET PARADIPPORT

(LIBRARIAN)138 52504341 APARNA DIXIT 07.11.1989 FEMALE LIBRARIAN CHILKA, INS

139 53238628 I REENA YADAVI I .05 .1990 FEMALE LIBRARIAN NO.2'CUTTACK

140. 54410381 SUDHSHNAKARMAKAR 18.05.1994 FEMALE LIBRARIAN BOUDH

141.142 5200940253807292 RAJNISH RANJAN 31 .12.1986 VALE LIBRARIAN SUNABEDA

ALI RAZA 18.05.1987 RILE LIBRARIAN SONEPUR

143. 54410416 NILADRI SHIT 03.12.1993 RILE LIBRARIAN DHARAMGARH

\ftyft( A.V.L.J. RAO )

DEPUTY COMMISSIONER

Ei

SERVICE AGREEMENT CuM SURETY BOND (To be executed on mom.udiclal

stamp paper worth of Rs. _/- (Rs. (of the value as per rules of theState) oh[y and Rs 1.00 (Rs. One only) Revenue Stamp to be affixed on top left side

of first page.

This contract made on this _ day ofBETWEEN the KVS through the

KVS) having its office at

Two thousand and Nineteen

(designation of the person in

hereafter called the "Employer"

(which term shall unless repugnant to the context mean and include its successors-in-interest and permitted assignees) of the ONE PART; AND,

Shrvsmt./Ku......

Shri.... Resident of. Son/ daughter of

.................... in the tehsil of the ....................................... „ .........

District ................................. „, hereinafter called the "Probationer/employee" (which

term shall unless repugnant to the context mean and include its successors-in-interest

and perm itted assignees) of the SEC O N D PART; AN D ,

Shri/Smt./Ku .... „ ............. „ ............. „ ........ „ . . .

..................... Resident of

............................ „ ..,...... in the tehsil of the

son/daughter of

District ..................................., hereinafter called the .'Surety' (which term shall unless

repugnant to the context mean and include its successors-in-interest and permitted

asslgnees) of the "THIRD PART".

WHEREAS the employer has offered to engage Shrvsmt./Ku+..

............................... as .......

for a period of(post) for on a probation/ training

years, which may be extended and the probationer/employeehas agreed to accept the offer of the employer.

AND WHEREAS Shri/Smt./Ku

Employer as

No.

.... has been selected by the

vide its offer of appointment

dated .......,................... for undergoing

training/probation with a view to utilize his/her service with the Employer after Successful

completion of the training, which offer has been unequivocally accepted by the

probationer;

AND WHEREAS In terms of clause of the Main Terms and Condltions of the

said offer of appointment, the Probationer is required to undergo initial training as

determined by the Employer for a period of twenty-four months, which may be extended

to twelve more months in case of unsatisfactory performance by the Probationer, and to

serve the Employer for a minimum period of 2 years from the date of joining on initial

appointment in KVS.

AND WHEREAS in terms of clause of the Main terms and Conditions of the

said offer of appointment, the Probationer and his Surety are required to execute a

Service Agreement cum Surety Bond on non-judicial stamp paper in favour of the

Employer, undertaking to complete the training and to serve the Employer for a minimum

period of two years failing which the Probationer and the Surety shall be jointly and

severally bound to pay the Employer a sum of Rs.2,00,COO/-(Rupees Two Lakhs only);

AND WHEREAS the Probationer recognizes and accepts that at the time of appointment

as Probationer, except exposure to academic knowledge, he/she has received no formal,

effedive, technical or practical training enabling him/her to become professionally viable

to the Employer;

AND WHEREAS the Probationer is aware that the Employer would be incurring

substantial sums of money and incurring substantial costs, expenses, man hours in the

process of selecting and appointing him/her as Probationer & training him/her thereafter.

il

ANDWHEREASthisserviceagreementcumsuretytondexp€utedwiththeEmployerby

the Probationer along with a Surety to the extent Rs.. 2,00,000 (Rs. Two lakhs only) will

be used for indemnifying the Employer against all such costs as mentioned above by

reason of breach and/or non¢ompliance of any of the terms of this agreement with by

the Probationer;

AND WHEREAS the Probationer also agrees that if he/she commits any breach of any of

the conditions Of this agreement, the Probationer and the Surety shall be jointly and

severally liable to pay to the Employer on demand immediately the above said sum of

Rs. 2,00,000 (Rupees Two lakhs only) from the date of breach of tlie terms of the

contract.

AND WHEREAS in order to secure the Employer against the expen6®8 Incurred by lt on

the training of the Probationer and to ensure due compliance of all tens and conditions

stipulated by the Employer and accepted by the Probationer. it is agreed that the

Probationer Shall be liable to compensate the Employer in the manner and under the

circLimstances enumerated in this agreement;

lN WITNESS WHEREOF THE parties hereto have signed these presents on this date

and year in the presence of the following witnesses:

WITNESSES: (For the Probationer& Surety) Clear Signature :

.. Signature of the Probationer Address.....,.,.I,,,,.,,,,,,.,.............................................................'.................,....,.........

