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Dau, of joining i n \he Go\rt. S,ervlce : ') • 1 CY{ ') 01"> M

'Date o f jolnlng in \he DOP :

F.ilheT & Name S I\J'" 1H' I'M n I\ \ /\I RO

Mother's Natne hA~rl f\ Pl\\ P0 (l-'Jtta vo Oo
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Mat1tal Status UNM I\RR.HD
Spouse N:ame '

Children's Name:
1._ _ _ _-;,k/
_______

2. 7
3.
- - - - - -- -- -
Family Detail (Father, Mother, Spouse, Children and any other fomlly momborJ
Family Member Name Relation Date of Dependent If Employed , name th9
Birth (Y/N) depart me ht.
51\ M\~ KAt---ITA ~A1H~R '24/f>/6~ £X- A\t\--'1
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PATRO
K.AB1TA PATR.0 \y'K)1rt~R. to/q, t:H

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Category: G&Nftf\L
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Religion :_H_t_N-----'D
_U_ _ Identification Mark : D
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Blood Group B ,t\/e._ Height (In Centlmetero) : \ : \ ~C.Ul

Home State DD W,lrl A Home Dlstrlct_ ~

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LTC Horne Town B£P}-\A ~U R..,

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 Personnel Management Information System Form

Name of Employee: SU BHE~I k,UMAQ PATRo

DateofBirth : \b- L1--\99S
Date of joining in the Govt. Service : 2-1- Ot -10'l'l.
Date of j oining in the DOP :
---------
Fathe r' s Name SAtvlIR KANIA PATRo
Mother's Name kA Bl'T f\ PA1 RD (Please do
not staple)
Marital Status UNMARR.tED
Spouse Name •

Children 's Name:

3. _ _ _ _ _ _ _ _ _ __

Family Detail (Father, Mother, Spouse, Children and any other family member)
Family Member Name Relation Date of Dependent If Employed, name the
Birth (Y/ N) department.
S~ M\Q.___ lZAt---trA ~A1H~R 24-/b[,~ f X·-ARM'/
PATRO
K_AB1TA PATRO ~I01H.~ t0/9,/'fl

Category:

Religion ----'-t-'-N
:. _ H __c...D_U__ Identification Mark :

Blood Group B-t\le__ Height (In Centimeters): l}s'(Jt)

Home State OD Home District GtANTA~

LTC Home Town B£~A~u-g.__ Contd ... Pg/2..
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Present Address : S UAA1 VIHAR., 2:' 1DLAN~ TuLAQ\ N A.C1 AQ_

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Permanent Address ~UPA::I \/!HA ~ ' -\DLA~l E \l>LA- ~ I l'\lA~A-(l

BB\U-lAMf-t> R,, OiA~LTA-tV1 , t,Dl.9.t{ 4
PtN - :/--G,000 \

GPF/CPS No.- -- --- - E-Salary Code :_ _ _ __

Education Detail (photocopies of the certificates may be enclosed)

-
Edu. Qualification Board/University Year of Marks

,o~ • H£8
Passing

2 J9 L\
%age

99 ·;.
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tv6k.n ~vmor Po¾ro / 1"10

Dated : 11P 2..1-- l-:- 2 '2.
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Name/Designation/Signature of the Employee
Place: l<o.b,Q.Ur:JOl, O~C\f