Jishnu Barua, IAS JOINT SECRETARY (S&Vig.- II)

TEL : 011-23093591 FAX: 011-23092930

No. A.11013/12/2016-AT

1-77:ff c.1)1 Trrrt- 5rDmivr fo-Fr

Trf#, 711,4, Ditiqo 74r 9)4 ,14 It-4t — 110001

GOVERNMENT OF INDIA DEPARTMENT OF PERSONNEL & TRAINING

MINISTRY OF PERSONNEL, PUBLIC GRIEVANCE: AND PENSIONS

NORTH BLOCK NEW DELHI-110001

ebruary, 2017 (b1/4'5-' F

Sir/Madam,

Applications are invited from eligible candidates for filling up eleven (11) vacancies of Judicial Members in the Central Administrative Tribunal (CAT) arising during the calendar year 2017. However, the vacancies are likely to vary due to various exigencies like acceptance of resignation, if any, tendered by any Member (s) and also consideration and decision of competent authority regarding proposal for extension of one more term of appointment as per Rule 8 (2) of Administrative Tribunal (AT) Act, 1985.

2. The AT Act, 1985 was amended by the Administrative Tribunals (Amendment) Act, 2006 (No. 1 of 2007). As per sub-sections (2) and (3) of Section 8 of the Act:

"8(2) A Member shall hold office as such for a term of five years from the date on which he enters upon his office extendable by one more term of five years:

Provided that no Member shall hold office as such after he has attained the age of sixty- five years. 8(3) The conditions of service of Chairman and Members shall be the same as applicable to Judges of the High Court."

3. Regarding the eligibility conditions, Sub-Section 2 (b) of Section 6 of the Administrative Tribunals Act, 1985 as amended by the Administrative Tribunals (Amendment) Act, 2006 provides that-

"6(2) A person shall not be qualified for appointment,-

(b) as a Judicial Member unless he is or qualified to be a Judge of a High Court or he has for at least two years held the post of a Secretary to the Government of India in the Department of Legal Affairs or the Legislative Department including Member-Secretary, Law Commission of India or held a post of Additional Secretary to the Government of India in the Department of Legal Affairs and Legislative Department at least for a period of five years."

4. It is requested that this circular be given wide publicity. Names of eligible • officers who have unimpeachable integrity and having enough judicial experience with

1E) aTruT7 http://persmin.gov

special knowledge and experience of service laws and are willing to be considered for the post of Judicial Member in the Central Administrative Tribunal may be sent along with their application / bio-data in the enclosed Pro-forma (attached). While forwarding the application (s), it may be certified that the applicant fulfils the eligibility criteria as prescribed under the Act. The candidates may indicate their availability to join the Tribunal vide para 17 of the Annexure-I. It is requested that while forwarding the applications of candidates, the following points may be kept in mind:

It should be ensured and stated that the applicant(s) is/are clear from vigilance angle. In case any penalty had been imposed in the past against any applicant under the relevant Service Rules, the details of the same may also be furnished.

(ii) Original ACR/APAR dossiers, failing which certified copies of ACRJAPAR for the last ten years as applicable in respect of applicants, may also be sent positively along with the applications.

(iii) The Cadre Controlling Authority / Registrar of the High Court / Supreme Court while forwarding the applications may clearly indicate (with dates) that the officer / applicant fulfills the eligibility criterion i.e. held the post of Secretary for two years / Additional Secretary for five years as mentioned in para 3 above or that the applicant is qualified for appointment as a High Court Judge as per Article 217(2) of the Constitution of India.

(iv) Interested applicants may also send advance copies of their applications by Speed Post or by hand. Advance copies of the applications would be considered only if the actual applications (to be sent by speed post or by hand) are later received with all the above necessary requirements from the cadre controlling authorities.

5. Retired Judges of the High Court and Members of the Bar may send their applications directly.

6. In the case of the Members of Bar, para 10 (f) of Annexure-I regarding details 'of income in the last three Assessment years (2013-14, 2014-15 & 2015-16), it should t

invariably be filled up, failing which their candidature is liable to be rejected summarily (Copies of the Income Tax Returns shall also be attached). Such applicants should attach documentary proof of fulfillment of the qualification to become High Court Judge as per Article 217 (2) of the Constitution of India. Attestation form, duly filled in with 3 photographs, along with identity certificate, should be sent by Members of Bar. Prescribed attestation form is enclosed as Annexure-II.