2. Name Signature of the Surety Address .............................

Name. " . . ' ...-...............-..........

Occupation..........„..„....,....... •... PAN NO.

Address........„.............„.........

(Attestation of signatures of Probationer and Surety by Gazetted Officer)

Signature of theProbationer Signature of the Surety Attested Signature & seal of Gazetted OfficerSig nature & seal of Gazetted

For office use only)

WITNESSES: (For the Employer) 1. Accepted.Signature of the

Officer

.. Address

For and on behalf of KVS ..... „ ....... „ ........................... Name ...... „ ...... „ .... „ ...... „„

2. Address„ ....,. „ ................ „.

............. I ..,,,,,,,,,,,,,,,.

AC+:EPTANCE OF OFFER OF APPOINTMENT

appointment to the post ofhereby accept the offer of

No. dated

in Kendriya Vidyalaya

made in your Memoand also the terms and

conditions mentioned therein.

I agree to join duty at the place and on the date indicated therein.

Signature:Name:

Place:

Date:

ToThe Deputy Commissioner,Kendriya Vidyalaya Sangathan,Regional Office, Railway Colony,Mancheswar, Bhubaneswar ~ 751017.

ACCEPTANCE OF OFFER OF APPOINTMENT

appointment to the post ofhereby accept the offer of

No. dated

in Kendriya Vidyalayamade in your Memo

and also the terms andconditions mentioned therein.

I agree to join duty at the place and on the date indicated therein.•/

/`

Si8natu,pe,Name:

Place:

Date:

TO

The Principal,

Kendriya Vidyalaya,

N.fm®fc.,n,#d[;#:L!.T.;founntCwh .®f .R.coa- ttl'

F.Ch .... n.in. .ttd ^d¢ too

8.to of fa!rlh qr Chrfro+ n *r..gx.et a.icht ®v in+...l 'rty.Ptrerqtl.I in-rfe. Of t!d.de lte.lloft

S|gn.tore o`f Cprd!d.trI dri froed)r eniqb p tin I li.`.. .*|mrfu eMgivwh\giv

• c.rdtdr*® for *mpt®`m mt .If I th.. ttwhdrty*`'

-tottth a, oth-ff,:::n=:,a.tr#nrorha#froin#t=L='.

I do rtct. ¢ourld.r tl if. ,. ' 1I.qu.It"Ierb .for ,rtypk}rrmf to pe .' Vfty.Igiv.~~=__ __,=`= Wl.I.I.. ¢d.I.. .Gcoraln. to Wqmr alm..` ct.lqunt.

f .-.,- nd ho\4ho epee.r. .eotltfrofi hertd ti``«nb uno flng., to p}ri.lon ®f th. a.n!etdde.~

8lqom.I. of lf.. €.ndF®utB : iTdr trfon.I:

`,w.in. of tFt. ®Itlopr :i -~

rm-

t.f.

D.utitt.tlon al Offle.I { Th tt`-.fllcor

quf I.tr.`` =~

a" ,a,b,,.-

choule ho Cfvll ,€q!g.qiri or M.Ptcd Otlle.I..q.

i.+ ^preNpix.vii {A\cANDit]ATE's a.TriTEmevT ^ftD Deci^n^TroN

..``

Th. a.ndtdltfo mvor mute ttw .Iettmen< t.qulr.a holew prto.1® tin .Ouq;elo**ttil&.«Ou qfld tryuAt €iafi tfro da¢ .cotarr .fpp.ale.d'ther.te. . Hb .veontton !339col®lly dlT®cted io the wem|ni}{-cO."nSd lttlpr`P€cte.holonr :I .

.1. St.t®7ournema lf` fJtf ;`2. S`.to VOL" .ee eTtd plde. tf blrlh :LL3. {.} tlfr`+. roy .`r.f 'htl.a.thper;..toe.mftt.otqu .mr other fomr,

#.i:€¥®tdrgr...qi#|'dE#ho.'eTe'rm;::m##?torE'u==::•gp,ndldtf® ?

(b)t'B

mAo?,c¥ih::d.#,4fo",f%?,#tutzngulinecewh~`t®-.b.done

Wh.n w.ro Toui. fo.` vac¢fnon .a ?H.v®.you oj .riy ?f |ro`ae n..I r.Iofl®I.-I..in utllte..I lrt!ll coftowlptlm.•orofuie, q®ut. ae.ft'qu.`, to. f ;plt.PV Or tfU.Itltr t

a. I+eve You etlffer®d fibih .mr fom of n.rvoum.ae de.. to a-,iEjas*.rly cth.I coon. }

7. H.in y®v be.f] ®qunfo.d`grl .giv!,nljiifea M.die.I `O{rf¢e.: / M.dfeof r }o.id v.Ilhfo th. lut thte® .v.or., i

•gr¢e-t .prho giv

8. fumith lhe lollowffig p.rtle v I.ro caf`e.mlrty Your I.fully i .

