EASTERN RAILWAY EMPLOYEE MASTER FORM OF HRMS (ALL FIELDS FROM PAGE NO. 1-4 TO BE FILLED IN CAPITAL LETTERS ONLY) + Mandatory Fields [ENPLOVEE BASIC INFO 4. IPAS Employee Id (Emp/PF No) * 2. Employee Name AS in SR 3. Employee Name Asin Aadhaar* 4, Aschaar Number 65. (Employee First Name) * =ace) [ 2 To be filed by SR dealing clerk [isoeapeeneme ead Oe Cornet £6. (Employoe Middle Name) 1. (Employee Last Name) [ (a SS ee) 8. Employee Name Hind 2. Employee Name Rapional 10. County of Birt * 42. Date of Bich * } (Sa SSS eee 13.Gender cree) [JM [Je [__Jotners 11. Bith Place 14, Father Name 45, Mother Name 16. Guarcian Namo. 17. Spouse Name 416. PAN Number 20. Superannuation Date * [Rarmmeneners ss), 10. Blood Group 21. SR Page Number # (PERSONAL DET = 1. Religion 3. Caste # 4. Identifoation Mari 1 “# 2:Communty 5. Identification Mark 2 6. Maral Status * 8 Mother Tongue 40. Nationality" a] 12. Nationality Certiicate Egiity Date [COMMUNICATION INFO. 7. Date of Mariage 9. Helgnt (en, inch) 111. Natenalty Ceniflcate Number (Other than indian) 13, Service Record Page Number 4, Personal Mobile Number* 2. Oficial Mobile Number eer] [ 3, Personal Email 4 Official Ema iz ‘5. Communication Adéross (Tick) Present Address [—TPresent accross 6. Aadress Line 1” [ SS = 7. Address Line 2 wits PS 8. Pincodo* ] 9. Statet 10. District” [ J 112. Is Present Address same as Permanent Address? (Y/N) es] Pormanent Address 13, Address Line 1 * aety 114, Address Line 2 with PS 1 18, Pincode* SS ee] 46. Stator C [ [ C ] Sa 17. District 49. SR Page Number # 18.cly [BAS Employes! Bint Page 1 of 5(CAL DELS a wo page onal ree z | 4. Femi Member No 2. Member Name f : J 8 Menter Ne (Roglona) 1 A.manternene Gnd) —[ z } ‘8. Aadhaar Number ae 6.Relation* C 7 Member 008 CL ———] ec remiy momtarage~ 8.tendasoped Fagctee) §(]ves L]Ne Fe eR ‘1. Handicap Category Tis) [I ]vevet___ [Jono [Hearn inpaied (wert Retardation 12, Handicap Certiicate eect From [| 18. Handicap Certificate Effect To Sc eee 14, Member Dapandentcnicey* —— [__]Yes No 15. SR Page Number i 1. Famiy Momber S No * 2. Monir Name * c ] 2. Momber Name Region) = 1 Member Name Ging) : J 5 Aadhaar Number a See 7. Menber 008 = as 8. Handeapped Fag(Ton) von Cod (ee ee ‘1. Hanacap categontTiex) [veuet __[E—Jorho [ering Inpaied [Tena etareation 412, Handicap Cerncate Effect From = 3 418, Handicap Certificate Effect To ves JNo 18. SR Page Number C 1.Famiy Member srNo* [3 2, Member Name * [ J 2: Member Name (Regional). [= 4.Momber Name ind). ] 8. Aadhaar Number (LSS 5 Se oe [Sea eames] 7. Member DOB 8.FamiyMemberage* [WA d 8. Handicapped Flag(Tick) [__]Yea Cre 10,HandloappedPercat [ ae Caesar [U_ veun caksae (eam Gcrienan cloacae ie Es 12. Mandeep Centca Etect from [=] ta Hendin Carmen ete [Ed 14, Member Dependent(rick)* —_ |_]ves [Jno 15. SR Page Number 2 ee 4.Fomty MemberSrNo* [4] 2. Member Name ™ [ = } 2. emer Name Regina) [ } .mambername gin) } chcteatiteiegs -? Pesan te Taam eran [_ Sane 7. Momber 008 SS ener a. Handcapped Fagen) ]ve0 TC _ ee 1. Handicap Categon¢riek) [Just orto (Tenia npstes [Tiverta Retardation 12 Handicen Caren Etec rom [Ta Handicap Certeatoenectte “4. MomberDependen(Tie)* __L__]vee [Jno 15 sk Page Number [ats recot pospor a a ai reams aay cae eear a cee eee sy Eisen esr is pRatogeh a esmecomerel | Raa nbn enioteee ene [IPAS Employes 10 “Bill Unit, ‘Department, J[EMPLOYEE CURRENT STATUS & (To be filled by the SR dealing clerk only) a ] 3. BUN ‘3. Mode Of Appointment * 4, Curent Zane * 6. Current Staton Code * 8, Parent Workshop 40. Lien Zonal) 11. PH Quota +2. Tket Number 49, Service Statu 14. Raiway Group 18. Offer Type 16.Cadce 18, NPS Scheme substantive 20. Pay Level * 22. Designation = IPAS Designation Code * ‘Standard Designation Officiating 24, MACP 20. Pay Level * 28. Designation * (Te appointment Date * ss [Dncircorentcorp [cea [olomual ate LJexsence Men [lee serice ven cuca [looce (ilimatesrs