File No.

EPG-A04(E3)/1/2020-EPG-PZ

भारतीय सव ण िवभाग SPEED POST

SURVEY OF INDIA

िनदेशक का कायालय OFFICE OF DIRECTOR

पूव मु ण वग Eastern Printing Group,
14, वुड ीट, 14, Wood Street
कोलकाता -700016 (पoबंo) Kolkata-700016 (W.B.)
Phone No. 033- 22834694
दूरभाष संo : 033-22834694
Fax No. 033- 22834694
फै स संo : 033- 22834694
E-mail: epg.kol.soi@gov.in
ई-मेल : epg.kol.soi@gov.in
सं. 561 /4-E-3 दनांक- 02 /06/2022
To

Pankaj Kumar Mishra

S/o Devendra Mishra
8/7 Annapurna Nagar, Benachity, Durgapur
P.O- Benachity
Dist- Paschim Bardhaman,
State- West Bengal
Pin- 713213

SUBJECT : OFFER OF PROVISIONAL APPOINTMENT TO THE POST OF MULTI-

TASKING STAFF IN SURVEY OF INDIA, DEPARTMENT OF SCIENCE &
TECHNOLOGY.

On recommendation of the Staff Selection Commission, Eastern Regional Office,

Kolkata vide it’s No.3/5/2021-Exam-II/1764 dated 25/04/2022 and Surveyor General Office’s No.E3-
155/1011-MTS, dated 19/05/2022 Director, Eastern Printing Group, Survey of India is pleased to offer
appointment to you as Multi-Tasking Staff in the Directorate Eastern Printing Group, Survey of India, 14,
Wood Street, Kolkata-700016 in the Central Civil Services, (Group ‘C’), Non-Technical in the Level-1 of
Pay Matrix, i.e. Rs. 18000/- in Pay Scale of Rs. 18000-56900/- plus admissible allowances in force
subject to the instruction issued by the Government of India, from time to time. The provisional
appointment is subject to his/her Medical Report and verification of Character antecedents from the
concerned District Magistrate / Police Authorities.

2. The terms and conditions of appointment are as follows:

(i) The appointment is temporary and the appointee will be on probation for a period of 2
(two) years with effect from the date of appointment, which may be extended or curtailed
at the discretion of the Competent Authority, failure to complete the period of probation
to the satisfaction of the Competent Authority will render the appointment liable to
discharge from the service and
(ii) The appointment is temporary subject to termination by the Appointing Authority at any
time during the period of probation and thereby giving one month notice on the either
side viz. the Appointee and the Appointing Authority. The appointing Authority
however, reserve the right to terminate the service of appointment forthwith or before
the expiry of the stipulated period of notice or by making payment to him/her of a sum
equivalent to the pay and allowances for the period of notice or the unexpired portion
thereof.
Contd...P/2
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3. The appointment will be further subject to the:-

(a) Production of Certificate of fitness from the Competent Medical Authority viz. the Chief
Medical Officer / Civil Surgeon of the Government Hospital (enclosed Form 0.91[Cor.])
(b) Submission of Attestation Form (in quadruplicate with latest passport size photograph
duly affixed). (enclosed 4 copies)
(c) Character Certificate from two serving Gazetted Officers of Central/State Government or
stipendiary Magistrate in the Form appended (enclosed Annexure- I). The certificate not
being more than three months old.
(d) Submission of declaration to the effect that he does not have more than one wife living,
the appointment will be subject to his being exempted from the enforcement of the
requirement in this behalf. In the case the appointee has more than one wife living or
having a spouse living marries again and in case such marriage is void by reason of its
taking place during the lifetime to such spouse, he shall not be eligible for appointment.
Marriage Declaration Form attached (enclosed Annexure-II).
(e) Taking an oath of allegiance /faithfulness to the constitution of India or making of solemn
affirmation to the effect.(enclosed Annexure-III)
(f) Production of the following original certificate together with an attested copy of each :

(i) Certificate of Educational and other qualification.

(ii) Certificate of Age.
(iii) Certificate of discharge/release from the present employer, if any.
(iv) Caste certificate from the Competent Authority, if he/she belongs to a Scheduled
Caste / Scheduled Tribe/OBC.
(v) Character Certificate from two senior Gazetted Officer of the Central/State
Government or Stipendiary Magistrate in the form appended. The Certificate not
being more than 3 (three) months old.
(vi) Specimen Signature (Annexure – V)
(vii) Specimen Impression of Thumb (Annexure – VI)
(viii) Name & Address in own handwriting (Annexure – VII)
(ix) 4 copies of recent passport size photograph duly attested by Gazetted Officer.

4. The appointee should also state whether he/she was/is under obligation to serve another
Central Government Department, a State Government, or Public Authority.

5. The appointment is provisional and subject to the Caste/Tribe/Community Certificate

being verified through proper channel. If the verification reveals that the claim of candidate belongs to
SC/ST/OBC is false or claim of the candidate belong to OBC creamy layer is false, the service of such
candidate will be terminated forthwith without assigning any further reason and without prejudice to such
further action as may be taken under the provision of the Indian Panel Code for production of false
certificate.

