APPENDIX-XII CERTIFICATE TO BE FURNISHED BY THE CANDIDATES BELONGING TO CATEGORY NOVEMBER 1984 RIOTS AFFECTED DISPLACED PERSONS, CHILDREN OF ARMY DISERTERS KILLED/100% PHYSICALLY DISABLED, CHILDREN OF THE FAMILIES OF PERSONS KILLED AS A RESULT OF TERRORIST VIOLENCE OR SECURITY FORCES ACTING IN AID OF CIVIL POWER AND THE CHILDREN OF INNOCENT CIVILIANS HAVE SUSTAINED 100% DISABILITY IN TERRORIST VIOLENCE OR DURING OPERATION BY SECURITY FORCES ACTING IN AID OF CIVIL POWER. Certified that Mr. /Ms. _______________________ S/D of Sh. _________________________ Father/Mother of Mr. ___________________ (Name of the candidate) who was killed in terrorist action/operation against terrorist which took place at ___________________________________ on _______________. He was serving as Police Personnel/Para Military Personnel/Civil Govt. Employee as___________________________ (Rank/Designation) in ______________________ Department. Date: (Official Seal) Signature of Deputy Commissioner of the Area/Head of Concerned Department
