SWARUP

SERVICE B00K
aerd

ndhwa

aHarrt 51 T4 (Name)

ye (Designation) I ET-2 TuHAdel

5T4ta(Office)
 210ge

(Oath of Allegiance)

.do swear/solemny affirm that I will be faithfully bear

true
allegiauce to India and to the Constitution of India as by law established meI will carry
out the duties of my office
loyally, and with impartiality.
(So help me Cod)

IT (Notice)

(Money deposited in the Saving Bank as security for the proper discharge of his official duties b-
the official to whom this service book is used is liable to for freiture for
any misconduct, act or commissio
on his part in virture of his official position which involves loss of money either to the Govt. of to an
person, this is a condition of his employment in the Government Service)
 G.PF Account No
TH TT J u (Name &Surname) 1RT l - a
2 fdcT 57 TTA (Father's Name)

3
(PostalAddress)
b-08- 1919 THTTUCT
(Date of birth in figure &words) ps SaitES 3sasIRÝ Attested by)
S
(Caste Religion or Race)
(Exact height)
TETPT tTT (Mark of ldentification) ( U UA Ë eABR Buea c&G Aea
8 efren aNec Fryfn vTT (Educational Qualification)
art aT aT fa.fa uft fa
(0 ...6.S(moth) 200 ..almecsTa Asdle. .... 1ele...

(1) ..2 ....193 -1:HtuSTa). aim. ..

-*-...... ....R1

(11) .1o** ..199...5i5.ntnya.9 . .

..I nM . A.
(iv)Cmpuka diplana. .90.2...

hd..
****
Tc
(v). SC 2.0.13
MED 20l6 of left hand)
9 7tet a ET2 3iTe va GTforat s fATPMmband Higerimpression Sendhwa
(Fore finger)
(Little finger)

(Middle finger

(Thumb)
(Ring finger)
(Signature of Govt. Servant with date after every 5 years)
10 91TRTC6g 5tqi EFTTERa i
(1) cL ..o1-07.2003...
...
(2)
(3) st
(4)
(5)
(6)

Signature of attesting Authority

cbHTC

O1 a e t a T T ato-a
02 3itadfkT. etea tytre
03
 atAT aTAT 1985
TEzyeT T4ch a5tart HyE
51H 34in 8
T AT 1985 3-afa art f ATH A}a
yeqy TE6 5faTt EHE

3Fria iqr i aT, a fafafèe otrumy gTa A ferq 3feefaa afs/afaT T f Ht ofian a1/
1985

fe-
Hq f e fu
faba-T
5. HTHfAdra / fadfNTfai T/5 TH 3HT fET

TTUTT

etcaTogT aiouT T

2 -itefcuneur
87
3 3712T- eftetotG Iiur

fHT%.18.. HTE.D. ...20.17....

Rak-ues
..4 zl)aSeias
2-chouhan ziTel
 aT TAT 1985
TE29VT T H h aaTt HqE
5TT 54T5 7

afbc-TH1
afar 3H1 fB
TT/Td

s t elaiesT a 4
2.

S373eRZST Slond

F2F.......

,
E... F ....... ****

2 hauhan 2ipr-ieT
 FORM 'D'
(See Rule 9 of the M.P Government Servant's Famil Benefit Fund Rule 1973)

NOMINATION

Name of Father's/Husband's Name * ***********

***************************** ****** ************

Name and address of Nominee

RIa RT-o . ...
GTHSJ
******** *********************

fMeT.aSAIad)..CHSo. *********

2. Relationship with the Government ** *** ***** *****

-********

3 Age....U..

4 Date *************** day of.

Signature to the Government Servant....C * * * * * * * * * * * * * * * * * * * * * * * * * *

Witness of Signature

1. atd)-sHq Counter Signature

chouhaM2 er
Note Nominee shall be wife of husband minor child or children mother of father
(in that order)
neoositor No..... G.P.F. 9 BB

Subscriber's Nomination
.... Provident Fund..
one member there of)
(when the subscriber has a family and wishes to nominate
as defined
hereby nominate the person mentioned below who is a member of my family

Rule .... of the... * *

to receive that amount

that mays and my creditin
Provident fund .......... Rule... ******
. .

amount has become payable or having become payable

the Fund in the event of my death before that
has not been paid.
Predesh
the name of the fund çoncerned Madhya
Here insent the word necessary to complate
etc.
General Provident Fund Contributory Provident Fund

as the may be.

