F. R. FORM NO.

10
THUMB AND FINGER-IMPRESSIONS OF GOVERNMENT FMPLOYEE
Thumb -

Fore Finger -

Middle Finger

Ring Finger

Little Finger -

BOLPUR [Link]
Bolpur,Birbhum
 2

(For use in Police Department only)

Heirs:

1. Medicile Exominutiom dome b crM.D-H: Bi bhem

Ske s -tit tor"Jon im (ue Govt Serice.
2
BoipurS. D. Hospital
Bolpur, Bibhum
3
26-6-19

Verification Roll No. J54/s dated 07-0S 2019 received back

Notting Om Reco ds o m S-p. DIB
aibun.

Bopur I. [Link]
Eolpur, Birbhum
26-6:19
Left Thumb-impression

of

Qualifications Date Qualifications Date

English on Drill instructing
Bengali on Court duties

Kaithi on Reserve duties

Urdu on
First Arts

Oriya on B.L. or B.A.

Plan-drawing
Pleadership examination
Finger print TrainingSchool final examination

N.B.- A line to be drawn under the

qualification possessed
 3

1. Name
RuBINA YASMN
VILL i DUBRD J PUR
2. Residential address :
(1) Permanent - poST+ PS!- DUBRDJ PUR
(2) Temporary -
DIS 7 BIR BHUM
PIN 731123
3. Date of birth by Christian era as nearly as can be 13.12. 1996
ascertained and accepted by the competent authority
(the date of birth as accepted shallbe recorded in figures Supenatendert
as well as in words) Bolpur S.D. Hosptal
SBaipur,Birbhum
26-6.19
4 Educational qualifications HS
Two-yEAR DipLo MA NeRITICA
coRE TELHNDLOGycouRSC:(MeeT)
5. (0) Exact height by measurement
(ü) Personal marks for identification

6. Father's /Husband's name and residential address ABDUR RAZZAK,

7. Date of first appointment I|: 12- 20 18 (F/N)

8 General Provident Fund Account No.

Contributory Provident Fund Account No.
|MED/NG/93439
9. Nominee (s) of General Provident Fund / Contributory
Provident Fund if any -
(as recorded and accepted by the competent authority)

10. Nominee(s) of Death Gratuity, if any

(as recorded and accepted by the competent authority)

11. Nominee(s) of Group Insurance Policy

(as recorded and accepted by the competent authority)

12. Signature of the Government employee.

Rubira osmin
13. Signature and designation of the Head of the Office, Superihtendent
or other attesting officer - Bolpur SD. Hospital
Bolpur, Birbhum

Note - The entries in this page should be renewed or re-attested at least every five vears and the signatures in items 12 & 13
should be dated. Finger prints need not be taken afresh every five years.
 P AY Signature
and Date of
(C)
Date ofo (b) Signature of egcthe substan.
Other
oluments Government competent ve or in the
order No. ment talling under Employeeauthoriyin poct

and date the term pay

HT/IDM-24
2013
columo Nos.
Bibk 1to 5

12.
torpital,
MIs L lo
lorStn
No-Datoo
Bolpu G
oe)g-0sden
Pecíalty
Medieile6328
Tehno |[-122018
at Rubina
yasmin
1TU 09
D-HS.n
Ceriieal
V/A 2
S RopA.
2016/Pt
vide WBsR.

Superintgride
BolBulpur, BiHosptal
rbhum
 5

10 1 12 13 16
9 14
Releronce to Roforonco to Dolay in
Signature of the whethor whother tho Leavo takon whilo on foreign
disciplinary action, jolning in sorvico or on deputation
Reason of disciplinary Anothor post
Jaction is pending if any complotod
the termina (delalls Such as, Iroatmont of tho |Allocation of perlods of
against him
poriod in oxcoss Naturo
tion such as (a) (b) (dotails of such dato of ro loavo for which loavo Remark
Head of and
Promotion Govern Dction whothor instatomnont, ordor of Joining timo duration salary is dobitable to
ment Office or he is undor of punishmont olo., another Government
transfer,
other susponslon and treatmont of tho Ordor No. of leave
employoe Dato. Govt. lo
dismissal if so, trom which period ol takon which
attesting Poriod
etc. date) suspenslon etc. dobitablo
authority

...Days
v./CoaudLcoy:lil. PLeave
his leavo.
on. 6:6.:(.io.Z6.:06: 9ldcrement,
[Link] be chunled tawards

