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EASTERN RAILWAY

EMPLOYEE MASTER FORM OF HRMS


ALL FIELDS FROM PAGE No. 1-4 TO DE FILLED IN CAPITAL LETTEns ONLY)
Mandatory Fields To bo led by SRdeling cion
EMPLOYEEBASICINFO
IPAS Employita ld (Emp/PE No)*
Employeo Namo As in SR°*
Cmployeo Name As in Andhnar *

1. Aadhaar Number

5. (Employee Firot Neme. Employo0 Lant Namo)


B.Employoo Midsla Namo)._
Employco Name indi
9. Employee Name Regional
10. Country of Birth"
11. Blrth PMaco
12. Dote of Birth
13. Gonder' (Tmek) M F Others
. Falno Nama

15, Mother Namo


16. Guardlan Name

.spoUse Name
1. PAN Number

0. Superannuaton Dato
21. sRPage Number i

PERSONALDETAILS
1. Raligion
2G01mnunny
3. Casto B

. ldentificaion Mark 1 #

5. Identification Mark 2
6. Marital Statua
7. Data of Marlage
6. oUher Tongue
9. Hclght (amt, inch)
10. Nationaily 11. Natlionaliy Cerincote Number
(Othar Ihan Indian)
12. Nalionaity Cortiicato Eigibilly
Date 13. Servlca Record Page Number

coMMUNICATIONINFO
1. Parsonal Mobila
Nurmbor 2. Offldial Mobile Number
3. Paruonal

4, Ofcial Emal

5. Corimunicabon Addross (ljex)


L JProsant Addrees Pemanont Addrauss
Present Addross
0. Address Line 1*

7. Addreso Line 2 with PS

Pincode 9. Stata
10. Distnct"
11. City
12. Is Presonl Addross name as Permanent Address?
(YIN)
Formanent Addrona

13.Address Line
4. Adidress LIne 2 with PS

15. Pincode
15. Stote
.Oistrict 18 Gity
19. SR Page Numbar #

PASEiployes1D i#RNAA2AANA1FalFUSLEORIPago1 of5E Dephitment MTMS2


LY DETAILS (omployoo imay
Farnily tMernber Sr
ndd parma page ndaitonally lf requlred)
No
Momber Name
3
Member Namo
4.
(Rogonai)
Member Name
(Hindi)
5. Aadhaar Number
7. Member DOB
.Relation
9. Handieapped Flag(Tick)
3.
Farmily Member
11.
Handicap
Tes

NO Age NA
categonyrck) JVisual
0. HandiCapped Fercent
12. Handicap Certificate Jonho
14. Momber Dopandent{tick)
Efect From Hearing Impaired JMentai Reancaaen
13.
Handicap Certificato Efoct To
Tes
1
Famly Member Sr No 15. SR Page Number
No
2. Member Name

3.
Member Name
.
(Reglonal)
Member Name
(Hind)
Aadhaar Numbor
. Member DO8
5.Reation
. Handicapped Fiagtick)
.
Famly Member
11. Handicop Catogory(ek) JNO
Age
VIGUal
10. Handicapped Percent
12.
Handicap Cartificate Hearing Impaired
19, Member Depondent(Tick)
Efect From 13. lental Retarcasion
Handicap Certicate Efect To
1.
Famy Member Se No
No 15 SR Poge Number
2. Mormber Narne

3. Momber Nome
4.
(Regional)
Member Name (Himdi)
5.Aadhaar Number
7. Member DOB
6.Relaton
9. Handicapped Flag(ticR) 8.
Famiy Nember Age
11. Yes NIA
Handicap catogoryrick) L Visu 10.Handieapped Percont
12.
Handlcap Certficate Visual
Efect From
Ortho
Hering ImpatredF
14. Member Dcpendon(tTick) 13. e n a l ketardaton
Handicap
Ye JNo 15. SR
Cortificato.Effoct To
1.
Famly Member Sr No
Page Number
. Member Name

.
Mombor Nano
(Kes9onai)
.Momber Name (Hindi)
5. Audhaar Number

. Momber DOB 6.Relaton


.
Family
.Handicapped Flag(Tice)
11. Handicap Calegory(tick)
JTes NO
Member
10. Handicapped Percent
Age NA
Jvissua
12.
Handicap Certificate Efect From
oruo Heering impsired
14. e m b e r Dependent(Tick) "
L 13. Handieap Certficate Efect To
ua Retandation
No 15. SR Page Number
Arlx recont pasport
ize photograph of AE
TeCnt paspo
cnployoo A recent pasport
SIze phoograph of
1amlly momber 1 ntpasport S cht pa3por
embor2
n i y mmember 3 SOotograph of
ymciibor4

