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HRT: 2-2 (54) 2003-72T. f c : 27.03.2024
HTats IYT/Office Memorandum
faqy : 3TH G0E TT I4, 2004/ Lok Sabha General Election, 2024-Reg.
Hqt/Ref. : Assistant Returning Officer-Cum-SDM, Palampur letter No. SDP-EL.N
41/2023-546-600 dated 21.03.2024

GyrdT f q Assistant Returning Officer-Cum-SDM, Palampur IRT GIRT 4 ¢

je qifg Yy Herg frffra yya 4HIR Assistant Returning Officer-Cum-SDM,

Palampur t fe# 02.04.2024 Tch G sqI

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 Employee Data Entry Form
Name* Home Resd. Address*

Father Husband Name* Epic No.

Gender* Vote Registered at AC

Mobile No.* Part No.

Email Id Serial No. in Part No.

Date of Birth* Already Exercised Election Duty(if Yes Select)

Date of Retirement* Select As*

Designation*

Employee Type*

Class (AB\C)*

Pay Scale* On Long Leave

Basic Pay*
Bank Name

DDO Code
Bank Alc No.

HRMS Code
IFSC Code

IFMS Payee Code

Employee Photo

Native Assembly Segment*

Residence Assembly Segment*

Place of Posting under which Assembly Segment*

Office Name and Address*