NORTHERN POWER DISTRIBUTION

COMPANY OF TELANGANA LIMITED

RD CODE NO

Name : .................................................................
S/o.D/o. : .............................................................
Designation : .......................................................
Place of Working : ..............................................
............................................................................

Cell No : ............................. Signature of issuing Authority

Height : .................. Weight : ..................... Blood Group : ......................

Identification Marks : ..............................................................................
.................................................................................................................
Cardiac : Yes / No ............. Diabetic : Yes / No : ......................................
Date of Birth : .............................. PAN No : ...........................................
Address : .................................................................................................
........................................................ Phone No : .....................................
Spouse Details :.......................................................................................

Signature of Employee