1PAS Employeo 1D
IUnlt Dephrtment
Page 2 ofS
EMPLOYEE CuRRENT STATUS 2d0 be tlied by the SR dealing clevk only
Bl Unt

Mode Of Appointmenl 2.Appolnbrent Dete


JActApprenticeship
ex S JcGA Cultural uota e Sevkw Men
E N SIVICe Mon Quota

LPHQuota
odcE Land Levers Largess
LReengagement RRD RRC
Regulariastilon Casual Labourer Scouts & Guldes sports Quota
JUPSC ubstiate
Lument~one . Cuiront
Cuent Station Code Uit Dvision
8. Parent Workshop .CuTOnE Working Office"
. Workshop Number
. Len (Zonan

PH CUota
Visual Lortho Haaring Impaired
cket Numbur Montal Retartaben
13. Service Stotus
uisonly Retired
Doputatilon Outslkdo Oamksadremoved Medicaly invald
New Employue Enay
UNomal Retremant L
esgned USeving(No Salary/8top SalaryiLong ngagwnent
UTochnlcal Resignation Tormination Death on
Abaonteo) Bening(Salary)
V R on Medical Ground Transfen ovf ef
pay u t
o n w y Kedred
14. Ralway Group

15. Ofcer Type D


Gazetted INon Gazeted
16. Cadre
17. PF Number
8 NPS Sheme
Yes LNo 19. PRAN
Substantivo
0. Pay Level

22 Designeo 21. Dapartment


IPAS Designaton Code" 23: Baala Pay
Standard
Deslgnation
Standard Dosignation Code
orficlating L
ADACP
26. Pay Level
Yes 25.
Oparaling in ix-Cader vos No
28. Designason Dopartment
29. Baalo Pay
30. Serice Record
Pago Nunbor
8EOICAL(To ba filoid by tho SR doialngt clert bnty)
1. Medical Typ
L OROgOno Periodo Speslol
.

Medicaly Ft Certicato Date


3. Mödical
Medical Cerificate Number Certfncate Issued By L
. Medical Clasaiicallon

J. Handicep Flag"
Y No . HandloappeC Percent
8. Handlonp Codo
Doaf and Dumb
ouble TPANih doubl T uonpton
Doublo TPA WIth nomal T exompton

Uorthopaedlc with disablly of kower extrernst


D. Fland icop Corificote Efect From
11. Handicapped Cerdficale
10.Horndicap Curtficafa kftet to
Date
L 12. Sevloe Recvd Pape Numaer

0 Ded a
parStandard Deslgnaion Ust provided by HRMS Team of CRIS.
JPAS Emplayse.10
Buntias
Pago 3 of Diartiant
Gaton CTobo fled by tso SR dealingclork only)
No

Quaifcation Level
Coura
Subjects/ Specializallon
6. Bourdunlveraity

7. Schoolinstiltuto Nama
8. Year

8. Grade 10. Percentnge


.At Jolning?
Yo . 6orvco
ROcord'Pago Numbor
S,No

2. Qualiflcatlon Leve
2
4. 3. Courao
Subjøcts / Spocializalan
S. Duration
6. BoarUilversity

7. SchooVins6tute Namo

. P Yoar

0. Grind0 10, Porcontogo


11. At Joinling7
LNo 12. 3orvice Rocord Pago Numbar
. S.No

Quaification Level .
4. Courso
Subjects / Specialization
6. Board/Unlvorsity . Duralon
Schoovinsttauto Narmo
Year
0. Grado
1. At Joning? 10. Poraontago
JYes No 12. Seivice Record Pnge Number
S.No
4
Cuaihcalilors Level
4. Subjacts/Specialzation
.
Courso
. Duraion
6. Board/Univoraiy

7. Schoovinstute Name
8. P.Y
9. Grado L
10. Percentage
T.At JGining?
LNo 12 Sevico Rocord Pago Numbar
S.No
5
2. Quaification Level
3,
4.
Subjecs / Speciollzaton Course
5. OuratiOn
6. Bourd/Unlveraity

. Schoovingtiuto Namo

Year 9. Grada
0. Parcantago
11. At Jolning?
Yo Na 12. Sorvica Racord Pago Numbar
*
DECLARATION
EmployeeePF No.
do hereby declare thot all the
Intormallon furnlalicd
namg in Cnpital) bearing
Form" of HAMS io true. The In Pago No 1& 2 of tho "Employeo Maater
Ralway Aominoration.
undersigned will be
oololy rosponaiblo for aubmisgion of any inappropriato/ mioleadlng/falge Intormatlon to tho

Dato:

(Sgnaturo of the
amployeo in Fuiutn)
Signaturo (To be slgned boforo tho
of the Immodlate
in-chargesupervisor with stamp)
Immedinte In-chargeiupervisor)
PAS Employog 1D
Fage

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