6. The appointee will be covered under the New Pension Scheme. As per DOP&T’s OM
No. 28/30/2004-P & PW(B) dated 26th July, 2005, the candidate who already in Government service on or
before 31-12-2003 will be governed by the provision laid down under Central Civil Service (Pension)
Rule 1972.

Contd...P/3
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7. If any declaration given or information furnished by the candidates proves to be false or

if the candidate is found to have wilfully suppressed any material intimation, he/she will be liable to
removal from service and such other action as Government may deemed necessary.

8. No travelling allowance will be allowed for the joining to the post.

9. The appointment order would be issued on the receipt of the following:-

(a) Medical Certificate of fitness. (attached Form 0.91[Cor.]).

(b) Satisfactory Character and Antecedent verification report by the Police (Undertaking in
Annexure –IV attached).

10. In case you accept the above terms & conditions, you should communicate your
acceptance within 21 days from the date of receipt of this communication. If no reply is received in the
stipulated period, the offer will be treated as cancelled.

Enclosures : Attestation Form/ Annexure-I, II, III , IV, V, VI,VII/ O.91(Cor.)

(R K MEENA)
DIRECTOR

Copy to:-

1. The Surveyor General of India, Dehra Dun for information with reference to his letter No.E3-
155/1011-MTS, dated 19/05/2022.
2. The Additional Surveyor General, Printing Zone, Hyderabad.
3. Survey of India Website.
 ATTESTATION FORM
____________________ “ WARNING
Affix signed
Passport size 1. The furnishing of false information of suppression of any factual
( 5 cms. X 7 cms. ) information in the Attestation Form would be disqualification, and is
Approx. Copy likely to render the candidate unfit for employment under the government.
of recent photograph
____________________ If detained, arrested prosecuted, bound down, fines convicted, debarred,
2. acquitted etc. subsequent to the completion and submission of this form,
the details should be communicated immediately to the authorities to
whom the Attestation Form has been sent early, failing which it will be
deemed to be a suppression of factual information.

If, the fact that false information has been furnished or that there has been
3. suppression of any factual information in the Attestation Form comes to
notice at any time during the service of a person his services would be
liable to be terminated”.

1. Name in full (in block capitals) Surname Name

with aliases, if any (Please
indicate if you have added or
dropped in any stage, any part of
your name or surname):
2. Present Address in full (i.e.
Village, Thana and District, or
House No, Lane/Street/Road &
Town):
3. (a) Home Address in full (i.e.
Village, Thana & District, or
House No, Lane/Street/Road and
Town and name of District
Headquarters)

(b) If originally a resident of

Pakistan/Bangladesh (erstwhile
East Pakistan) the address in that
country and the date of migration
to Indian Union.

4. Aadhaar Card No.(if available)

5. PAN No. (if available)

6. Nationality
7. (a) Date of Birth

(b) Present Age

(c) Age at Matriculation

8.(a) Place of birth, district and state in

which situated
 (b) District and state to which you
belong.

(c) District and State to which your father

originally belong.
9 (a) Your Religion.

(b) Are you a member of a Scheduled

Caste/Scheduled Tribe/Other
Backward Classes? (Answer
Yes/No
10. Particulars of places (with periods of residence)where you have resided for more than one year at a
time during the preceding five years. In case of stay abroad (including Pakistan), particulars of all
places where you have resided for more than one year after attaining the age of 21 years should be
given.
From To Residential Address Name of the District Head Quarter or the place mentioned in
in full (i.e. Village, preceding column.
Thana& District or
House No.Lane/
Street/Road
&Town.

11. Name (in full Nationality (by birth Place of Occupation if Present Permanent
& aliases if & or by domicile. birth employed give Postal Home
any) designation & Address (if Address.
official dead vive
address. last address)
(a) Father

(b) Mother

(c) Spouse

12. Information to be furnished with regard to son (s) and/or daughters in case they are studying/living in a
foreign country.
Name Nationality by birth & or Place of birth Country in which Date from which
by domicile Studying/living with studying/living in the
full address. country mentioned in
the previous column.

13. Educational Qualification showing places of education with years in Schools and Colleges since 15th
year of age:
Name of School/College Date of Entering Date of Leaving Examination Passed
(with full address)
 14 (a) Are you holding or have any time held an appointment under Central or State
Government or a Semi-Government or a Quasi-Government body or an autonomous
body or a public Sector Undertaking or a private firm or institution? If so, give full
particulars with date of employment up-to-date.
Period Designation, emoluments Full name & address of Reasons for leaving previous
From To & nature of employment. employer service.

14 (b) If the previous employment was under the Government of India/a State Government/undertaking
owned or controlled by the Government of India or a State Government/and Autonomous
Body/University/Local Body.