7. The duly-filled in (neatly typed) original applications should reach the Secretary, Department of Personnel and Training, North Block, New Delhi — 110001 by 05.30 P.M. on or before 27th March, 2017 (by hand or by Speed Post). Applications received after closing date of receipt of application will not be considered. This Department will

( i )

To

1. 2. 3.

4.

not be responsible, for the postal delay / loss of application, for the reasons whatsoever. It is therefore, in the interest of applicants to ensure that their applications reach well within the closing date & time as stipulated.

8. The appointment of Members in the Central Administrative Tribunal shall carry All India transfer liability. The selected persons are liable to be posted to any place having a Bench of the Central Administrative Tribunal depending on the availability of the vacancies / exigencies of work and as decided by the Competent Authority.

9. The designated Committee may prepare a list of waitlisted panel to meet any exigencies like the selected candidate not joining, vacancies arising in 2017 due to resignation, vacancies carried forward from previous years etc. The waitlisted panel will remain valid upto six months from the date the panel is prepared by the designated Committee. However, the Government of India reserves the right to extend the validity of the panel.

10. It is also clarified that persons selected for appointment will have to join within thirty (30) days from the date of issue of appointment order failing the which appointment will be cancelled and the candidate will be liable to be debarred for a period of three years in terms of extant guidelines of the Department.

11. It is in their own interest that the candidates should go tlwough the Administrative Tribunal Act, 1985 and it's amendment from time to time regarding eligibility, service conditions etc. before applying. It may also be noted that subsequent amendment, if any, to this notice , will be posted in DoPT website (persmin.gov.in / persmin.nic.in) only.

With regards,

Yours sincerely,

Registrar/Registrar General of various High Courts. Registrar General, Supreme Court of India, New Delhi. Secretary, Department of Legal Affairs, Shastri Bhavan, New Delhi. Chairman, Central Administrative Tribunal, Principal Bench, Copernicus Marg, New Delhi.

Copy to: NIC with request to post in DoPT website.

ANNEXURE-I

PARTICULARS/BIO-DATA FOR THE POST OF JUDICIAL MEMBER IN CENTRAL ADMINISTRATIVE TRIBUNAL

1. Name:

2. Date of Birth:

3. Current/Past Service (i) High Court Judge (ii) Indian Legal Service (iii) Judicial Service (iv) Member of Bar 1=1

4. In the case of High Court Judge

(i) Date of appointment as High Court Judge: (ii) Place of posting:

5. In the case of others

(i) Name of Service: (ii) Year of joining service: (iii) Since when in Grade I of ILS/Judicial Service: (iv) Present scale of pay:

6. Educational Qualifications

(Mention award of prize, scholarship, fellowship or any other distinction)

7. Date of Superannuation (If applicable):

8. Designation of Present / Last Post held:

9. (a) Office Address & Telephone Number:

(b) Residential Address & Telephone Number:

(c) Correspondence Address (along with Mobile Number and Email ID):

10. Practice (for Members of Bar)

(a) Date of enrolment (b) Actual number of years of practice (c) Places and / or the courts before whom

practised and the period (d) Nature of practice-

Civil, Criminal, Constitutional, Taxation, Labour, Company, Service etc.

(e) The field of specialization, if any

(0 (i) Professional Income for the last three Assessment Years (2013- 14, 2014-15 & 2015-16) - gross and taxable

(ii) Year in which first assessed to Income Tax- gross professional income in that year be furnished.

(g) Reported judgments of Supreme Court and High Courts, for the last five years, in which argued independently (give citations)

(h) Unreported judgments of Supreme Court and High Courts, for the last five years, in which argued independently (annex certified / attested copies)

11. Association, if any, with any political party

(a) Name of the party (b) Period of association (c) Whether held any organizational office

and if so, period (d) Whether held elective office in any legislative

or local authority and, if so, the period.

12. Whether held any office as Advocate General, Government Advocate or Standing Counsel for the State or Union or any statutory authority or public undertakings (give particulars).

13. In the case of a Judicial Officer, details of the posts held during the last ten years with dates. Details of any departmental

inquiry held or contemplated, with particulars as to the

nature of charges and period or periods involved and the

outcome thereof, should be indicated.