Name & Address of nominee

subscriber
Relationship with the

Age
Contingencies on the happening of which
the nomination shall become invalid.

of the person
Name address & relationship
at whom the right
of the nominee
inany
shall pass in the event
of his predeceasing
the subsriber.

AT..
********* **************

DAY OF..
***
*******
* t * * *

DATED THIS. . ****************

Two witness to Signature

,MaAaLMANTR 60RE

RU PLATA
2
 For use by subsriber having family
Provident Fund No..

Form G.P.F. 3

Provident Fund Nomination

M.P. Finance Deptt. No. F.B. 914/73 R-1/IV dt. 10-9-75 See Rule 8 (3)
rule 2 of The
having no family as defined in the
. . .

Rule, hereby nominate the person/persons mentioned below to

receive the amount that my stand to my credit in the Fund as, indicated below payable has not been
paid. This nomination shall become invalid in the event of my subsequently acquiring a tamily.

address &
Name & Full Relationship Age of Share
are Contingencies on Name,
of the
Address of the with the nominee payble thehappening ofrelationship
which nominee person/person's if
nominee/nominees Subscribe (to each)
Shall become nominee right of the
invalid nominee shall pass in
the event of his/her pre
deceeasing subsriber
3 5 6

- Np-

Dated ****
******
.
.

day
Qd t... ******

two witness to signature

Name Address Signature

1 BASANTI KHANDE LWAL INDIRAOLONY
SEnlhu hdtha
2 Shobhd chouhah Signature of subscriber

Space for use be Head of Ofice/Accountant Generals Ofice

Nomination by Shri/Smt/Ku...**** ** Signature of Head of Office
Account Office
Designation.
Date of receipt nomination.
** Designation
Date
 FORM-E

Nomination For Family Ponsion

(REFERRED TO IN RULE 117)

my family members of to receive

Ihereby nomination the person/persons mentioned below who, are
Government in the event of my
in the order shown below the family pension which may be granted by
death after completion of 25 year qualifying superior services.
Whether Mamed or unmarried
Name and address of Nominee Relationship with Age
Govemment Servant

taTe
AlOallecT

NB the Government Servant should draw lines across the

blank space provided after the last
entry to prevent the instruction of any
name after he has signed.
.. Day of. **** ... 20.
Date

at.. * ***** l a l l o

Two witnesses to Signature Signature of Govemmet Servant

1
T..... . *. Hdf 2gejMaiy
2 ChohaM ZT>T
(To be filled in by Head of office in the case ofa Non Gazetted Govt.)

Nomination by . * * * * * * * * * * * * *
Signature of head office

Designation.. ****** ****************

Office. *******.*.*** ***

 FORM-A
See Rule 4 (6) (a)]

NOMINATION FOR DEATH CUM-RETIRMENT GRATUITY

When the Govt. Servant has a family and wishes to nominate one there of I hereby the nominate
the person mentioned below who is member of my family and concern on him the right to receive any
graiuity by sancioned by Government in the event of my death.

Name &address of nomineesiteRETOR STiGaT gRA) R:7.0 ERGq1A

Relationship with Govt. Servant qtd

3 Age 41
Contingencies on the happening of
which the nomination shall become
invalid

5 Name, address & relationship of

person if any to whom the right
conferned on the nominee shall pass
in the event of the nominee predeceasing
the Govt. Servant.

DATED THIS. ..DAY OF.. 19 AT... .. .....

Two witness to Signature-

l i h q

1....
H d 2o03teh Signature of Govt. Servant

2.... houhanstTule Designation

(To be filled in by Head of office in the case of a Non Gazetted Officer)

Nomination by.. * **************

********* * * *

Designation. ****** ************ *** office.

