Health Card Employee Enrolment Form (Page 2 of 4) in pdf

Health Card Employee Enrolment Form Page 2

IDENTIFICATION DETAILS

Ration Card Number:

Identification Mark 1*:

Identification Mark 2:

CURRENT POSTING DETAILS*

Head of the Department:

District of Posting:

DDO Code [write the DDO code of your Drawing and Disbursing Officer given by DTA]:

Category [write the name of category of post you are holding. Ex: Senior Assistant]:

CURRENT PAY DETAILS*

Pay Grade [write your paygrade as per PRC, from 1 to 32]:

Source [write your source PRC 93, PRC 99, PRC 2005, PRC 2010] :

Pay Scale [write your payscale]:

Current Pay[write your currenty pay]:

ATTACHMENTS*

SELF

Service Register (two pages): Scan the pages 1 and 2 of old service register (or) pages 4 and 5 of new service register with your name etc. clearly

visible.

Photo: Scan a 45 mm x 35 mm ICAO compliant passport size colour photograph of 200 Kb size.

Aadhaar Card/Receipt: Scan the Aadhaar card with your name and number clearly visible if you are giving the Aadhaar number (or) scan the Aadhaar

enrolment receipt with your name and enrolment number clearly visible if you are giving the Aadhaar enrolment number.

Disabled Certificate: Scan your disability certificate if you are disabled.

DEPENDENT FAMILY MEMBERS

Photo: Scan a 45 mm x 35 mm ICAO compliant passport size colour photograph of 200 Kb size.

Aadhaar Card/Receipt: Scan the Aadhaar card with your name and number clearly visible if you are giving the Aadhaar number (or) scan the

Health Card Employee Enrolment Form Page 2