TRANSFER OF DISPENSARY

(In Triplicate)

1. No. of Identity Card : 02 Nos, 5564974 & 5564976

2. Name of Govt. Servant : Rajesh Kumar Meena

3. Ministry/Department/Office in : Ministry of Urban Development

which employed

4. Previous Residential Address and : Type-2, Qtr No.1, CPWD Essential Staff
Dispensary from which transferred Quarters, Palavanthangal, Meenambakkam
DGQA complex, Meenambakkam

5. New Residential Address : Type-2, Qtr No.11/9 CPWD Quarters

K.K. Nagar, Chennai-78
6. Signature of Govt. Servant :

7. New Dispensary allotted by the : N. Rajarathinam, Executive Engineer

issuing authority

8. Signature and designation of issuing :

authority (With Tel. No.)

9. Signature of Medical Officer in-charge :

Dispensary from which transferred

10. Signature of Medical Officer-in-charge :

Dispensary to which transferred

Date the __________________________