Emp - Code:: EDP Inward No. & Date (Supplied Free of Cost)
Emp - Code:: EDP Inward No. & Date (Supplied Free of Cost)
Emp - Code:: EDP Inward No. & Date (Supplied Free of Cost)
Emp.code :00
Note: If any child is physically handicapped, please indicate “Disabled” below the name.
If received indicate :
Sl. No. Scheme Certificate Control No. Authority who issued the scheme Certificate
- -
Not applicable Not applicable
(ii) The particulars given in this application are true and correct.
(i) The particulars of the members are correct:
(ii) The particulars of Wages and Pension Contribution for the period of 12 months
preceding the date of leaving service are as under:
(In case, the wages is not earned for all 12 months, the block of 12 months will
commence backwards from the last pay drawn.)
11. (Only in the case of illiterate Claimant (Pensioner) Left hand finger impression
Clark S. S. A. A. O. A. P. F. C. (Pension)
Dt. Dt. Dt. Dt.
(FOR USE IN PENSION PRE-AUDIT CELL) ,
The input data sheet verified with reference to the application and documents and found correct
PPO may be generated through computer.
Clark S. S. A. A. O. A. P. F. C. (Pension)
Dt. Dt. Dt. Dt.
Clark S. S. A. A. O. A. P. F. C. (Pension)
Dt. Dt. Dt. Dt.
NAME OF THE MEMBER :
NAME OF FATHER :
DATE OF BIRTH :
SEX :
ADDRESS :
PHOTO GRAPH OF
PHOTO