E.R. FORM No. - 10. i. sali. séaraaa - 10 (See Rule 2 of Part If of Annexure 1) SERVICE Book Adm qasan - Namne (Full) PEESA. NARAYANA RAO. ‘bm fang) Provident Fund Account No, (PeBstis Bom eT Ie, | 3. Podtil Life insurance polley No. BaF Abs bee Bol So. 4. Permanent Home Address (in Full) Yo 1) oie (El peddeseedht (yi) = pathapatram (red SS Saike knlam (22D S. Fitther’s name fand alee husband's wane in the ease. cof a wou Governuneat Servis] and residence dog $e [ediag asta § woud sonihes! azo a Peesa- Simhachatarn & Natiowaliy [not aciiren of Toa, Namber ant ite ‘ef the Certificate of eligiility granted by she govern sent af india} wrbsia (eo Bees tat Hed Geays Heeemcs as uga opitigsss S205, 30) Unditows — Hinder Ifa member of ichesialed Caste” Scheduled ‘Tribe Particulars of Casey Tithe. enya nents Bene DSS wes BF SORE ep poliratt- velama , | Date of Binh by christian Era Wherever possible “ip saka Een fot in-wocds end figures as deter- mined by the compitent nuthority} eggs vordagand pyfasesiarbom Uayerozten, Doguacty m8 ac optiom Batata % ‘Bcalional Quali Foxioe. ‘O 25 - 08-1985 spac Pve = Pruguil ~ Gre nine eight -rhnee. rie Gaba) a er SRIKAKULAM. ET -Gelugu) ar-oct2er3, Ode Siadyors AS APSE, rebeges « 2b, Nov — 201.(aati by mesa te 18. Signatire avi dexigninion af the het sent [Widhout Shoes] re) “ymole an tke Le below Se Sah patle oth 2° belootte Led ry 13. Signaite of ese Governrpenit Rerva ore wl of the: atfeer or other antenting offers Adininistratve Onteg, rejearted te poses gos wae Boone se Gove Degree Coity IMG! be rep Wed vor eeatteste Ne art 14 4h ed ay 'leas Fi cri Se guds states tag al wuld be died Sen He TE Wye tess scorton dbus tensne, (2) For Memorandisim ry Se [Rs Memoria ai ey et Strtesuzeas: dev pon gosneces |"Foe aibitbenal extafes lin respect of gua cota Sac he’ Chivermaneint Seer ke (py Dowails of pirewioin qualiticatinn service Uheny. (2) Verification of character and antecactents, (35 (ath of aligance affirmanin ro the sen yitution (4) Prostiation of Miniticad certificate of fineaxun first syrermment Secerce 48) Receipt of Nerminations for prenvidest, Prin and Dy sath Gumi Retire rants, (4) Blcction of tay Jeane andl pensiueradiys. (7) Rates of eaye satay ana pedir contnibelton ind particuats of tecomeey while or doreing acrvice ete), ete 5 Sai abies Dt Mags oS Soca 12) Yas aHEjStS BBerse IN jonah ATES ayptencia} romtm adtociayen cacpaautgy Be) SSH jo (hog stags apouse wotihsu, () Ses. 4 Sten hesasrde ty nea qi wrod! ostyf ioe BASPS Dit) douedubt very stessui. —AgssSlur sneraben'= 9.simhechalam pasta (fathin) ———$§ - D)_Lsvfletha . paatio. Custyie)) sBescionas et suey tat th teem elas i eh Beted —_Ql-ouk =2013 fey wo. Ozona | ap tek mM vedliferl to telaegen __ ber 2 94 n : Bis wena (en) TT Ane « Reiuilnicrwrinry Oltbeae Gaye Dograr College they < SRIKAKULAM, Note z+ Declaration received fram the Goverment Servant, Yike (1) Declaranon of hse ww fue firs pote of leave raved conccation. (23 details of family mombers for the purpose of family peusinin etc. may be appeaded (in original) with the vervice book, AESQL t Smog sdlnsred (N MeQh SArnscteeey Mogae odes mteos Oy Ges Uy) atvoD tess Seip ou Dia tice dejo Tete ates Qdravel (woes go) umuesesueasysName of prasvand senlo of pay (site whether subsiaalive or aificinng and whother post is Permanail oF teraporaty) antyresstesSory spetyeeae Bs Gpiclutem aes Satyr neta Oe ere bee sebecuts) Officiating stale ssubytantive: ‘appaditrsent vbtaibdtots teas goes actymaia Supe 4 ‘Naration in chronological order of even to like intrants (with iy seals of pay and the names of office and Ieaye inceerents ft onfiraation, passing Or | Head ofthe Office Pay in punishmentsrewad ete,| OF ower attesting Swbitet, officer, Pas acl By ye set " (eeyors, sensagotue . i ‘Saet som) bem 7 eee, a] SS | wig reaene, | TAOS | PetonseEee bet Sais abys Hotty miwEneon Blowts Sonedoct pantidoam eds sialions of posting) Signature of the scemif alive Ors? Govt, Doses Collago Tien. { {J |Allocation (Wherever Hecexsary) of peri of leave] for which Inave salary: dt hinge debits to another, “trac omar ing dearmeas pray if Shyam the | Resse 4% ree om Government | FOUR Se 2208 Date of effect Servait o2asneee a9 caysn Sg | wom asy do aaget oset ast Be Aah an umtae flea “iene ssp eatdasen Pins erga sotew | debitable Decoys ey westeetse 7 8 9 1p Re ponte, uk gry Inne oie eh) En. [ {—_ { iD Admintateatl’s|Oficer 7 {Ment SRIKAIUU AM, soe pay Tallane (iy CLL AM,