Decl

arat
ionforSpousePoi
nts[
Under
Rule7(3)
]

Tr
ansf
erAppl
icat
ionNo.
_ Tr
easur
yIDNo.

Nameoft
heTeacher
:_

UDI
SECode:
_ Nameoft
heSchool

Nameoft
heMandal
:_ PhoneNo.
_

MyspouseSr
i/Smt
.

Wor
kingas(
Desi
gnat
ion)
:_ Tr
easur
yIDNo.

UDI
SECode:
_ Nameoft
heSchool/Of
fi
ce

Nameoft
heVi
ll
age/
Town:

Nameoft
heMandal
:_ PhoneNo.
_

No.ofPoi
ntshe/shei
sel
igi
blef
or .

Idecl
aret
hatIam appl
yi
ngf
ort
ransf
erwi
tht
hesespeci
alpoi
ntsandei
therIormy
spousei
snotappl
ying/av
ail
edf
ort
hesepoi
ntsi
nhi
s/hert
ransf
eri
nthel
ast5Year
s(f
or
HM Gr
-II
)/8Year
s(f
ort
eacher
s).Fur
therIdecl
aret
hatIwi
lloptf
ort
ransf
ernear
ert
oand
t
owar
dst
hepl
aceofwor
kingofmyspouse.I
fanyi
nfor
mat
ioni
sfoundi
ncor
rectbyt
he
aut
hor
it
ieswear
eli
abl
efordi
sci
pli
nar
yact
ioni
naddi
ti
ont
opr
osecut
ion,i
nit
iat
edbyt
he
aut
hor
it
ies.

No.ofPoi
ntshe/shei
sel
igi
blef
or .

Si
gnat
ureoft
heTeacher

Count
erSi
gnat
ureoft
heAut
hor
it
y

*
Encl
:Ser
viceCer
tif
icat
eofthespousewithadecl
arat
iont
hatthesespeci
alpoi
nts
werenotavai
ledbyt
hem inthelast5Year
s(f
orHM Gr-I
I)/8Years(
fort
eacher
s)

*Author
it
yi.
e.,
incaseoft
eacher
sinPSandUPS,
MEO/
incaseofHS,
HM/i
ncaseofHM,
DyEO.