Annexure-C Prescribed Form for Inivitng applications for Khadim-ul-Hujjaj for Haj-2016 Attention of applicatnts is invited towards Rule 20 of CCS (Conduct Rules), 1964 which says “No Government servant shall bring or attempt to bring any political or other outside influence to bear upon any superior authority to further his interests in respect of matters pertaining to his service under Government.” Haj Committee may recommend disciplinary action against such applicants who violate the above-mentioned clause. Nominations filled up incompletely and received without supporting documents will be summarily rejected. Sl. No. 1. Particulars 2. Father’s Name 3 (a) Date of Birth (attach duly attested copy of proof of date of birth) (b) Age as on 01-07-2016 4. Whether Government Servant/Employee of PSU/ Statutory body of Government, etc. or not. 5 (a) Name (b) Name & Address of the Office (Present working on duty) Designation 6. Educational Qualification 7. State of Health (attach a certificate issued by Certificate issuing authority of Government Hospital) Languages Known (other than Arabic READ (R) WRITE (W) SPEAK (S) (please tick in the relevant box) 8. Details Affix Your Latest Attested Photograph YES If yes, (Please attach a copy of the Identity Card issued by the parent office) (1) R (2) W S R (3) W S R (4) W S R W S √ 9. Knowledge of Arabic SPEAK YES (Please tick) READ YES √ (Please tick) WRITE YES √ (Please tick) Contd…2. ::2:: 10. Have you already performed Haj ? ( Plase tick ) 11. Experience in organizing public congregations and in social work ( please give details ) 12. Previous experience as a Khadim-ul-Hujjaj/ AHO/HA (please tick) 13. Yes. ( Performed ) ( If yes, attach copy of documentary proof ) 1. 2. 3. 4. Any other information of interest Place: Hyderabad. Date: – 02 – 2016. Signature of Applicant Seal and signature of EO/Secretary/ Chairman of forwarding State Haj Committee Date: - 02 - 2016. Important Note:(i) (ii) (iii) Incomplete application form/application form not signed and forwarded by the State Haj Committee will not be entertained. Application received without supporint documents will not be entertained . An individual who has not attended the Training Camp will not be eligible as Khadim-ul-Hujjaj. Cont..3. :: 3:: Other Details: Sl. No Particulars Details 1. Profession / Occupation / Designation with Official Address, District presently working. (Attach Proof) 2. Year of 1st Haj performed (Not as Khadimul Hujjaj) (Attach Proof and mention cover number and details) 3. Previous Experience as Khadim-ulHujjaj (Please mention the year and number of times Haj Performed as Khadimul-Hujjaj with Cover Numbers) 4. Head of the Departmnet for Relieving 5. Native Place as per service Record 6. International Passport No. & Date of Expiry 7. Residential Address: 8. Mobile No: 9. Email Id: DECLARATION I solemnly declare that the information furnished above is correct and true to the best of my knowledge and belief. I also understand that in case, if any material information is suppressed or found false at a later date, the Haj Committee shall have a right to take legal action against me at any state besides cancelling the canditature. Place: Hyderabad. Date: 05 – 02 – 2016. Signature of the Applicant CERTIFICATE This is to certify that the particulars furnished by the above applicant are correct as per offical recordsand he is a Government Servant/Employee of PSU/ Statutory body of Government, Signature of Head of the Office With Designation and Seal. Contd..4. :: 4 :: Terms and Conditions: 1. The individual (male) must be between the age limit of 25 to 50 years as on 01-07-2016. 2. 3. 4. 5. No family member should accompany to perform Haj-2016. The individual should not have any connection with any of the Saudi Moallims. The individual must have performed Haj earlier (attach proof of Haj). He should be sound health and medically fit to travel. 6. The applicant should enclose certificate/documents, duly attested by any gazetted officer. 7. Only Government Servant/Employee of PSU/ Statutory body of Government, are eligible subject to approval of Haj Committee of India, Mumbai. 8. The period of deputation/absence for Central Government employees shall be treated as on leave. 9. The individual should submit NOC from the respective department, if selected. Selection is at the discretion of the Telangana State Haj Committee. 10. The Telangana State Haj Committee is empowered to accpet or cancel any application without specifying any reason thereof. 11. No TA and DA will be paid for attending selection process. 12. No TA and DA will be paid for attending the Orientation/Training camp of Haj committ of India. 13. If any false information is furnished, the same shall be rejected without assigning any reason thereof. 14. The selection of your candidature is subject to the final approval of Haj Committee of india, Mumbai. 15. The selected Khadim-ul-Hujjaj should not leave the place of his duty during his stay in Makkah Mukarramah and Madina Munawwara. 16. He should have valid international Passport with validity upto 10th March-2017. with Machine Readable Passport. 17.The application must be submitted through respective department through proper channel. 18. The individual who did not attend the Haj Orientation/Training Camp are not eligible for selection as Khadim-ul-Hujjaj for Haj-2016. 19. He should be well acquainted with the Religious knowledge including Haj rituals and should have experience handling functions and public congregations. 20. He should ready to travel on any moment as per the direction of the Telangana State Haj Committee. 21. All correspondences will be communication through Official address of the eligible candidates for selection as Khadim-ul-Hujjaj. *NOTE: The selection of Khadim-ul-ujjaj for Haj-2015 will be based on the individual working in the office situated in concerned District. I shall abide by all the above terms and conditions as laid by the Telangana State Haj Committee. Signature of the Applicant - &&&-