I.tot

(a)

I deol.!® 811 ih® Bt!avli all.w®.a to be, lo `h.. be.` ot my "tol,car,,ct , "I Dl.a sol®mmy glllm ttot+ bey® rot tope!yut . dlaebltfty cenLttcste/p.enelonoo ®ccoiimt o!.ant dlapae oi pther cgivapq. `

caedl¢ae.. €rfunedt. i _.,

•. 3qu.a.. ty rty Prtysldh.Ium ot Ctwll, 8wioe®n `or M®dlcol O!flcw ®f apu.L rquk

Npto :-The ¢.ndldet. w!II be hutd fe.poe.lbl. f®nho rmitrty of. fro dr.4#io!%£fzyii¥::!!##::or¥d:}*a;%,i:#e¥*Onf*"#'.I,ra'i.#

•€?t,tt .

a E a L A a I.T I a "

{!. I 'ebrl / ®I]flmmt / fro4rldutr. er AHdtry :.-,

0.I, I-

APPcOO-VcO

if.`

§T¥tr#£th£:i#fuRErfewl#+OfL=Of_ul#--')i Tin I m` rmqd ``ed in+ hig..md b...no otm ftyno vtr..to fry

ii..¢ Of mr.kmawhdor.I) " I `ho. ecoo~,. \.dprin wh a -rfu tw'4bgivopemryqi ,ef'ftrm fry, Agpfbctfon tor grut Of +xrtylon beeknd

I .armrty -'qfro`ftyut tlt. .tin. dutfwhn 'if. in .giv. I ,vg~iinrf bi.ch-tprul} Of IIi.--emm.aptt mt. mnb tfr b .uN~ .fro`givv' quelptomrf, I ch.« b ftyM. t®'h combed in- .,

8tryrfu. :givm. .oI*ai...' nco mplto.tal..^ppllcobi. .fro th. one ®f cl"ut {.}. {b| ed {e} chfr. -

Of Tvs ,.VIt»"r*®^" `to--ut. TAIImr,. Iarim.< ti..I .-c*Jp"^M ; r*ineir*i '`

to

A,querxit*

mmrtydrty~ `rfu .` -•rd ho ®ve tw. b rm mtl®®t€eei6iiiiijiio.Of

tedpt t. try'qn. qudybed ulJ {ftyi I lull...rty'tfo-tkfro* ct ftry -.,tmitr.I.aertfy,qnd.aAfthtrprithtlty.

uho' I wll'.tr

Sti help in Cud.

a,t. 8

I-Dutcotfro g_

cHAneTth Cant-,tC.ftlfhad 8ict I h.v. l`nowt. 3rgivboutyftyL_v

cO.'d-.Ier ' 'de

Ofqut

-pr'#

ed " to qhe in*rtyqprfu:!dr%j¥LholtJ&..i=#+=qti#EL±tryto+#dywhM~in=|flrN*rty* Giferitenrtyl Kom,ri.i. I Vr.l nco r.I.tod to in..

I,toco :

Dgiv ,_

Com-

®torfu,

` Dqt-

-me

rigiv.,ut

quo¥-,*

an'd-hut iRETrii==-.. a

fp.qdrtdr:iiriE;;-riEi.elm.'pe.ut~utth'drfutrfugivin the lcqumf..Vtequ.w ermwtha .

?quee¥-Ptm=

m'ai

abq-. t•0-

``to i_-_

D'-Oe

8t.rl / 8fgivu } "".I.helped ben unrfutry aeatlnlfl.¥jBeftmmontquftrtram__Brutrty

Pen

to' th

Mgiv W

p quv''Wlth / mrtll.a.ft` .N®iri.nf-. .i`e up /'ho•tournlil.Etod '*m off.st .ten

oa gndgiv` of,r-apatiali fe ..I.oufrowh

a. I+quhe in. .mM.Iginp inm.giv fro Upton pt.th Mffro qm~

EELELEEEiEEEEEEELEEE

q~,`tw. (ie.fl Or ut..trmr t® b.

*qqurfu{ fb.I.ng`l®n ot.

/' /. ,'//

I.'{;

.

2.

ATTgsTATiow Foriifi

-I -.-. : :-.i. - -rJ:'

qucoRAPH'

Nem ln full ('n oopl,a!®tw!t'' .II..ee t' e«y,tpt...®.` {*dfc.f®,(f you 'b.v- '®dd®d, or dtappnd .t 4fiy of qeeJtrt)*rt of'your ham® oF r .

ulfrom®). .

