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35 views2 pages

Eis Form

Uploaded by

vivek170402
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PROFORMA FOR NDMC EMPLOYEE INFORMATION

(To be filled by the employee in CAPITAL letters)

Employee Code: Employee First Name: Employee Middle Name: Employee Last Name:

Father/Husband: (F/H): Father/Husband Name: Sex: (Male / Female) Marital Status:


(Married / Unmarried)

NDMC Group : Blood Group: Designation: Division:


(A/B/C/D) (A+/A-/B+/B-/AB+/AB-/O+/ O-)

Department: Establishment:

Employee Status: Religion: Category:


(Permanent/Temporary/Deputation/Contract/Suspension) (GEN/OBC/SC/ST/PH):

GPF A/C No: Nationality: Govt. Accommodation Whether Probation or


(Y/N): Confirmed Employee:

Home Town (LTC): PAN: Health Card No: I-Card No:

Date of Birth Date of Appointment Date of Joining: Date of Retirement:

(DD / MM / YYYY ) (DD / MM / YYYY ) (DD / MM / YYYY ) (DD / MM / YYYY )


Pay Band : (VIth CPC) Grade Pay: Basic Pay:

Present Address: (Use The Portions Applicable):

City: State: Pin Code:


Residence Phone: Office Phone: Extension No. Mobile No.:

Permanent Address:

City: State: Pin Code:

January, 2013 Department of Information Technology, New Delhi Municipal Council Page 1 of 2
Family Details
Sr. Name Date of Birth Relationship Whether
No. Dependent
1.
2.
3.
4.
5.
6.
7.
8.
Family Photograph: [Family includes wife/husband dependent children, parents,
widow/sisters/widow daughter/sister and divorce/dependent and step mother
(Please paste photograph properly)].

Self Passport
Size Photograph
(Please paste photograph
properly)

I hereby declare that

1. My father/mother, whose name (s) is/are______________________________________,


is/are fully/principally dependent on me and he/she/they generally stay(s) with me. The total
income of my parents is not more than my salary including DA (if applicable) and is also not
more than Rs. 1500/-.

2. My son(s)/brother(s)_______________________ age ____ years is/are unmarried/


unemployed and is fully dependent on me.

3. My daughter(s)/sister(s)_________________ is/are unmarried/unemployed and is/are fully


dependent on me.

4. I undertake to resubmitted the card on transfer/retirement/resignation etc. before demitting


the office.

Name: Employee Code: Signature of the Employee

(To given by the office establishment)

Certified that the details given are correct as per records available in the establishment
and have been entered in the personal file and service book of the employee.

Section Officer (Estt.), Signature with SEAL

January, 2013 Department of Information Technology, New Delhi Municipal Council Page 2 of 2

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