14. Whether employed at any time either on part-time or full-time basis. If so, give status and period and the reasons for leaving.

15. Special knowledge and experience in dealing with service matters and laws (Please elaborate):

16. Indicate special achievement during last 10 years (separate sheet may be attached for indicating special achievement — in not more than 150 words)

17. Indicate the month of year 2017 in which the officer will be available for joining the Tribunal, if selected :

The information furnished above is correct to the best of my knowledge and belief and nothing has been suppressed. I understand that in case of my selection, if any information furnished above is found to be false or mis-represented at a later stage, my selection is liable to be cancelled with the approval of the Competent Authority.

(SIGNATURE)

(NAME IN CAPITAL

Place:

Date:

Surna.rne Name

1. T.! 717

7-11:7! Ak'

canc.;,,)

Narne in full (in Block, Capitals), with aliases, if ani.. (Please indicate if yOU have added or dropped at any staue, part of your name or surname).

2. 17,in

Present address in full (i.e. TI-aana and Disti-ict or House Number, Lane'StreetiRoad and Town)

3 . 74'2) -6-77 IT.T. 7,71; C. 34 t7,1 ■

3-t: 77.

(a) Home address in full (i.e, Village. Thana and District or House Number, Lane/Street/Road and Town and name of District 1-leaciquarter).

tTas: „. , , „.

(b) If originall ■ a resident of Pa'tiistar, the address in that country and The dale of rniz-ation 1.(,) Indian Union

(a)

A&INEXLIE-..11T

To bc filled in by the candidate in his own handvaiting No. I:- Rol] Nci.

37, 21T/L.P.S.C.-21 A

T".7 4!t-, _

74•:-

Affix signed Passpon size t.5cm 7cm approx.)

ccip of recent phoiogapir:

4-iii:iirATTESTATION FORM

Y^.7-77j . . „. c-R7 ;

The funcishin2 of false information or sdoriression of ai-1\. factual informaiion in the. Anestaliori Tom-; -be a disqualification and is like iy to render the candidate unfit for employment under the Government.

2. 1W-1

67fr4 '"7; •H 7'41 7"--t5-7 .`=

r=1-. 7.1 H,7,7.7:q ! t ,

if detained, arrested, prosecuted. bond dow.n, fined, convicted, debarred, acquitted etc. subsequieni to the comple- tion arid submission, of this form the details should be cornmunicated immmediateiv to the Union Public Ser -vice Commission or the authority to whom the attestation form has been sent earlier, as the case may be, failing which it will be deemed to be a suppression of factual information.

3. e-771t, i771 :4=n;-27..tt 7:t r-t-C""I'`41'1"4;t- 71T

•71; !

If the fact that false information has been furnishPd or that there has been suppression of an:. fa.crual information in the attestation form comes to notice at any time durinci the service of a person, his services would be liable to be terminated.

7-77! N.71_77;f2

1

) '1:: 75--;‘:/1:Th (b) ,! .----, 71.! ._.-. ___...,,,...,:!, ,-.-17---,,-,-1 7:-..,--

Inft,i-rnation to bc fill-nisi-led ,,vitil rPoard to con(s) and. or daughter(s) Ill case fney are

I 7.77-5_,T, ( T.,-,7,-7-zt--; 7,---, 1 , - ;

i :-!,-7- --7, -,-"+":" ."---7,-.- ...:, ', I 1 ""'l , ,' '-1 ' --% ..-1 , ; ''" t .) i

I Natiortaii.av 1 1 1 (by ',.irt't-, ah,f

. t Or t)..., C...-'077111,Ci i 1 I

'

S:L.,;f(ff

stud; inz -,],, Ms,: in a forer-2-,n couni.7:2,,. ‘7=-!--, Ti--- . 7-F-,--7,--: i TT 7-7 "T-r-! 77 --7-f- -t. 1 I f7i -ffa1 - --H--71.-7 -4 i:.---'7.) i Mace ofbirif 1 777 -;t: * 7- 7-7-- I I Count-7, in .,-,1-nch ,

I 1 1 st!„1:',\ int,i, 11‘1712. I I 1+ :I:: f11;1, aCICZZ'S.:. I 1

I I I

1.)ate from which studyinct" th!F

Meriti,7,71 p7e.vi,20-Z.3 C01,11:11T1

7=1. 7-;

4.

