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RESIGNATION PROFORMA

1. Name of the Official:_________________________________________________


2. Staff No:__________________________________________________________
3. HRMS No:_________________________________________________________
4. Designation:________________________________________________________
5. Date of Birth:_______________________________________________________
6. Father’s Name:_______________________________________________________
7. Qualifying Service along with a certificate to the effect issued by the
AO (TA):___________________________________________________________

8. Date of entry in the Department:__________________________________________


9. a) Status of Disc/Vig. Clearance:__________________________________________
b) Indicate Currency of punishment, if any:_________________________________

10. Rule under which resignation is requested:__________________________________


11. Date from which the resignation requested:__________________________________
12. Govt. dues if any, pending against the
staff along with certificate issued to
the affect by the AO (Cash) concerned:_____________________________________
13. Status of absorption in BSNL:____________________________________________
14. Bond obligation if any:_________________________________________________

Signature of applicant________________
Designation________________________
Staff No.__________________________
Unit of Working____________________

Certified that above particulars have been verified from the service record of the
applicant and found correct.

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