Part A

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(Filled by the Applicant)

Comprehensive e-Pension Application for the Employees` of recognised AND aided non-Government Educational
Institutions
Part-A

e-SUBMISSION
EMPLOYEE CODE : ZAHS3765 APPLICATION NO. : 12022303038

INSTITUTION / ORGANISATION: SCHOOL EDUCATION DEPARTMENT DATE OF E-SUBMISSION: 23-Nov-2023

PERSONAL DETAILS
Employee`s Name: SULATA GHOSH Father`s Name: RABINDRA NATH GHOSH
Employee`s Date of Birth: 15-May-1964 Gender: FEMALE
Religion: HINDU Marital Status: MARRIED
Spouse Name DOB of Spouse Dead/Alive
DIPANKAR CHAKRABORTY 01-Nov-1969 Alive
Identification Mark (as recorded in Service book): CUT MARK ONLOWER ABDOMEN
Aadhar No.: 774973369604 Category: GEN

PRESENT ADDRESS
House No:- Street:- Town/Vill:- SUBUDDHIPUR DEY PARA, P.O:- BARUIPUR P.S:- NA PIN:- 700144 Dist:- SOUTH 24 PARGANAS
State:- West Bengal
PERMANENT ADDRESS
House No:- n0056 Street:- nandi para Town/Vill:- netra P.O:- netra P.S:- NA PIN:- 743368 Dist:- SOUTH 24 PARGANAS State:- West
Bengal
APPROVAL OF APPOINTMENT
Date of first entry into Approved Service: 16-Sep-1999

APPROVAL OF APPOINTMENT IN THE PRESENT INSTITUTION IN PRESENT POST


Name of the Present Institution: RAJPUR PADMAMANI GIRLS HIGH SCHOOL
Present Post Held: ASSISTANT TEACHER w.e.f. from 16-Sep-1999.
Memo No: GEN/25 Vide Dated: 05-Jan-2000
Last Date of Service: 31-May-2024

DCRB SCHEME
Fresh/Revision Pension: FRESH CASE Option to DCRB Scheme 1981: PENSION INCLUDING FAMILY PENSION CUM GRATUITY
DCRB Option Date: NIL

Last pay drawn/to be drawn under ROPA: ROPA-2019 Class of Pension Applied For: SUPERANNUATION PENSION
Commutation of Pension Applied For (Yes/No): YES Amount of Pension to be commuted: Rs: 10171
TREASURY / PDO / PDA INFORMATION:
Treasury: BARUIPUR
APPLIED BY:
Name of the Applicant: SULATA GHOSH Relationship with Incumbent: SELF
E-mail ID of Applicant: Mobile No. of Applicant: 7430071230

OTHER INFORMATION

Joint/Single Photograph duly attested and attached : Yes


Specimen signature duly attested and attached: Yes
Nomination to DCRG furnished : Yes
Nomination to LTA of Pension furnished : Yes
List of family members furnished: Yes
List of Legal Heirs furnished: No

Whether any Court Case regarding pay and services is pending/disposed off with No
Hon'ble High Court or any other Authority:

( LTI/Signature of Applicant )
SULATA GHOSH
Employee`s post: ASSISTANT TEACHER
RAJPUR PADMAMANI GIRLS HIGH SCHOOL, SOUTH 24 PARGANAS
Generated By: ZAHS3765
Date: 03/12/2023 11.17 am Page 1 of 2
EMPLOYEE CODE : ZAHS3765 APPLICATION NO. : 12022303038

INSTITUTION / ORGANISATION: SCHOOL EDUCATION DEPARTMENT DATE OF E-SUBMISSION: 23-Nov-2023

Other enclosures: No

e-SUBMISSION
I, Sri/Smt. SULATA GHOSH hereby declare that if the amount of pension granted, afterwards is found to be in excess of that to which I am entitled under
regulation, I shall be called upon to refund such excess.

I hereby declare that I have neither applied for nor received any Pension or Gratuity in respect of any portion of service included in this application and in
respect of which Pension or Gratuity is claimed herein, nor shall I submit an application hereafter without quoting a reference to this application and to the
orders which may be passed thereon.

I, Sri/Smt. SULATA GHOSH of RAJPUR PADMAMANI GIRLS HIGH SCHOOL, SOUTH 24 PARGANAShereby declare that any amount of excess payment
and overdrawal in pay and allowances, Loans, Advances etc. If found during scrutiny of any pension paper should be adjusted from the gratuity and pension
/ relief.
I hereby promise to raise no objection whatsoever for such adjustment.

( LTI/Signature of Applicant )
SULATA GHOSH
Employee`s post: ASSISTANT TEACHER
RAJPUR PADMAMANI GIRLS HIGH SCHOOL, SOUTH 24 PARGANAS
Generated By: ZAHS3765
Date: 03/12/2023 11.17 am Page 2 of 2

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