(SigastiPl E Besigiatdnafawrú

Date +*******************
 Whether Additional Date of
substantiveof 1f officating here Pay in Other Signature of Roference to pay recorded
Appoint- Signature and design Reason of Signture of the Leave taken Signature of
oficiating& Statethe substantive comluments pay
ment
Government ation of the Head of the Date of
terrmination Head of the
Head of the ano Hesd
nature and
of the punishment or consure or
appointment falling under officiating Servant office or other
substantive durationAttesting Officet ward orofice
Name of Appointment whether Officer or other praise
A-Y office or other
office or other attestingemination
aeo (SUch as
and Scale of pay permanent or appoinlment FT TE the
term pay of appoint
appoint- Atesting
Officer in attestation ofO promotion Officer
temporary columns (1-8) ment Dismisal etc)
hfers fAg
Tatau aga
3- a
HTUTaRu (GR ETAT wHTUTUDT
(7191 1 R 8)
Rs PRs PRs
0 11 14
T
2spo 7.63 RanoRaitt atrer
S 5 H15919-407ajfy 2003/161
31S
6 201 33RT 31 T4T
-
70do 11 11
HE, fc-gart (EM.)
 Whether
substantive of If officating here Pay in Other Ad Jitional Date of Signature of Signature and destgn-
Date of
Reason of Signvsture of the Leave taken Signature
ad oftheofRaference to pay recorded
punishrment or consure or
of the termination Head of the nature and
officiating& State the substantive comluments pay Appoint-Government ation of the Head
office or other attestingermination (such as
Officer or other duration Atte Faward or praise of the
Name of Appointment whether ment
and Scale of pay
substantive appointment falling under officiating Servant
Oicer in attestation ofO
appoint promotion Attesting office
permanent or appointment AT T the term pay I 4 7 dh g URI. columns (1-8) ment Dismisal etc) Oficer
temporary feHi 34612 34
T 344
MHTUTRUht (H TeTafd yHTutarurbet 3/a1a
a51 faaeUT
(TH 1 8 )
Rs PRs P Rs P 10 13 14
EraT TRTH5 TERT 12y28 5
30. 6T2 33R 5 Ri91
5772008/ 20-17T13TS74j5 SAK
15
(7o0 (4bop-12sse)
1:.0B 7 o0
24.12.1)
err, forc-A (..)
 Whether
Signature and design Reason of Signuture of the Leave taken Signature of Raference to pay recorded
substantive of If officating here Pay in Other AdJitional Date of SIgnature of Date of termination Head
Head of
of the nature and
the nature ead or tne Punishment or consure or
Officer or one duratioan
ation of the Head of the
officiating& Appoint-Government office or other award or praise of the
State the substantive comluments pay office or other
attestingermination (such as
Attestin
Name of Appointment whether substantive appointment faling under officiating ment Servant dPpo Atesin9 Office
and Scale of pay
Officer in attestation of promotion
Officer
permanent or appointment RT 1 the
term pay -19 TH columns (1-8) ment Dismisal etc)
temporaryY
hfrs Pryf i 3Tf a1 faaU
ERI&R HTUTeurht (G YEIAG TUtU 3faoi
(71TH 1 8 )
13 14
2 Rs PRs PRs 0
2
400b F123 std 12 era, freT- (.)
3
P)TP
 Whether Reason of Sigruture of the Leave takenSignature ofRoference to pay recorded
Date of Signature and design
substantive of If officating here Pay in Other Ad Jitional Signature of ation of the Head of the Date of termination Head of the nature and e oe Pinishment or consure or
officiating& State he Substantive comluments pay AppointGovernment office or other
attestingemination (Such as Officer or other Office or other
durationAttesting Office zward of praise of the
Name of Appointment whether substantive appointment falling under officiating ment Servant apPpoint- Attestr office
Officer in attestation of promotion
Officer
and Scale of pay permanent or appointment RT Te T the term pay - 4 H
columns (1-8) ment Dismisal etc)
temporary
hfes fagf 3fafR (A YATATA TUrU aTf2 a1 farre
MTUTYet 3a14 ferart
3fT91
(61H 1 8 )
7
2 Rs P Rs. PRs 9 10 11 12 13
T9 E3
osTatat T 5T2173T|
796NT37.3.T-3pE72 2R-133 T726TN7t1332014 1 Eraft
3P 1H A0-t1 so-834oo
45-2seea
BEO
46so
Sepdhwn
69h0+-6so E O
72op +16sa BB Sa ol 21 BEO
hdhwa
usOO2s000
l650 TU66 65p 9U6 Tap(5
Pndthwe
us00- es90o 1139t 1G 5 9389
16 50 B.EO
apl6 Cndhwa
 Whether
substantive of If officating here Pay in Other AdJitional Date ofSignature of Signature and design
Date of
Reason of Sigrviture of the
Head of the
Leavetaken Signature
nature and e20 o e
of Rcference to pay recorded
Punishment or consure or
Appoint- Government ation of the Head of the termination
officiating & State the substantive comluments pay Officer or otne oftice of oer award or praise of the
Name of Appointment whether substantive appointment talling under officiating ment Servant office or other attesting
