-1

yfaPi^Rm ^ 30^^ xrsr ̂

1. ̂ ̂ areRt"

2. vji-^Rif^ :

s-arrt^ ¥tP?t ̂ arl^ ^ arr^

4. 4dHM ^ grf^cjjf^fcjl ̂

5. qcf*iii ^cHHH

6. W W\ tjcTT

7. XT^ anf.^.

8. qcfqi-l WrfcRf Wl xj^ yf^

3pft wjfer fi

9. ^zrhRmr

10. ^ Ti^ ̂

H4lHdH

11. f^wol MiRd f^cj^ui ̂ .

cbH £TTRw ̂^ -TFT

ar^ ^rrf^ X7^ ̂^dd TJ^

J|-^ ^TTiff ̂ TI^1

CR)

# ̂ ̂ikmr ^ ^ ̂ an^^ t?^ 77^ ^ f^wT ̂Tj^ ^ 3rj^ ̂ 11 f^r^ ̂ ̂ ^ ̂ ^ ̂■

^ ̂ ^ ufPT^ ^ ^ ̂ ̂ ttttt^ :^- ^

R'll^ :W^T :

[an^^ ^ ^fTi%cr)

( aTTj^PT t+Jl-qfel'U ^ yij1-il )

^^tr^iRiid uTmr t ap^^ ̂ ant^ xm feir w ^rtrfOT ^ar^^ ^ ti w ^ yxTTP^RT viTTcn- t ^ifwrft

#/-^n^cfl. q^WT. ^^ ̂ ̂ff%^ 777 f^^^RFfhr ^ ti ctj4xji>^ ^

ticqpi^di ^ ̂ # I d-iqj Bt^ ^ (H^lel \3n1̂^

2. arrt^ ^ trf^ ^ Jily-fl^ RyM/Tj.xft.acjK. ^

TJt%"^/ af^

RdfttJ :^^STFT :

(qji^jfci^ ^rg;^ ^ FOTm]McidlH, T7^ ^7f%^

Annexure-I

APPLICATION FOR THE POST OF DIRECTOR ON DEPUTATION BASIS

1. Name (IN BLOCK LETTERS):

2. Date of Birth:

3. Age as on last date of

submission of application

4. Date of superannuation

from the present service

5. Present basic pay andscale of pay:

6. Correspondence address:

Affix

Recent

Photo

7. Mobile No.

8. Name & address of the

Organization wherepresently working.

9. Educational Qualification

10. Date of entry in Govt.Service

11. Posts held during last 10 years (in chronological order)

s.

No.

Post held Name and

Address of

Organization

Period Pay Scale

with

break up

Nature of duties

performedFrom To

-

1

1

DECLARATION

I solemnly declare that the details given above in theapplication form are correct to the best of ray knowledge and belief.In case any of the details in the application from are found falseat a later stage, ray candidature / appointment may be cancelled /withdrawn.

Date:

Place:

(Signature of the Candidate)

(FOR USE OF FORWARDING OFFICE)

It is certified that the details provided by the applicant asabove are correct as per our records. No vigilance / disciplinarycase is pending / contemplated against Shri / Smt. / Ms.— . If selected, the individual will berelieved immediately.

2. Gist of his/her preceding 05 years ACR/APRs is as under:

S. No. Year Grading / Marks

(Signature of the forwarding officer)Name .

Designation

Date

Place:

Seal of the Office