Performa for PMC Sick certificate
(To be issued by private medical practitioner)
-----------------------------------------------------------------------------------------------------------------
I here by certify that I have examined (Name) -----------------------------------
(Designation) ----------------------------------------- (Branch or Department) -------------------------
------------------------ (Station where employed) -------------------------------------------- is sick due
To (disease) ------------------------------------------- under my treatment and unfit for duty. He is
likely to be unfit to perform his duties for ------------------ days with effect from (date) ---------
Signature of the employee
-----------------------------------
Signature of private Medical Practitioner
Date:-
Name: ------------------------------------
Place:-
Qualification: --------------------------
Registration no: ------------------------
Address with phone no: --------------
Pro forma for PMC Fit certificate
(To be issued by private medical practitioner)
-----------------------------------------------------------------------------------------------------------------
I hereby certify that I have examined (Name) -----------------------------------
(Designation) ----------------------------------------- (Branch or Department) -------------------------
------------------------ (Station where employed) -------------------------------------------- was under
My treatment for (Disease) from (date) ----------------- to (date) ------------- and consider
Him/her fit to join duty on (date)------------------
Signature of the employee
-----------------------------------
Signature of private Medical Practitioner
Date:-
Name:------------------------------------
Place:-
Qualification :--------------------------
Registration no:------------------------
Address with phone no:--------------
ANNEXURE-A
SCHOOL/COLLEGE/CERTIFICATE FORM
This is to certify that Sri/Kum S/o Daughter of Sri/Smt
Date of Birth is a bone fide student of class of this
school/College/University for the session------------------
He/she is getting/not getting any stipend/scholar ship other than the merit/means basic.
School/College/University will be closed/Commencing from to
on account of vacation/Holidays.
The School/ College/ University is recognized/ affiliated to --------------
NB:- Starting and closing of the session must be mentioned for college student.
SEAL OF SCHOOL SIGNATURE OF PRINCIPAL/
COLLEGE/ UNIVERSITY HEAD MASTER/HEAD MISTRESS
I certify that the above named is my son/daughter proceeding to to
see his/her at
SIGNATURE OF THE EMPLOYEE
Designation
Office
Date
Note:- Portion not required should be scored out. Any alternation will be attested by the
signature other wise the certificate will not be accepted.
EAST COAST RAILWAY
FAMILY DECLARATION – 2018
NAME: DESIGNATION:
OFFICE [Link]:
DATE OF BIRTH: PF .A/C No:
RATE OF PAY: SCALE OF PAY
[Link] NAME OF THE FAMILY RELATIONSHIP DATE OF BIRTH
.
LTI/Signature of the applicant
Signature of forwarding officer with seal
NB. 1) Family includes
Spouse of railway servant whether earning or not.
Son/Sons below 21 year’s age and fully dependent on the railway servant.
Son/Sons of the age 21 yrs and above who are bona fide student/invalid.
Unmarried daughter of any age whether earning or not.
Widow/legally divorced daughters provided they are dependent on the railway servant.
2) Dependent relative in relation to a railway servant ,whose father is not alive, means
Mother/ Divorced mother
Unmarried /Divorced sister
Brother /step brother below 21yrs age provided he resides with and is wholly
dependent on the railway servant.
Brother above 21 yrs age who are confide student/invalid.
3) Dependent relative in relation to a widow appointed on compassionate ground means
Dependent widow mother of the deceased railway employee.
Provide that a person, shall be deemed to be wholly dependent on the railway
Servant only if
His/her income w.e.f. 01.01.04 including person, dearness relief does not exceed
Rs/2415/-per month [Link]/-1500/- (Pension/Family pension) + Rs/-915/-
(Dearness on Rs/- 1500/-) or 15% of the pay of the railway servant, whichever is
more.