Sugeitedsht
Bolput [Link]
Bolpur, Birbhum
26-619

If12.2ciS
Servide Verified W. e. f..!...
to.30.06.:2las per achuitance
rollard other ffice recotds.
Supenpsa
BolpurS.p. Hospital
sBolpus,|Birbhum

dut to een

Boldur S. D. Hospital
Bplpur, Birphum
 5
4
2 Signature
1
P A Y and
Date of
designationncrementin
(C
Signature ofl |the substan- D
(a (b) the of the
(c) Other tive or in the er
(a) (b) Date ofSubstan- Officia emoluments |Government| competent
Name of appointment Officialing appoint
Substantive appointment tive |lalling under Employee authority in officiating
Station ting post
post ment attestation of the
order No. the term pay
order No.
and dato
column Nos. e tion
& dale 1to 5 Pro
tra
dis

Kehina yasmfn
[Link] ealcao

8y virtue of F.D. Memo No. 5562:f Dated 25\09.2019 read with

Corrigendum Notifcation No. 6016-+"2) ated d6.11.2019 ad with
tomo Np. G471(P2) Datet02.12319 UNDER ROPA 20109 the
Basic Pay of s [Link]..be.s
is hereby notiongly fxe on Rs. .. from pre
revised þasic r R:. 1.12 b
y D a . i the Pay Band

= Rs.0.40.a. 2.57 =
Rs...i|32ester R..[Link] he Pay
2837
Matrix L nseoeo..o... W.e.f

o1.01.20fe .Il:1.2.24a (o4 idr) in the light of

option exercise by the incymberi c¢:..sJ.

Here by, albwye the rarical incrmn allowed undet

Fule 10 of RUi 1b.: uedt.: !
Date i Levet Nd nthe!Lell No ct Baslc Pay
ncreme : Py ,i fesp tive l e , :

01.07.2016

1.07.2017

b1.07.2010

l01.07.201e

Basic Pay n 01.01.2020 Rs. 29 8toa Superintehdent

Periodigal increert an 01.o,2020 Rs. Bolpur S.D. Hdspital
Bolpur, Birbhum
Ba_ic Pay oh 01.07.2020 Rs 30o0a
Next hcrement Data 01.07.2021

Superhtencent
Bolpur S.g. Hospital
Bdipur, Birbhurn
 9

11 12 15
Reforonce lo Roloronco to Delay in Leave taken whbilc on foreigr
whothor whothor tho jolning in
disciplinary action, sorvico or on doputation
disciplinary another posl
laction is ponding If any complotod
(dotalls such as, troatmont of tho Naturo |Allocation of periods of
Overn
(b)
Head of
Offico or
ngalns AUch
(dotalls
him
dalo oorder
action whothor Instatomont,
period in oxcoss and
of Joining tlme duration
leave for which leave
salary is debitable to
anothor Government
Remarks

ment he is undor of punishmont ot.,Ordor

employeo other suspenslon and troatmont of tho No...... of loavo Govt. to
Ssal Dato.
attosting it so, from which poriod of lakon Period which
etc sUsponslon etc.) debitable
authority dale)

Vgited w.e...o.202!
acqurttance
To ....4sper
occice recoS
röu and other
31/rt
stprintendanit
BolpyrS. D Hspta |Bolpu
Supehoendent
S. D. Hdspital
|Bolpu,BirbBum

Servjee 'eohirrdd [Link]

rde no-l649s/( Dale-23-02-2022
Servee oAre d cw o I-12-202

Superintent
BOLPURSHOSPTAL
Bolpur, Birbhum

e to pezelo deal

Buper Service Vehified W.e. f.Qih2. 2022

BOLAUR S.D. HOSPITAL to3R.R4}A?as per acquitance
Bolpur, Bibhum roll and other office records.

Superinendent
BOLAUR S.D} HOSPITAL
Bolpur, Brbhum
 )
Wife(dHusband 7. 6. 5. 4. 3.
(c) Mother(b) Father(a) (i) Profession
(e) (d) (c) (b) (a) Particulars
Nationality If Permanent PresentFather's PIN)
district
Present surmame). or
The dropped, if
in Fron1 Name
(b) any.
) service, (a) namc
Postal name of
country,
Bangladesh, lane/street
If thanaHomc or
address (Please in
ofmigration originally at
of home places house of
l give and the any Full
address in address indicate (In
designation address full the number, in post stage,
where district
and full . . .pt [Link]
with address
toNepal a block
Recvi
[Link]
(if Indian resident road, in (i.e. and any
To you if of
dead, aliases, orfull lane/street you
capitals)
. in or village, scrvice part the
and have Union. that any of
PIN)house (i.e.
£ give ofhave
official if Pakistan,
other number,village, applied
resided dominion youradded with 354/s/1VR.9
the any andthana
Residential name
CMOMerification
last alisgagture Reccipti.
Date...
address for
road, and for or
address)
NO? more
house DI`T:BiRBHUM,PIN-3|23 w,
B
DUBRATpUR,[Link].0:
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in year NA
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[Link] village,
140 NO. the
and preceding L0
RA22AK
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354/5 read,
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and five
DUBRAJpUR district years

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