APPENDIX’A’

FORMAT FOR FURNISHING DETAILS OF PERSONNEL ON LOW MEDICAL CATEGORY

1) Name of sector:-
2) Quarter Ending:-

3) Total number of LMC case at the beginning of the quarter in each category
(Shape):-
SHAPE-II SHAPE-III SHAPE-IV SHAPE-V TOTAL
Temp. Permane Temp. Permane Temp. Permane Temp. Permane Temp Permanen
nt nt nt nt t

4) Number of LMC case detected in each category( Shape) during the quarter:-

SHAPE-II SHAPE-III SHAPE-IV SHAPE-V TOTAL

Temp. Perma Temp. Perma Temp. Perma Temp. Perma Temp Perma
nent nent nent nent nent

5) Changes in LMC cases during the quarter due to:-

Casualty SHAPE-II/III SHAPE-IV SHAPE-V

Temp. Permanent Temp. Permanent Temp. Permanent
Death
Invalidation
Retirement
Category
Up
Gradation
to SHAPE-
I
Detection
new cases
Others/Tfr
Total

6) Total number of LMC cases of the sector at the end of the quarter ( supported by
details of such personnel per appendix-“a”) ( SL.No.( 3+4)-5):-
SHAPE-II SHAPE-III SHAPE-IV SHAPE-V TOTAL
Temp. Permane Temp. Perman Temp. Permane Temp. Perma Temp Perma
nt ent nt nent nent
NAME OF FRESH LIST OF LMC PERSONNEL AND UPGRADED PERSONNEL OF
-------- SIG PLN

S/NO. F.NO.,RANK/NAME MEDICAL REASON FOR DUE REMARKS

CATEGORY PLACING IN DATE
AND DATE LMC(DIAGNOSIS) FOR
FM WHICH REVIEW
PLACED
ON LMC