116

ifjf'k"V
APPENDIX

o"kZ -------------------------------------------------------------------------- ds nkSjku --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- }kjk

¼uke½ ¼inuke vkSj dk;kZy;½
dh xbZ lsok dk lkjka'k -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Abstract of service rendered by ..................................................................................................................................................................
(Name)

(Designation and Office)

r ld
............................................................................................................................................... during the year ............................................

isa'ku @ e`R;q&lg&lsokfuo`fÙk minku

Wo vof/k] ;fn dksbZ gks] tks lsok ds :i esa vgZd u gks]

l
gsrq vgZd lsok dh vof/k vkSj mlds dkj.k
Period of qualifying service for purpose
of pension / DCR gratuity

it a Period, if any, not qualifying as service,

and reasons

ls
1

fnukad
rd
2

fnukad D ig 3

vof/k
ls
4

¼fnukad½
rd
5

¼fnukad½
6

vof/k
7

dkj.k
From To Period From To Period Reasons
Date Date (Date) (Date)

r ld
Wo
ita l
D ig

r ld
Wo
it a l
D ig
dk;kZy; v/;{k ds gLrk{kj
Signature of Head of Office

eSa ,nr }kjk ------------------------------------------------------- dh vof/k ds nkSjku dh xbZ lsok ds lkjka'k dh izkfIr Lohdkj djrk gw¡ vkSj bls lgh ekurk gw¡@ uhps fn, dkj.kksa ls
Lohdkj ugha djrk gw¡A
I hereby acknowledge the receipt of the abstract of service rendered by me during ..................................................................
..................................................... and accept as correct / do not accept it for reasons indicated below.

ljdkjh deZpkjh ds gLrk{kj

Signature of the Government Servent