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    Id Card Form

    Uploaded by

    Rajgauravkatiyar
    This document provides a format for retiring or retired employees to submit particulars to receive an identity card. The format requests information such as the employee's name, identity number, date of birth, date of retirement, residential address, telephone number, blood group, emergency contact details, a recent photograph, and specimen signature. The employee must verify and sign the form, and a branch/office head must certify the signature and photograph.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Id Card Form

    Uploaded by

    Rajgauravkatiyar
    173 views1 page
    This document provides a format for retiring or retired employees to submit particulars to receive an identity card. The format requests information such as the employee's name, identity number, date of birth, date of retirement, residential address, telephone number, blood group, emergency contact details, a recent photograph, and specimen signature. The employee must verify and sign the form, and a branch/office head must certify the signature and photograph.

    Original Title

    ID CARD FORM

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    This document provides a format for retiring or retired employees to submit particulars to receive an identity card. The format requests information such as the employee's name, identity number, date of birth, date of retirement, residential address, telephone number, blood group, emergency contact details, a recent photograph, and specimen signature. The employee must verify and sign the form, and a branch/office head must certify the signature and photograph.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    173 views1 page

    Id Card Form

    Uploaded by

    Rajgauravkatiyar
    This document provides a format for retiring or retired employees to submit particulars to receive an identity card. The format requests information such as the employee's name, identity number, date of birth, date of retirement, residential address, telephone number, blood group, emergency contact details, a recent photograph, and specimen signature. The employee must verify and sign the form, and a branch/office head must certify the signature and photograph.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Annexure-I

    [Annexure to Instruction Circular No.10576/PA/2009-10/11 dated 29.06.2009]

    Format for Submission of Particulars


    for Issue of Identity Card to Retiring/Retired Employees

    1. Name of the retiring/retired Employee : …………………………………………………………….

    2. Identity (PF) No. : ………………………

    3. Date of Birth : ……………………….

    4. Date of Retirement (Superannuation) : ……………………….

    5. Residential Address : …………………………………………………………

    …………………………………………………………

    …………………………………PIN .……………..

    6. Telephone No. : …………………………………..

    7. Blood Group : …………………………………..

    8. Name & Phone No. of the person : ………………………………………………………..


    of emergency contact
    …………………… ………………………………..

    Affix
    Stamp Sized
    [3.5 cm x 2.5 cm]
    Recent coloured
    photograph

    Photograph of the Specimen signature of the retiring/retired employee


    Retiring/retired employee <in black ink>

    Verification: I, Sri/Smt. ……………………………………………………., son of/daughter of Sri ………………………… …


    ………………………….., do hereby solemnly declare and affirm that the information furnished above are true to the
    best of my knowledge and belief. I further declare and undertake that I shall be solely responsible for safe keeping of
    the Identity Card and its proper use.

    Place:

    Date: Signature of the retiring/retired employee in full


    CERTIFICATE OF THE FORWARDING BRANCH/OFFICE
    Certified that Shri/Smt. ………………………………………………. ………………………….. has
    subscribed his/her specimen signature as above in my presence. His/her said
    signature and the photograph affixed above are attested.

    Date: Signature of the Branch/Office Head

    Branch/Office
    Seal

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