Data Entry Form

1 Department HIGHER EDUCATION

2 Name CHANDER PARKASH
3 Father’ s/Husband Name BALDEV Singh
4 Designation COMPUTER TEACHER
5 Sex MALE
6 Class
7 Pay Scale/Grade Pay
8 Basic Pay
9 Office name & Address GSSS GULER THE DEHRA KANGRA
10 Place of Posting under which constituency DEHRA
11 Home Resi. Address Phone No. VPO KATORA TEH JAWALI KANGRA 176027
12 Residence Constituency JAWALI
13 Already Exercised Election Duty( If Yes Select at which) NO
14 Select as(PRO/APRO/PO/Micro Observer /Sector Officer ) NO
15 Home Constituency JAWALI
16 Date of Birth 31-10-1985
17 DOR/DOE Contract
18 Mobile 9816568453
19 E-Mail Id Cp.choudhary49@gmai.com.
20 EPIC No. HVJ0481804
21 Voter register at AC JAWALI-9
22 Part No 103
23 Serial No 91
24 Addhar No. 214784347872
25 Bank Name SBI
26 Bank A/c No. 31712570959
27 IFSC Code. SBIN0003248
28 Status
29 Employee Type Contract/ Regular
30 Remarks
31 Whether any criminal case registered againstthe official NA
(Yes/No)
32 Whether already appointed as BLO/Blo Supervisor Yes/No NA
33 Whether Handicapped if yes percentage ?( Enclose NA
Certificate)

Note:-If Already appointed as BLO/BLO Supervisor and handicapped then copy of appointment order / Certificate of
Handicapped may be attached. If the same is not found attached then concerned employee will not be treated as for
Exempted .

Signature and stamp of

Head of office