Statement Showing Fixation of Pay due to completion of 18 years continuous and

satisfactory service in terms of G.O. No 437-SE (P&B)/SL/5S-408/19 dated 13.12.2019

1. Name of Institution with Address :

2. Name & Designation of the Employee :

3. Date of First Joining with Approval No. & Date :

4. Date of Completion of 18 years continuous and satisfactory service:

5. Date of Option for coming under 18 years benefit :

6. Existing Basic Pay as on (Date of option for 18 yrs. Benefit) :

7. Basic Pay after adding one increment in the same level :

8. Pay to be fixed at next level due to completion of 18 yrs. Service :

9. Revised Basic Pay (Level: ………….... Cell: ………...…….) :

10. Date of Effect :

11. Date of Next Increment :

Submitted to the District Inspector of Schools (S.E.), …………………………………………. (Name of District)

Signature of the President of Signature of the Secretary of

the Institution with seal the Institution with date & seal
 Option of 18 Years Benefit
(In terms of G.O. NO. 437-SE (P&B)/SL/5S-408/19 dated 13.12.2019)

I Sri / Smt. ……………………………………………...……………………………………. Designation ………………………………… of

…………………………………………………………………………………………………………………………………………........……………….. School
completed 18 years continuous and satisfactory service on ……………….………………………
I do hereby opt 18 years benefit on ……………………………………………………… (From the date of entitlement /
date of next increment).

Signature of the employee

(With Designation & Date)
Countersignature of HM/TIC
With date & seal