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ANNEXURE B-1

APPLICATION CUM RECOMMENDATION FOR APPOINTMENT ON


COMPASSIONATE GROUND OF DEPENDENTS OF DECEASED
EMPLOYEES IN EXCEPTIONAL CASES.

1. a) Name of the deceased MIRZA REHMAN BAIG


employee.
b) Branch / Office where SBI GODOWN ROAD BRANCH
posted NIZAMABAD

c) Grade / designation HEAD CLERK

d) Marital status MARRIED

2. Date of joining 11/08/1992

3. Date of death 11/08/2018

4. Reason of death Liver failure

5. Date of birth and age as on the 04/04/1960


date of death 58 years, 4 months and 7
days.

6. Total service as on the date of 26 years


death

7. Whether belonging to Minority


SC/ST/OBC
8. Salary last drawn; gross and Grosss = Rs. 39,043/-
net net = Rs. 13,350/-

9. Whether any disciplinary NO


action was pending /
contemplated against the
deceased employee?
If so, give details
10. Whether any disciplinary NO
action has been concluded
against ht deceased employee?
If so, give details
11. Whether any other NO
dependent / family members
has been appointed on
compassionate grounds ?

12 PARTICULARS OF ALL THE FAMILY MEMBERS OF THE DECEASED


. [IF SOME ARE EMPLOYED, THEIR INCOME AND WHETHER THEY
ARE LIVING TOGETHER OR SEPARATELY.

S. Name Age Relatio Mari Edu Employed Addre


No nship tal cati / not. ss
. statu onal If
s Qua employed
lific particulars
atio of
n employme
nt and
emolumen
ts
1.

13. CALCULATION OF MONTHLY INCOME OF THE FAMILY.

[1] Terminal benefits.


i. Provident funds
ii. Gratuity
iii. Leave encashment
Total
[2] liabilities
i. Loans taken from BaNk
and / or other financial
institutions
ii. Any other dues payable
to Bank
Sub Total
[3] Net Terminal benefits C [A-B] =
[4] Investments
Sub Total
[5] Net corpus available
Sub total E [C+D] =
[6] Monthly income of family
from all sources
Monthly notional interest of
Bank’s maximum term deposit
rate applicable to Public on
80% amount of the not corpus
available - E
i. Weighted average
Pension
ii. Monthly Gross salary of
spouse if employed.
Total monthly income of family
[i] +[ii] + [iii]

14. PARTICULARS OF DEPENDENT NOMINATED FOR


COMPASSIONATE APPOINTMENT
a) Name MIRZA ARBAZ BAIG

b)Relationship with the SON


deceased employee
c) Date of birth and age of 12/03/1998
the dependent of the 20 years
deceased employee
d) Educational B,Sc. discontinued
Qualification [copies of
the certificates and
marks list should be
enclosed ]
e) Whether any other NO
dependent of family
member has been
appointed on
compassionate ground
f) Date of Application. FOR WANT OF LEGAL HEIR
Reason for non CERTIFICATE FROM
submission of TAHSILDAR, NIZAMABAD
application immediately SOUTH
after death, if applicable
g) Whether nominated by YES
spouse of the deceased [
if the spouse is no more,
a sworn affidavit must
be obtained]
15. Whether the candidates has NO
availed of any loan facility
from the Bank and if so,
whether he has defaulted in
repayment
16. Particulars of compassionate NO OFFERS
appointments offered by any
other organizations to any
member of the family, if any.

DECLARATION / UNDERTAKING

1. I hereby declare that the facts given by me above are, to the best
of my knowledge, correct. If any of the facts herein mentioned are
found to be incorrect or false at a future date, my services may be
terminated.
2. I hereby also declare that I shall maintain properly the other
family members who were dependent on the deceased employee
mentioned against Point No. 12 of this form and in case it is
proved at any time that the said family members are neglected by
me, my appointment may be terminated forthwith.

Date: 01/12/2018 Signature of the Candidate


Name MIRZA ARBAZ BAIG
Address BARKATPURA, NIZAMABAD

Sri Mirza Arbaz Baig known to me and the facts mentioned by him
are correct and verified by me.

Date: Signature of the Witness


Name
Address

RECOMMENDATIONS: In view of the assets ad liabilities / income and


financial position of the family visa vi its size, we are satisfied that the
conditions of the family is such that but for the provision of
employment the family will not be able to meet the crisis caused by the
demised employee}

Appointment recommended Clerical / Subordinate / Menial

HEAD OF THE DEPARTMENT