Name of the Registers
1 Quarter
Register
2 Pass Register
3 Staff Register
4 Card Pass Register
5 [Link] Register
6 C.L. Register
7 D&A Register
8 Court Register
9 PM.E. Register of Gate-Keeper, Trolley man & Track man
10 ONR Settelment Register
11 Superannuation Register
12 Duty Booking Register
13 Festival Advance Register
14 Staff Grievance Registers (SC,ST&OBC)
15 Identity card Register
S.N File Establishmen S.N File Store files S.N File Inspection
o No t files o No o No files
1 1 S/1 Store maters
collection other
store details
2 2 S/2 Indent for
material
3 3 S/3 Scrap materials
4 4 S/4 BI FILE
5 5 S/5 Clothing
6 6 S/6 Verified challan
CS
7 7 S/7 Verified challan
NL
8 8 S/8 Verified challan
TP
9 9 S/9 Material
Destroyed file
10 10 S/10 Verified challan
Ballast
11 11 X/1 Telephone Bill
12
13 1 S/D Safety Drive
14 2 T/2 Theft case
15 3 P/1 Pway Diagram
16 4 M/2 ADEN/Meeting
17 5 A/1 Accounts,
Auditing, stock
sheet
18 6 I/4 ADEN Inspection
19
20
PROFORMA OF APPLICATION FOR AEN-30% LDCE FOR 2017-19 &
2019-21
EAST COAST RAILWAY
Whether Willing-------------------
Name & Community---------------------------------------------------------------
Father’s Name ---------------------------------------------------------------------
Designation & Station -------------------------------------------------------------
Date of Birth ------------------------------------------------------------------------
Date of initial Appt & Grade -------------------------------------------------------
PF No ---------------------------------------------------------------------------------
Date of Joining training/Apptt/Promotion to PB-2+ GP—4200/ (VIth PC) & above
------------------------------
Present Grade -------------------------------------------------------------------------
Posted under (Unit/Division) ------------------------------------------------------
Signature of the Applicant -----------------------------------------------------------
Date -------------------------------------------------------------------------------------
Counter Signature of the Controlling officer with
Designation and seal ------------------------------------------------------------------
Mobile No. -------------------------------------------------------------------------------
E mail ID --------------------------------------------------------------------------------
(Note: Willingness/Option to be submitted on or before 30.09.2019)
Pro forma of statement for submission of options to HQs.
S [Link] Name Father Whether Dat Date Present Date of Date of Date of Remarks
designati ’s UR/SC/S e of of Grade regular regular receipt (Eligible/i
on station Name T Birt initia (regular/a promotio promotio of n
& PF h l d-hoc) n in PB- n in PB- applicati eligible)
[Link] the Appt 2+GP 2+GP on
applicant & 4200/(VIt 4600/(VIt
grad h PC) h PC)
e
PROFORMA OF APPLICATION FOR AEN-30% LDCE FOR 2017-19 &
2019-21
ANNEXURE-A
EAST COAST RAILWAY
PROFORMA FOR APPLICATION
Application for the post of APO/AWO-70% quota
(Assessment period 2017-19)
1) Whether Willing/ Unwilling -------------------
2) Weather eligible for 2017-19
3) Name
4) Designation & Station
5) Whether UR/SC/ST
6) Date of promotion to grade in pay Band-2,GP-Rs 4200/-
7) Post under
8) Unit/Division
9) Date & Signature of the Candidate
Counter Signature of the Controlling officer with
Designation and seal
(Note: Willingness Application to be submitted before 04.11.2019)
ANNEXURE-B
statement for submission of options For the post of APO (70% Quota) for
the Year 2017-19
Office-----------
S S.N o Name Father Whether Dat Date Qualificatio Present Date of Date of Remark
designa ’s UR/SC/S e of of n Grade regular receipt of s
tion Name T Birt initia (Education (regular/a promotio applicati
station h l al/ d-hoc) n in PB- on
& PF Appt Technical) 2+GP
[Link] & 4200-
the grad
applican e
t