nination
dppoint
(SUch as
Attestir durationAttesting Officen olfice
and Scale of pay RII 7T the term pay T9 51| Officer in attestation of ment promotion Officer
permanent or appointment columns (1-8) Dismisal etc) 3q1
temporary fi
3taiRE 34 Tuitvurt
TYA 3
MHTUTUTdt (GR TETaAHTUTeRUD 3qta
a51 faarUT
FRITT (a1HH 1 8 )
3FRTT
Rs PRs PRs 9 10 12
13
-1 3797T fa
ferE-fFpfar
T2013 274 2
2016 37 271/E ETRT 5
15 rd
Ha DK
1i 01 01.PO16 TH 93\ GIEILTE
-34BPDt2*0
.32e.
CE0107-2046T TeT
113232
20
 Whether AdJitional Date of Signature and design- Reason ofSigrstureofthe Leave taken Signature ofReference to pay recorded
substantive of If officating here Pay in Other gnature
Appoint-Governmentof ation of the Head of the Date of termination Head or tne nature and Head of the punishment or consure or
officiating & State thee substantive comiuments pay office or other
office or other attestingermination
Officer or ward or praise of the
Name of Appointment whether substantive appointment falling under officiating ment Servant or appoint-
attestation of
(Such
promotion Attesting durationAttesting Ofice olfice
HI45 g TR. Officer in
and Scale of pay permanent or appointment RT U 1 the term pay columns (1-8) ment Dismisal etc) Oicer
temporary
HTUTUTbe
pHrutrurbel 37414 3Tf a1 faqeU
RIAIU 3
3RT ( TCTH 1 R 8)
Rs
2 Rs PRs 10 13 14
- 3 8 4
50 jauceRC9-6 feathe-t-012 ER tET
19-1
3-7 6&
Lo o-o2o14
Glso ol-092s1
 Whether erence to payrecoded
Pay in Other Aduitional Date of Signature Signature and des g Date o Reason af sgitire of meLea
Date of
substante of officating here substantive comiluments pay Appoint-Governmen ation of the Head of the erminaton Head of nenature
e and
and pumsimert or consuTe or
officiating & Stae the
office or other attesting
nation (such a Oiceror ather e r d or prarse sf the
Name of Appointment whelther substantive appoinimend faling under officating mens Servant Officer in attestation of
ppoint- Attesting afice
and Scale of pay the tem pay H T Ry promotion Officer
enen or appointimet R columns (1-8) Dismisaletc
temporaryy
Py HTTR (a a H T
a
(STH 18)
Rs P Rs Rs 12
10
-20
2o16
3 1221 2 15 3
S 31T(T)TATEAT 3737atrE
o 0 1 2016 93 -348
EATeR T (ucpo-(25-5)
OTUT 2015
3 3-34& S+3d
91734+sl sdndhwe 22 227 |412 27 5EOTEid
120tD+ 34o B.8
53-343oti Sehdhws
ERSTSTETRT
2 4p t+ 3 4co o7
$3 248p +2 a nde
 Whether Signature and design- Reason of Signature of the Leave taken Signature of Reterence to pay recorded
Other AdJitional Date of Signature of
substantive ofIf officating here Pay in
substantive comluments pay Appoint- Government ation of the Head of the Date or ermination Head of tne
Officer or otner
nature
anoofica or other
punishment or consure or
raward or praise of the
officiating9& Statethe
office or other
attestingermination (Such as durationAttesting Officer
Name of Appointment whether Substantive appointment faling under officiating ment Servant Officer in attestation of
of appoint-
promotion Attestin9 office
and Scale of pay permanent or appointment T Y the term pay T9A 5 YIEh columns (1-8) ment Dismisal etc) Officer
tempora 34-4
HTUUT 34afa 37tarcpri 5
FIUA 3TR
RT FT-HRU 3foRI
(PIT4 1 8 )
Rs RS. Rs P 9 10 11 12
129s0 a
48 6
fam -
H.H.TTi TET. KGT.fa.PITHiiaa
22/.42fain o-07-20177 31 T720T37
2208-2017
.
57 deT T9.0 4860 36.60
*
fen062,201
E RT
 Reference to pay recorded
Whether Reason of Signature of the Leave taken Signature of
Adu itional Date of Signature and design- or
substantive of If officating here Pay in Other
Appoint-
Signature o
Governmen ation of the Head of the
Date of
termination Head o nature and
office or otner
Punishment or consure
ravward or praise of the
substantive comlumernts pay Officer or one
officiating& State the
ment office or other
attestingermination (such as
durationAttesting Office
Namê of Appointment whether substantive appointment falling under officiating Servant attestation ofO
ppoint-
promotion
Attesting office
Officer in Officer
and Scale of pay
permanent or appointment RIT T the
term pay|H4 H columns (1-8) ment Dismisal etc) Tata ga 337
temporaryY yeia
37fR5 afarpri
RHT 3 HTUTFRU
F1 faaqUT
(TH 1 8 )
14
Rs PRs Rs 9
13
Haudenaaayaia ri l217
.. 3n.a.aTe //04-
22720197172 4 T07 20T T T
i 1/7/246 a a n2 1H&
413d0
93n9-212
2o8
 Whetner Date of Reference to pay recorded
Jitional the Leave taken5gnature af
ead of of
Reason of
substantive of If officating here Pay ir Other
Signature o Signature and design-
Date of Sigrviture
the nature 2
Panishment or consure or
Name of Appointment
officiating &
whether
State the
Substantve

