G. B. PANT INSTITUTE OF ENGINEERING & TECHNOLOGY Pauri (Garhwal) - 246194 (UTTARAKHAND) (AN AUTONOMOUS INSTITUTE OF GOVT. OF UTTARAKHAND) Ret: £29 ]D¥. OFF Date: 31.03.2022 All the HODs / Registrar/OIC library As per the approval of BOG, the SGHS scheme of govt. of Uttarakhand is to be implemented in this institute. For this, every regular employee has to upload the data related to him/her along with the data related to his /her dependent(s). The required data format for employee and his/ her dependent(s) is enclosed herewith Every employee has to submit the required data in the prescribe format and also upload online by the employee. As per the attached schedule, the employee of concer department has to submit the filled and signed format to Mr. Vinod Pokhriyal in the central library and help him in uploading this data online on the SGHS portal. If any employee is not interested to join this scheme, they will also fill the format mentioning ‘NO’ in his/her consent in the format. enered MP 1 Schaclule 2. SGUS. Formed for Cun|pteye Director 3. SHE Permat fey deperckd1 Department wise Schedule for Online data filling on SGHS Portal S.No. | Date and Day '04.04.2022, Monday 2. | 05.04.2022, Tuesday a, | 06.04.2022, Wednesday 4 ~/07.04.2022, Thursday | | 08.04.2022, Friday. _Department | ASHD, BioTech, _Library ECE, EE CSE, MCA, ME “Administrative block Any remaining Time _ 9.30AM to 5PM |9.30AM to 5PM _ 9.30AM to SPM 9.30AM to SPM 9.30AM to 5PM_ Me \te. alc HewEmployee Basic Information format for SGHS scheme [S.No. | Employee Type Regular/ Pensioner 7 Name Father Name - Mother Name wa Photo | Marital Status __| Spouse Name 7.__| Aadhar No. PAN No, Mobile Number Date of Birth Date of Joining Designation jay commission \e7" |__15. | Department 16. | Category(class) | Grade1/Garde2/Grad (47. {Scale : [| 18. |BasicPay 719. Bank name : i 20. | IFSC Code 21.__ Bank Branch —_t 22. AIC. No. L Declaration: | ..... declare that the above information are true to the best of my knowledge and If any information is found wrong then | will be fully responsible ‘ Consent: | am giving consent to join the SGHS scheme of Govt. of ; Uttarkhand: YES/NO Signature of employee with nameEmployee Dependent Information format for SGHS scheme [SNo. | Employee Dependent relation i (Son/Daughter/Spouse/father/mother brother/sister/adopted [ | grandson/ daughter - - - : | __1._[ Name of dependent a | Latest ee | Date of Birt - =| | Photo Marital Status Gender (M/F) ‘Aadhar No PAN No. Mobile Number - a Handicapped (Yes/NO) - Employee Dependent Address _ ——— _|_ Boas Group Location(Rural/Urban) - District Municipal - 7 Ward a . - Address Line 1 —__TAddress Line 2 Pin a Block H Tens 1 Village/city - - ©} 9) ~1] 00] on) a] 0] r0) Declaration: | .. ....declare that the above information are ie to ‘the best of my y knowledge and If any information is found wrong then | will be fully responsible Consent: | am giving consent to join the SGHS scheme of Govt. of Uttarkhand: YES/NO Signature of employee with name