F7r7 1775- *-7,77-7 '-,.;i!!:7;!-; -Fa; z-e77--4', c77,

3-7-5;Trt-- -67171.'• 3Fr-t. ft,-t 1 Particulars c,f places (with periods of residence0 here \ ou e rtsiied, for :hat, onc ■ tar a: a flint durina the ;.at afte! 'dt:;=!1!-;m:_! aL.c ■:.!1'21 ■ (a!--s :hottic1

pre( ett.i!q! year, in caNe ctt slat., I-r-oad Pakistan; narlicalars of al; 7,1ace,!, ticrc!!

.,,tfti ha; e resided for more thar; one -"=", ( Trp 7-774 -at:' s-F- , .•

7=7-7", 77,1

-77-7

".77-77-,. - T"?..R2 T4,,z7 17F7.7-, -47 I Resider-1:1a! ad.rire.ss tu!, :;,e Triana and 11 1-"is',7•1(-1 I-i:_'!use 3'■'urriber, l_ahe 'Street 'Tslc!,,ad and Tov,T, 1 place mentioned in the precedimr: cohirtm

I Namt C1,1- the District Headquarters of ripe

7-7T-!

'r-,:e'lat! -",:arne

ft-717 I

1 Q!,, Farnef COme in Full ,---!!!.a‘t.es. tin!:-,.! I

(IF! 777.

Wifa,1-iusband I

Brotnarfs)

•

-,sf="'7

l''';,?•[i01".C'

07 C.:, C,30.711]

7.•-•.. • ' I , 0.

•

I 7'17 '-7:77 ;

Occupation (if emp,ioved :rive

I lull desig.--Jiat;on 1 , •

1 it. =TT ;!

I Present

I! Postal address (if dead give

I 'Iasi- address)

7-17 -77

Permanent I Home aCcirc.'ss

1

•

FrOn•

3 6 .

Nationalir. 7. 7-,744 ( 7-rw, )

(a) Date of birth (in Christian era') OD) .E?-1=-CF; (b) Present Age

(c1 Age at matriculation

8. f.3177-TI fa) Place cf birth. Distric! and Stait in which situated (.7=7) 77,7 t- (b) Distric and State to which vou belong

c-q-7-474; f±rfiri 7.-frtz. (c) Districi and State to which your father originally belongs

(a) Your reiiigion (7.7s- "q7:7). &TN

I --it

(b.) Are you a member of a Scheduled Caste/Scheduled Tribe/OBC? ,6.nsw.er 'Yes or No'

cr'j ■..)-177 -;.j 30. c

f:Fre.-7 Educational qualification showing placec of education with vears in Schools and Colle_ies since l5th year of age : 4,---,,c115-77.---7-7 7:7 TF-TT

77'7773 Narne of School/Coilege w'ith full address Date of entering Date of leavin 1 Exarnination I

1]. ( &T.) :377 .7 :;71,--3-t-i cr,' z--;; -41 3717,7--, Z".7 tc.i>Thtl-f -`54"-! -g7 747 *":Th`..-"ET1 .°7-; '77; t E-7.::f ? 07:Ft c"Ra (a)

Are you holding or have any time held an appointment under the Central or State Government OT a semi-

Government or a quasi-Goveniment body or an autonomous body, or a pu'olic undertakin2 or a private firm or institution? If so., give full particulars with dates of employments up-to-dates :

arcirEi LOVnic67-7-1 Trz7 Period Destimation, emoluments and

nature of employment 767

From To

Full name and address of employer

777-7-;) Reasons of leaving previous service

Ca) f7-07-1.'T *‘-577 •:-R zr: -ff-',7t171/71cri7927-1' Zft, ITF—c 3-"P111 1965 IF' 5 7-TT 77,751 311,f17-,, Lie; 3---7 .:73/77 3-77-itt rqc., TE'j 73.7 t-77-"‹ ;17-7 ETT c;r: ET4-776 Er' (1-1) If the Pre\ lOus ernPlOyment was uncle; the Governrr,ent of India State Geo.:eminent:an Lincierta;:ing c-r•vne:: controlled

the Govt. of incila or a State Government'Autoriornous bodyLtniersity local bod:.. If ou hacl left service on izivir,2 a month notice under Rule of the Central Civil SerNis.es (Temporary Service) Rules, 1965 or any siiTilar con-espondinF rules were any disciplinary proceedings framed againsi you. or had you been called upon to explain your conduct m anv matter at the time you gave notice of terminal:Ion of OT at a subsequent dare before your services actually teiminated?

