Submission of Family Declarations for obtaining Privilege Passes

Submission of Family Declarations for obtaining Privilege Passes
Note
No. B/C 19/Staff/Family Declarations/2023
Dt.20/12/2022
Sub: Submission of Family Declarations for obtaining Privilege Passes.
***
All the staff members are requested to please submit their āFamily Declarationsā for obtaining Privilege Passes during the forthcoming calendar year of 2023. The Family Declarations are to be submitted in the revised format, a copy of which is enclosed herewith. Submission of āFamily Declarationsā before the end of the current calendar year i.e., 31/12/2022 will facilitate getting of Privilege Passes from 01/01/2023 without encountering any hurdles.
Further, it is also requested to please check up all their respective details I data available now in HRMS and ensure the data is corrected I updated if found necessary.
Encl: One Format.
Sd/-
KVR NAGESWARA RAO
Ch.OS/Commercial Sr.DCM/0/BZA
PF.No:Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā HRMS ID:Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā Ā
DECLARATION FOR FAMILY MEMBERS AND DEPENDENTS REQUIRED FORĀ ISSUE OF PASSES & PTOāS AS DEFINED UNDER IRCA CONFERENCE YEAR ā 2023
1 | Name of the Employee in Full | : | |||
2 | Designation | : | |||
3 | Office/Station | : | |||
4 | PF No. /B U No. | : | |||
5 | Pay Band /Level | : | |||
6 | Present Basic Pay | : | |||
7 | Date of Birth | : | |||
8 | Date of Appointment | : | |||
9 | My father is alive/not alive | : | |||
10 | Previous pass account maintained in the Office. | : | |||
11 | I am Married /Un-married | : | |||
12 | Mobile No. | : |
DetailsĀ ofĀ familyĀ members/DependentĀ RelativesĀ forĀ whomĀ PassĀ / PTOās required.
S.no | Name | Relationship | DateĀ ofĀ Birth | AadharĀ no. |
01 | ||||
DEPENDENT RELATIVES:-
(Attendant if any)
NOTE: Date of Birth to be furnished invariably for son 21 years and above.
I hereby declared that all the above mentioned members residing with and are wholly dependent on me.
Passport Size photo
|
Passport Size photo | Passport Size photo | Passport Size photo |
Self |
DEPENDENTĀ RELATIVES:-
Passport Size photo
|
Ā Ā Ā Passport Size photo | Ā Ā Ā Passport Size photo | Ā Ā Ā Passport Size photo |
Ā
- No Brothers / Sisters of mine working in the Railway are obtaining privileges /PTOās for the above dependent members.
- The un Ā ā Ā married Ā Daughters Ā / Ā Sisters Ā mentioned Ā above Ā who Ā are Ā working Ā in Railway are not avail privilege passes / PTOās in their
- The above dependents (as showing in āBā above) are not having any independent source of Income or more / that 15% of my implements or /- per month which ever is more inclusive of temporary increase in pension and pension equivalent of DCRG benefits from time to time
Witness:
1. Signature:
2. Signature: |
Signature:
NameĀ ofĀ the Employee: Designation: ⦠⦠⦠⦠ā¦, T.No ⦠⦠⦠⦠Date: |
ATTESTEDĀ BY IMMEDIATE
SUPERVISOR
Ā Eligible members as defined under IRCA conference
a) Family Members:
Wife/Husband unmarried and widowed Daughters/Sons under 21 years student son 21 year above, subject to production bonafide certificates form one recognized educational Institutes every academic year beginning in July.
- Dependent Relations:-
Applicable when father is not alive , Widowed mother , un-married and widowed sisters not having any brothers above 21 years, brothers under 21 years above subject to production of bonafide certificate from the recognized educational Institutes every academic year beginning in July.
- C) Attendant:-
Means, one employee on a salary in the service of the personal service of the employee i.e whole time domestic servant such as cook, Ayah but does not include a tutor, Dhobi etc, or any relative or the employee in the capacity of servant.
***