Fre+ept' ..d¢l.il ln full ' {l.I `®.V"!.`.,-:tl.ati. tnt Pfei.lot a.Heiie. «umb.r, Lan.PtF..fpe®adcth..t"n'

Sum7\.M€

a. (,a Jtququ® 7n ft[«®; ,thon& ,tld

ca ®r Hoe.. «urfur,Ldr;/`Stree`|ffoed ` cod Tom'

(tr if-.tl!ftyto*lly tt Tee(dcot of'Pckf.I.nr-lh. nddr®m ln` ,tti.I Cedntrr end the.q.I. of--i:in-n-i-.--_--

4, I]a(trot.I.I.`®f'Pfao.& {vyith.b.I lad ®1 ra*I¢eco.} vftryf® .YOUh.v® .r..|drd-for mare `thin I ,gin.ir®er fit i .ho` givrtT`g ih®, pr.cedlriq''f*® r.',r',

FROM ''a ' . ^._._.':,-ERE.RE

•, ` .I

riiii

8. .<.` {.I i.,q]et+ «.in. h lull wllh• .Itqu` iron.y

• (tl} . b...I.t'pcot.I .a.qri... {If deed ®he I.q .edrwh

.{®) pm`.nor J`Ogiv.ouT®cO

{e} . frof q,.lou`-I?#pdy«ro|#-a.%`£l.i:d..fB"tton

®. ,«eden,,I,y ,,• .,I., f.th'

I. .(b) «giv'e) fry.whpr,'.{d} c*rdftytr• (.I 'Piac.e. elwh

•. Huulnqu'.7. ``. {i} gx.®te.I.Oi.Biwh .

•.(b' p'-n'.qir(o} Ae..t ut.lrloulellon

a.

•`. +,..I..: `.:,, .¥tmjt,try,,

{l} pi.co of'BiTwh, oI.tfmled €iof. fo whleh .twed

` `tb.tr .P_T.¥!=¥ ii-I. to vyhwh

faTr=rfulch(q:

ap?T#rf#¥,,,ii:firfu#d- .nrmi. fe 've..'.`m th. .o.in

• , . I 1` .I.For.a,

a,. ' "uo.lap,ICh.llmrofro •howiro p.rfu::ed CdhedN !tue.1" in.r`.Of `.pe.

fry givl / Coldy,.wm`fyfi.ddMof,, ."-pe q'.

il+-,,-

d`.€eue.tt9rt'wllh.v+.r.-.to3thinot.

•Oun.ct. ,`.ngiv .

'gd, dr' f*-tooIell,lno.. PO,,a.

11. llyou'hrvM`.ny`tlm®tmq

D.®I,g"tfon Ofpdet h,ut ®EulroB,'Ptl®" ®{wO,k

a.

Fron

emu.pgiv.teed.fl.i

T®.

btl.-ct ..th. ottto' ¢ufro-er ..whwh"

Full qrty

frtw#

#'.¢#==.ron?'=fu#q.•`EE§ouRE#ap®,ty,`T

-..

1-`.

:g:,:fF#:[:'pe#i:#un*ou-'®m ?

•1tl...n.iml`fo'',¥.i',t¢ll..putlchu..atth'c..`.idednilch,quho,och+triion•.,- `- , -__,_`_'._- .

lho'rfu,ri gtfun..I,`.nc.,.,C.

is, .. i..«.inde af.the tvy® T.|\|,|S==== -, `-__ -(

per.on. o1. Tour tocoilty a. 'frty'. ___ Lri

+.

-'__._•tlltt.nco. .a wlioii` vau .I. *row"

#.Ttr##T=¥=##im=g=toi#isftr.-##grow.±tyf. oi. ,uit ' condldlf `i

E*," I

p',ch i

• .. IO`..wtiTy .cfBrmchTI

a.rtl.rfu-toiotry.Iona¢dy,.nr`eh-,;o!th.tolthln.!

i..a.act"Otlfo.note.ntr.lt,tq.atr`¢aromrtyuni.2.- .W!onto..al Pa.-ll.in.til a. Sl... Lapl.tw.. .3: ,mar,,a--"_I -_, _

. ,.I..TT„ .-.. ur, I.|I.I.in." a. 8*.le' Lapl.rtyin...... : .-: .a..won.aco«ct sub.Divi.iopa".atotr.quin. ,A4"t.fuii¢"afN.lb®p.TafrolldorGuth.Ihodto~mngtwkl~

.,

aprtl!l.a th.I I thaw 8h.i/§mqurm; . .'`egiv / drhtw .'`ct 8hii

whey,I.dg. .rid

p',.ci.,f .

-n,,,toll,i froJPrfufty,'mtyTi,btry giv

tryonth,.nd

• ,.'.-, `,' .,-. I .,...

~ ,_' .....`- I

..t

I

-