If you had left service on giving a month’s notice under Rule 5 of the Central Civil Services
(Temporary Service) Rules 1965, or any similar corresponding rules, were any disciplinary
proceedings framed against you, or had you been called upon to explain your conduct in any matter at
the time you gave notice of termination of service, or at a subsequent dates(s), before your service
actually terminated?
15. (i) (a) Have you ever been kept under detention? Yes/No

(b) Have you ever been arrested? Yes/No

(c) Have you ever been prosecuted? Yes/No

(i.e. has a charge sheet in a criminal case been filled against

you in any court of law)
(d) Is any criminal case pending against you in any Court of Law Yes/No
at the time or filling up this Attestation form?
(e) Have you ever been convicted by a court of Law for any Yes/No
Office?
(f) Whether discharged/expelled/withdrawn from any Yes/No
training/institution under the Government or otherwise?
(g) Have you ever been rusticated by any University or any other Yes/No
educational authority/institution?
(h) Have you ever been debarred/disqualified by any Public Yes/No
Service Commission/Staff Selection Commission for any of
its examination/Selection?
(ii) If the answer to any of the above mentioned question is “Yes” give full particulars of the
case/arrest/detention/fine/conviction/sentence/punishment etc and/or the nature of the case
pending in the Court/University/Educational Authority etc at the time of filling up this
attestation form:

Notes: (i) Please also see the “WARNING” at the top of this Attestation Form.

(ii) Specific answers to each of the questions should be given by striking our “Yes” or “No” as the
case may be.
16. Names of two responsible person of your 1)
locality or two references to whom you are
known:

2)
 DECLARATION

I certify that the foregoing information is correct and complete to the best of my knowledge and belief.
I am fully aware that by providing false information or suppressing material information while filling this form,
the authorities have full right to terminate my appointment letter and I am also liable for appropriate
criminal/civil/legal action as a consequence.
I am not aware or any circumstances which might impair my fitness for employment under Government.

Signature of Candidate:-
Date:
Place:

TO BE FILLED BY THE OFFICE

i) Name, Designation and full address of the appointment authority.

ii) Post for which the candidate is being considered.

 ANNEXURE-V

SPECIMEN SIGNATURE OFPANKAJ KUMAR MISHRA.

1. _________________________________________________

2. __________________________________________________

3. __________________________________________________

Signature of Gazetted Officer

 ANNEXURE - VI

SPECIMEN IMPRESSION OF THUMB OF LEFT HAND OF

PANKAJ KUMAR MISHRA.

1. _______________________________________________

2. _______________________________________________

3. _______________________________________________

Signature of Gazetted Officer

 ANNEXURE-VII

NAME AND ADDRESS OF PANKAJ KUMAR MISHRA IN OWN HANDWRITING

NAME :- _____________________________________________

ADDRESS :- ____________________________________________

_____________________________________________

_____________________________________________

PIN CODE :_______________________ MOBILE NO._______________________

AADHAAR NO. _____________________________________________

Signature of Gazetted Officer

 ANNEXURE-I

CERTIFICATE OF CHARACTER

Certified that I have known Shri/Smt./Kum. ______________________________

Son/Daughter of _____________________________________________________ that the last
________ years ____________ months ____________ days and that to the best of my
knowledge and belief he/she bears reputable character and has no antecedents which render
him/her unsuitable for Government Employment.

Place : _______________ Signature _____________________ _______________________

Date : _______________ Designation __________________ ________________________

 ANNEXURE-II

DECLARATION TO BE OBTAINED FROM NEW

ENTRANTS TO GOVERNMENT SERVICE

I, Shri/Smt.Kum. ________________________________________ declare as

under :-
*(i) that I am unmarried/a widower/a widow.
*(ii) that I am married and have only one spouse living.
*(iii) that I have entered into or contracted a marriage with a person having a spouse
living. Application for grant of exemption is enclosed.
*(iv) that I have entered into and contracted a marriage with another person during the
life time of my spouse. Application for grant of exemption is enclosed.

2. I solemnly affirm that the above declaration is true and I understand that in the
event of the declaration on being found to be incorrect after my appointment, I shall be liable to
be dismissed from service.

Date : Signature _____________________

*Note : Please delete clause/clauses not applicable.

 Annexure-III
OATH OF ALLEGIANCE

I Shri/Shrimati/Kumari ______________________________________________
do hereby swear/solemnly affirm that I will be faithful and bear true allegiance to India and to
the Constitution of India as by Law Established and that I will carry out the duties of my office
loyally.

Dated:-
Place:-
Full signature of the Candidate
 ANNEXURE-IV

UNDERTAKING

I, Shri/Smt./Kum __________________________________________________
Son/Daughter of ________________________________________________ undertake that my
appointment as MTS is subject to the satisfactory verification of my character and antecedents
and that my service shall stand terminated forthwith under Rule 5 of C.C.S. (Temporary Service)
Rules, if any adverse remarks is/are found in my character and antecedents.

Station : ______________________________
Signature of Candidate

Dated :

Witness : (1) Witness (2)

Name : Name :
(In block letters) (In block letters)

Designation : Designation :

Office/Unit : Office/Unit :

Station : Station :

Date : Date :

Signature of Establishment & Accounts Officer

Counter Signature of Director