4411

9.

(a)

(b)

12. C47) aliq 'Ws-ft -rn-7,-(Firr. f-*-77ii =IT:, ? (•?g) •q,-.-1 3Tm T47 Tt Tr<.- t? Tiii-e Yes/No

(a) Have you ever been arrested? (77.) 4.-R-Ti 3r11 •-,-s-it --777.---4-:,. T-:,. "a•-9-t1 Yes/No

(b) Have you ever been prosecuted? ( II' )

3T"' T"ii .--.i TiFit rt _: (c.. ■

Have you ever been kept under detention? er---ef Yes/No ( ,-...--) ER"; arr:: 7,7 f',7#"; f,T.Fi4 --z4-.77.7-'1-7 ,T,-,7T e.---ie Yes.No

(d) Have VOU ever been bound down'? .-[.-T fi'--4-74', 77:TT t? (a) Ha\ e \ ou ever been fined b) a Court of

La ■ .':' ei-ie Yes/No (--,) -6tQT: .3ircl -,*A-fl f-47.44t a-377-tt 4-1 ..1".7.; '-'it-'-'7377---1-4 '17.7 •.?..Tri- apm, TT t? (f)

Have you ever been convicted by a COLITI of Law iOr any offence? e-,,,--r,l,

yes/No

4

(-0) -4-7-17 3-3-7 '7=I-71-17 '1'4, •. -"17-1-257 4-7 .f,-.7 fq,--1--i-,7,- arT-7 -7-7 --7:: -fr4-7-4-f fro-i-p-9-t-4 =7 --,"--.3 ,,.,--7-----, -fi-.Th-fE7,-.--7-77,7-Ai--47, -0-.7 f--,--Ti--,,,-,1 Tit.:

'i.----77 (g)..) Have you ever been debarred from anv examination or rusticated b) anv University or

any other educational authority/institution? Yes/No CdT) ----z-T! 3-1-17 .q-:5-17 . -fd74--IT A --r-,f-, ,--tr-47 3n-trt./-4-.7-t 1=-17-FT :-S,5-4'--.,,i .7,1-4 .7,-,--T,') f&-'-.7-4-t rq-127-T -4 ..-;:34'4/

.C.-17-17 -4- .17;77 -cr-f-41----a./3--,--;i7zr -a-gr7 77 t% e.,"9t: (h)Have vou ever been debarred/disqualified by any Public Service Commission/Staff Selection Commission for any of their examinationSelection? (37,,) .7., - 74T.c.:;q1-5,---, -7 T-Frzf ----.i t77.-7--1 7--7-7,-_,., --7-+ ',-;=7-F-ttici --4-17q777--1,-7, ,.'i :B-1 i,"--1-47 i---q-i-Tg 1p--7-.1-4 --c'-r t:- er9-ei

Yes/No (i) If any case pending, ag_.ainst you in

any court of law at the time. of filling up this attestation Form? Yes/No

(.3,) ..7$-6- ±.n.P.----, , 7514 4'; 1“c,' .-:,-=---ici 4--R-7,; lc-4,-7-4" Irfa3--*-: 37-4-m-7---,AT, -4 ,..34-i, "-i,;--!:-.7,,t 9---;:rz: -13-1-4-.---. 1 ,-,-,- .,--,=-. '6,7 q;It%

Qii /QI

(i)

Is any case pending against vou in any University or anv other educational authority/ institution at the time of filling tc.,- this Attestation Form? Yes/No

(z) .--t --i---,T; ct 3-TLft9' '-'7"---7-4- -3ritkrui t--41 # , <.'T-ri-5:-/ --,,,,. ;--(5---4-iFff 1.ti 777 3-7-q---t 3-77--qq; rr

e-3e (k)

Whether discharged/expelled/withdrawn from any traininz institution under the Govt.

