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  • Declaration Form For All Types of Passes: - Railway - Division/Workshop/Unit

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    Sanjeev Kumar
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    This document contains a declaration form for railway employees, pensioners, and family members to declare their service details for the purpose of obtaining various types of passes. It requests information such as name, designation, basic pay, pension details, service history, family member details, address and contact numbers. The applicant needs to sign an undertaking that the information provided is accurate to the best of their knowledge and hiding any information could lead to disciplinary action. Required documents like PPO, pass identity card and photographs need to be attached.

    Original Description:

    Declaration form for Railway pass

    Original Title

    Declaration-Form-for-Pass-PTO-&-Complimentary-Pass-to-be-submitted-by-all-Railway-Employees-&-Pensioners-every-year

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    This document contains a declaration form for railway employees, pensioners, and family members to declare their service details for the purpose of obtaining various types of passes. It requests information such as name, designation, basic pay, pension details, service history, family member details, address and contact numbers. The applicant needs to sign an undertaking that the information provided is accurate to the best of their knowledge and hiding any information could lead to disciplinary action. Required documents like PPO, pass identity card and photographs need to be attached.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    851 views1 page

    Declaration Form For All Types of Passes: - Railway - Division/Workshop/Unit

    Uploaded by

    Sanjeev Kumar
    This document contains a declaration form for railway employees, pensioners, and family members to declare their service details for the purpose of obtaining various types of passes. It requests information such as name, designation, basic pay, pension details, service history, family member details, address and contact numbers. The applicant needs to sign an undertaking that the information provided is accurate to the best of their knowledge and hiding any information could lead to disciplinary action. Required documents like PPO, pass identity card and photographs need to be attached.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    ____________________ Railway __________________ Division/Workshop/Unit

    DECLARATION FORM FOR ALL TYPES OF PASSES


    (For serving employees/pensioner /family pensioner – including widow passes)

    To,
    DRM(E)_______________________,
    CWM _______________________,
    _____________________________.

    My Service particulars of is as under for declaration of passes:

    1. Name of Employee/ pensioner / Family Pensioner :_______________________________________


    2. Designation of Employee / pensioner :__________________________ Department :____________
    3. Basic pay / pension/ family pension : __________________________________________________
    4. Grade pay / level : _________________ Pay band /Scale : _________________________________
    5. Present/ Last working station : _______________ Working under :__________________________
    6. Basic Pension on retirement : _____________________ Last Basic pay :______________________
    7. PPO Number : ______________________________________________ Dated ________________
    8. Date of Appointment: _____________________ Date of Retirement : _______________________
    9. Date of death of pensioner (in case of family pensioner) : __________________________________
    10. Post retirement pass identity card No:________________ issued by:_________________________
    11. Details of family /dependent members :

    Sr. Name Relation Date of Identification marks


    No. birth
    01
    02
    03
    04
    05
    06

    12. Attached photographs of above family members / dependent members as per pass rules.
    13. Addrees : ________________________________________________________________________
    ________________________________________________________________________
    ______________________________________________Pin Code : _________________
    Contact Number :(M)_______________________________(LL)____________________

    UNDERTAKING CERTIFICATE :

    I the undersigned is certify that above information is correct as per my best knowledge & any
    information hides may lies to DAR action.

    Yours faithfully,

    Signature/thumb impression of Applicant


    Name of Applicant (________________________)

    Encl: 1. PPO 2. Pass identity card 3. Photos 4. Money Receipt for widow pass (whichever applicable)

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