PART-I(Applicant Details) 1 Emp Code* Employee name & Father’s Name 2 3 4 5 6 7 8 9 10 11 12 Sector Type* (see tableI) Name of the department* Designation* Date of Birth* Gender* and Blood Group Marital Status* (see tableII) DDO CODE* Designation status* PRC CODE* (see tableIII) Pay Scale* Present Basic Pay* PART-II(Official Address) 13 14 15 16 Address* Email (optional) Phone No Pincode PART-III(Residential Address) 17 18 19 20 21 22 Address Place City Pincode Email ID (optional) Mobile no

PART-IV(Additional information) 23 GPF No

widowed. Aided Education Institutions. Grama Panchayat. Urban Development Authoriries. TABLE-II (marital status) Married. Muncipalities. 2010.24 25 26 27 28 29 30 ZPPF No CLASS IV GPF NO PRAN NO APGLI NO PAN NO RATION CARD NO AADHAR CARD NO DEPENDENT DETAILS Dependent Name* Date of birth* Gender* Marital Status* (see tableIII) Relationship with Employee* Employment status* Blood Group* Signature of the employee TABLE-I(SECTOR TYPES) state govt zilla parishad. 2005. Zilla Praja Parishad. Agricultural Market Commities. Muncipal Corporation. unmarried. Other Grant in aid Instt. Zilla Grandhalaya Samsthas. Mandal Praja Parishad. consolidated pay . divorced TABLE-III (PRC CODES) 1999. Temples. State Public Sector Undetaking. Universities Coopertaive Institutes.