substantive comluments
appointment falling under
pay
officiating Appoint-Governmens
ment
Servant
ation of the Head of the
office or other
attestingerrnination
appoint-

termination
(Sucn 2s
Attesting9
office or dner
Officer or dtne duration Attesting Office
ravward or praise okthe
office
and Scale of
pay permanent or appointment T T pay
the term ATY 251 gs
. Officer in attestation ofo ment promotion Oficer
temporary columns (1-8) Dismisal etc)
FUTHIU 3R TaeUT
HTUTRUbt ( ia TUTtua aferr
(TH 1 8 )
2 Rs PRs PRs 7
9 10
22/019/1/25 feoS7io2019fr
9300-2ug4o Z
340 -
7
20 9
D f {R
y5900 ol 2D
7
2
48700 07
22
 Whether Signature and design- Leave takenSgnalure o
Reference to pay recorded
Date of
Reason of Signature of the Head of the punisnment or consure or
substantive of If officating here Pay in Other Additional Date of Signature of ation of the Head of the termination Headof tne nature and
officeor other reward or praise of the
Name of Appointment
and Scale of pay

officiating&
whether
State the
substantive
Substantive comluments pay
appointment faling under officiating
Appoint- Government
ment Servant
offcaor other attestingemination
appoint-
Ofier in attestation of o ment
columns (1-8)

(such as
promotion
Officer or otner
Attesung
Officer
durationAttesting Otice rewaoffice
permanent or appointment RT TE the term pay HIY 5 g ATH. Dismisal etc)
temporany femis
HTUTTRUjht 3Tf 1 faaU
(GTR YATATd HTUTUi 34aTe
(25ITH 1R 8) 3Te BT-T)
13 4
2 Rs PRs PRs P 9 10 12
Q
ol O4.2n7 o-25 (cod dpo/
01 o
2 cD8
ol a429 11
|Dl. oG-2-olo
ol. o4. 20l
475/
ol-0.2 /2 425
Dl.a4-2o/3 4
o14 2o (3 4 SPo-23DoD 1ds 7p o4so nn
Ol.o-2 13
O1.lo 2014 11
Dl 1o 21S
247|4s
Ol-0l 2o16 3-348+3
ol.7. o 16 3343L4
11
ol. )-2o7
ol o7 2o1 8 43 8ot14
 Whether Signature and design- Reason of Signature of the Leave takenSignature of Reference to pay recorded
ation of the Head of the Date of Head of the punisniment or consure or
substantive of f officating here Pay in Other Additional Date of Signature of
ermination
termination Head o te nature office or other reward or praise of the
officiating& State th substantive comiuments pay Appoint- Government o f o r other attesting (Such a Offcer or oine durationAttesting Office office
Name of Appointment whether Servant Oth.er in attestation of Oappoint promotion Attesting
substantive appointment falling under officiating ment ment Officer
and Scale of pay permanent or FT Y T the term pay H19 6 1lb columns (1-8) Dismisal etc) ztau Ha a
appointment yeta 1 U
3
temporary
sfaR (TH TETATAHTUeoUa safe 3faari
FT97 3R 3feremR EKAIN
1 faeru
RITT (71C14 1 8 )
13 4
2 Rs P Rs RS 10
ol.7-2o18 h 2 - sJn h31
ol. 29 M L3/12| T0TTTET
T915OKT6-7SS1TC
O.s7. 202
7-2o 2-14 2TTET
of-6 2h
TTTrtrTttu
TTUET7TET STUT UTU
TOT T ATTTTHT
eTtgpysat t OFu0Et
TETY5
Z11aPanchavat Barwani (M