or otherwise? Yes/No ( a ) , ,- - - - r t ' 1 -q ,, ---

; f*-, - tt 1. il\ - 9 7 .7 z r -, 1 7 sT - -k .q-t-,e--,-;,-ectin---, ,-6 ,-.1*-7,.,- ,:.; 4-1141:::i et) :i--,--zi t-T "4 VIrij -.'"if,..7".71 i

anft 75.-f; t17:41 3.11-trqj P-1 ..,--1.4 R", I 5.-71 -R7-4-tIT .-. cr-11"—ff4/107-11*-5-7. •--1,-1/tfkraTc ViftiTR-701 .'"'.: 7::?7,'

s.itai ...sis-,,-9-7-11/31-7---Rtzflio (1)

If the answer to any of the above mentioned question is 'Yes', Rive full particulars of the caseiarrestrcletention/fmeiconvictionisentence/panishment etc. and/or the name of the case pendin2 in the Court/University/Educational Authority etc. at the time of filling. up this form.

Note : feu:raft : a ) -.-.711-,4-1 TR-i-TT Ti7EF4i-E----9.4., Wit4 ''',' -a7-q-{ t'T Trf 4 ;t-i-j-' .--,'1 Lli '''fi.-_q-7,7 I Please also see the "Warning" at the

top of this Attestation Form. (2) zrEfiftq't -e-,77 - =re- '-.. ,--77_ .,,-,--,,- .;-----,- 7?-1- -,-r -6--t7 .3,--p-T-3,-; --it--,--q7 zi-i-, ,--17;-,t,-; be. Specific answer to each of the question s'nould

be given by. striking, out "Yes or "No" as the case may ..-13. 3t-e-t cr.-ITt t f-41:4-7-.7s- ck----(1-45-qi; * .91- 71 t4 t - f - q : a - - - q 1 t .974 ''.1•frf-1,,,' 3-177T-:'■ -,9-Fit ti I 1

Name of two responsible persons of your locality. or two referees to

vv -hom you are known. 2. A ,71-47-r-D7 -77.--1, R

/----,ttf--. -3-TEF -:-.5- -..-1- TT-----fr ,_-71- ----: vi -cm7 t --,1-41- fq-a-i-R t -4-e- -a-zr y,--

,-f t 1 A ---,t ■-=-*--4; -r----r-,-; -4 -Th--;;----;

Te 1 ts1-4,--; -.-i-T-ar A Tris-qm- -§.-; 3.7ift7-T --T1-7-,a * fffc, -q■-rq t --1-.is 1 1 cenify that the foregoing information is correct

and complete to the best of my knowledge and belief I am not aware

of any circumstances which might impair

my fitness for employment under Government.

7--4-a. .....................

Date

................ ....... Place

Siznature of Candidate

c717

Ire-qm 3TTrot-IN IDENTITY CERTIFICATE

fec4f

be signed by an) onc of the following:—

74•1

Gazened officers of Central or ( 2 ) ti-77 73T4, 74-7

fi-R73.4.7

91177--cr Certifica:e to

• ;

State Government; 1:11;17-

5

7.17.- 71, 7T-r-,7 f4z-Tri

guardian ordinaril,•• reside; Mernbc-s, of Par:lament or State legislature belonging to the cons-tituenev where the candidate or his parem! 3

Sub-Divisional Magistrate/Officers; (4 )

7,7;t7 3-F54-G7-7 -4T 74.7 - co.;

Tehsildar or Naib,Dy. Tehsildar authorised to exercise magisterial omers: (.:5) 77E7 qZ;f. -47T

! 6 Principail4eadrnaster of the recognised School/College/Institution where the candidate studied last;

Block Development Officers; (7) at;.-

Postmaster: and .(8)

Panchaya! inspeclors:

6 r4-7zr. t ,3ft/9,:itRaraE_•=iit -tp, 4,4

-Certified that l have known ShrilShrimatLiKumari sonrdaughtger of Shri

,=-177 • ''''''' '''' for the last years months

f. , -91t, -FWETti-;1 ch t arid that to the best of rnv knowledge and belief the particulars furnished by himTher are coiTect.

Signature 4:11 '

Desianation or Status and address

-Ts-T7

Place

I-)ate

1-71 z--Tr--'1 it-7")

(To be filled by. the Office)

q-,! -Fiqt TrEn

Name, desitr,riation and full address of the appointins authority 1-7.T isr4.-ol- fc7-70,- -N'---417 TE:1 t ! Post for whiich the candidate is being considered.

N1GIPF-- 130 UPSC/20 3 U-04 i 0.20 I :000 Forms