Professional Documents
Culture Documents
Various Proformas
Heads
Immoveable
Medical reimbursement
PF Advances
65
10
Advances
11
Application
for
purchase
car/cycle/scooter advance
12
Application
form
accommodation in the
13
14
Traveling allowance
15
of
motor
for
reservation
holiday home
of Holiday home
Form-I.
Form giving prior Intimation or seeking previous sanction under Rule 18(2) of the Railway
Service (Conduct) Rules, 1966 for transaction in respect of immoveable property.
1. Name and designation :
a) Name & address of the party with whom transaction is proposed to be made.
OR
______________________________________hereby intimate the proposed acquisition/disposal
of property by the name ( detailed above. I declare that the particulars given above are true.
Signature ___________________
Designation___________________
Date_______________________
Note: 1. In (On above form, different portions may be read according to requirement.
2. Where previous sanction is asked for the application should be submitted at last 30 days
before the proposed date of the transactions.
DECLARATION:
OR
Station _______________________
Signature______________________
Dated:________________________
Designation:___________________
Note:
TO
______________________
______________________
_______________________
Sir,
I wish to obtain a pass port for visiting ________________________ I request that I may
kindly be granted No Objection Certificate to enable me to produce it before passport issuing
authority. The details of Bio-data and others are as under:
1. Name :
2. Fathers Name :
3. Designation :
4. Date of Birth :
5. Date of Appointment :
6. Pay Band with Grade Pay :
7. Division/Branch in which working :
8. Station of posting.
9. Present Residential Address : __________________________________
___________________________________
___________________________________
__________________________________
10. Permanent Address :
__________________________________
___________________________________
___________________________________
____________________________________
I declare that :
1. I will abide by the provisions of Indian Passport Act, Indian Customs Act and any
other Acts of the Government of India.
2. I will not request for release of Foreign Exchange from Railways and will make my
own arrangements for finance as and when I intend to visit abroad.
3. I will get the approval & sanction of leave from the appropriate competent authority
every time before proceeding abroad.
4. I understand that the issue of passport will be subject to clearance from the Civil
Authorities Income Tax department.
5. I will not undertake to pursue any study or training while abroad without prior
permission of the Railway Administration.
6. I will not indulge in any of activity which may be prejudicial to the interests of my
country or any other country and my activities during visit/stay abroad will not effect
the friendly relations between my country and any other country/countries.
7. I will abide by the General conditions laid down by the Government of India from
time to time in this connection.
Yours faithfully,
Station :____________
Dated :_____________
Signature of the applicant with
address.
Note:
The following information/documents as required by Passport Issuing Authorities for AnnexureB may be provided:
1. Declaration regarding nationality of wife.
2. Three Passport size photographs with name mentioned on the back side of the photo.
3. Copy of Indentity Card issued by your office concerned.
4. Details of dependent family members with date of birth with relation.
NORTHERN RAILWAY
MEDICAL REIMBURSEMENT
1.
Name of Employees/Ex/employee.
2.
3.
Designation.
4.
Office/Unit of Posting.
5.
6.
Name of Patient.
7.
8.
Age of patient.
9.
Medical/
10.
11.
If referred by whom?
12.
I/Card No.
13.
Date of Admission.
14.
Date of Discharge.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
Signature of employee
Officer/Unfit Incharge
of employee/spouse
I, hereby declared that the statements in the application arfe grue to the
best of my knowledge and belief and
i) that the person for whom medical expenses were incurred is wholly
dependent upon me.
ii) the medical expenses were incurred for self, (strike out which is not
applicable from (i) & (ii) above.
Station.
Dated.
Foot-Note.
1.
2.
a)
b)
c)
d)
e)
f)
Detailed item wise break-up of all bills (this means all bills/vouchers
submitted at (a) above be reproduced in LEGIBLE MANNER for e.g.:
g)
Bill No.
Name of Chemist/Shop
Date
Description of Item
Quantity
Price
i)
ii)
iii)
iv)
Total
I)
II)
Signature of C.A.O.
1.
Name of employee
________________________________________________
2.
III/IV
Designation
____________
_________________________
(A) Class
(B)
Gr. RS.
__________________
Rate of Pay __________________
3.
Department
(C)
_______________________
(a)
(c)
4.
5.
6.
7.
8.
9.
S.No.
Name (Sh/Smt)
Relation
Age
Name
Designation
Name of the
Bank
Address of
the Bank
Account No.
Type of Account
Current/Saving
MICR Code
RTGS/IFC
Code of the
Bank
I, hereby declare that the particulars given above are correct and complete.
Date:
Address.
..
Phone No..
G.A.31/S.R.C/G-1677
G-6
TRAVELLING ALLOWANCE
Branch
Division/District..Headquarters..
Journal of duties performed by Shri.for which to allowance for
..........is claimed
DesignationPay..Date of appointment
Rule by which governed.
Mont
No.
Tim
Time
h&
of
arrive
date
train
left
Station
Kilomet
Day/
Object of
Night
journey
Rate
er
Fro
To
Rs.
P.
10
(P.T.O.)
10
It is certify that1
The T.A. claimed by me has not been claimed before & will not be claimed hereafter.
Conveyance charges claimed have actually been spent by me and according to local
Municipal rates.
3
The journey performed by road for conveyance has been claimed was over 1.6 K.M.
On T.A. Bills of transfer from one Railway to another a certificate whether or not a free
Annexure C
To,
______________________________
Sir,
1.
NAME
2.
FATHERs NAME
3.
DESIGNATION
4.
DATE OF BIRTH
____________________________
5.
____________________________
6.
7.
____________________________
____________________________
____________________________
DIVISION/BRANCH
____________________________
IN
WHICH
WORKING
____________________________
8.
STATION OF POSTING
____________________________
9.
10.
11.
PERMANENT ADDRESS.
PLACE
OF
____________________________
RESIDENCE
DURING
THE
LAST
____________________________
2 YEARS.
12.
13.
____________________________
____________________________
____________________________
14.
____________________________
15.
ESTIMATED EXPENDITURE
____________________________
16 SOURCE OF FUNDS.
____________________________
17 If the transaction for the source of funds requires the prior sanction of
the
competent authority as per the Railway service/Conduct rules, 1968 (Rules
18) sanction particulars of the same.
I Declare that:-
1.
I will not request for release of foreign exchange from Railway and will
make my own arrangement for the foreign exchange required for the trip.
2.
I will not over-stay abroad excerpt with the prior approval of the
competent authority.
3.
I will make my own arrangement to get my leave salary and other
allowances while abroad. I understand that these amounts will be paid only
in Indian Rupees.
4.
I will not seek an financial / assistance
country/institution /agency for his/her itinerary.
from
any
foreign
5.
I will not peruse any study for training while abroad without prior
permission of the admn.,
6.
7.
I will not indulge in any activity which may be pre-judicial to the
interest of m my own country or any other foreign country and my activities
dignity visit/stay abroad will not affect the friendly relations between my
country and any other countries.
8.
I will inform any change of address which may take place during my
stay abroad to the Railway Administration.
9.
I will not enter into any contract or marriage with a person other than
Indian Nationality without prior permission of the Govt.
10. I will adhere to the provisions of Rule 18 of the Railway services
(Conduct Rules 1956 in case I enter into any transaction for moveable
property.
11. I clearly understand that I am liable for action under D&AR Rules in
case violate any of the above provisions at any conduct of unbecoming of a
Railway Servant I am abroad.
Yours faithfully,
Station.
Dated.
Signatures.
Signature of Applicant.
with Name below the
1.
2.
Signature of witnesses
Station office
Date
Station Office
Date