Salereat pr outa [Eleeengegenene Eres rae [TTregularisation Casual Labourer [_]ecouts & Guides [_|sports Quota [_|substitute Course scorer ut tn (eae Se] aa a ee er ee a) Wrap Name | [lvecst LeJonno [[iearng impakes [] arta! Retardation Jessa Remon ees, [Llearpusony Reivea [Joopuaton ousee [CJosmeseareroved Jia twats tess [New Employee Entry [_]Nomat Retirement. [=] Re-engegement [resigned leoningte Saiay/topSelanf.ongAteerae) [=] Sving(Salan) [technical Resianaton [Termination on Death [Taner ou of pay unt [lvourtary retrea Jv on Medical round ila Oe Oe TN Lleecetes [non cazetios trp nano rT Lovee Tone 18. PRAN =o oeecnemmerel [eannenee] 21, Department * (= ee SS] Bcescrye Se Ss a a ee a lve ns a Onna iecater [elvan [Ine 30, Service Record Page Number [ [MEDICAL # (To be filled by the SF dealing clerk only) ] 4. Medical Type * 2. Medically Fi Certiiate Date 4 Medical Certncate Number 5. Medical Classification” 6. Handicap Flag” 18. Handicap Code (Elina, Leloecatoyorecs —[_]Poredo [speci (erie) en teece Conan emai ey [Sa ieee ad De Oe Os Ole Cle Cle: De Loves = no 7. Hancicapped Percent Ee a), [Loser and bum [oct TPA with double IT exemption [ocx Tea wit normal exemption [lonnepacdic win asabity of oner extremist ©. Handicap ConiicatoEfectFrom [| 10. Handicap Cortcate fect To [TT] ‘11, Handicapped Cortfeate Date [) 12, Service Racont Page Number [ “To be filed as per Standard Designation Liet provided by HRMS Team of CRIS, (AS Employes iO ‘Bill Unit ‘Department i Page 3 of 5(Giaatication # (Fe be fitea by the SA dealing clerk oniy) i” 1.8No 2. Quaiifcation Level~ ae 8. Course* {Serena 4 Subjects Spectatization | [Duration a | 6. Boar/University* 7. Schoodnsttute Namo * [ [ [ At voinng?* Tlves re eee eens ener 8.P.Year* ] 9.Grade [ ] 10, Percentage [ ] 1.880 2. Qualification Lovel * (ee ee Se aa) Se eel 6. Boareanivesiy~ 7. Sehootinstte Name ap Year” 1. At Joining? * 1.8.No 2, Qualification Level* 4. Subjocts Specialization 6. Board/Universty * 7. Schoolinatitute Name * 8.P. Year” ] a.cade [ ] t0.Percentase J [ tn atvonng? Dre. ne (pee ee or 4.81No @ 2. Quaificaton Level (SSS) “a coo 4. Subjects / Specialization 5. Duration * 6. Board/University 7. Sehootinettute Nama * ] 9.Grade 10.Percentage 1 f f 8. P.Year* [ ‘.Atvoiing? * Live. [ne Sy 1:8No fl 2. Quaiffcaton Level 8.Couree* 4. Subjects / Specialization 5. Duration * ee i 5 eeaetes ctieotran sens i ears ST tee Dee a rT at conng?* Eble ee ee DECLARATION eS ____________ (rr in Captad bearing 0 hereby declare that al the Information furnished in Page No 1 & 2 of the “Employee Master jon of any inappropriate / misleading / alee information to the Employea/PF No. at Form” of HRMS is true. The undersigned will be eolely responsible for subm Rallway Administration. (Signature of the employee in FuN/T) (Tobe signed betore the immediate in-charge/supervisor) {Signature of the immediate In-charge/supervisor with stamp) [PASEnployesto ‘Bil Gait "Page 40f5 -‘The following documents should be enclosed along with the "Employee Master Form” of HAMS 1. Copy of the employee's Aadhaar card. 2. Proof of Dato of Birth of the empioyes. 3. Copy ofthe employee's PAN Card. 4. Documents showing Proof of Relation of each family members with the employee 5, Proof of Dato of Birth for each family mombers. '5, Handicapped Certificate of family members (if appicabe). 6. Documents showing the Dependency of farily members on the employee (for Dependents). 7. Bonafied Member Document of family members. 8, Document ID of family members. 9. Community Certificate of employee (f applicable). 10, Nationaity Cerificate of employee (other than indian). ‘The following documents are to be scaned from Service Records. 1. Character Cortticat ofthe employes. 2. Medical Certficate of the employee. 3. Handicapped Certificate ofthe employee (If applicable). 4, Educational Qualification along with marks sheet of the employee. Page 5 of 5