Forms connected with DAR section
STANDARD FORM NO. 01
STANDARD FORM OF ORDER OF SUSPENSION,
RULE 5 (1) OF THE RAILWAY SERVANTS (DISCIPLINE AND APPEAL) RULES, 1968
No……………………………………………
Railway………………………………………
Place of Issue…………………………………
Dated…………………………………………
ORDER
Whereas a Disciplinary proceeding against Whereas a case against Shri
Shri
……………………………………….
……………………………………….
…………………………………………
…………………………………………
(Name, Emp no. & Designation of the
(Name, Emp. No. & Designation of the
Railway servant) in respect of a criminal
Railway Servant) is contemplated/
offence is under investigation/
pending
Inquiry/trial.
Now, therefore, the undersigned [the authority competent to place the Railway servant
under suspension in terms of the schedules II and III appended to RS (D&A) Rules,
1968 /an authority mentioned in proviso to rule 5(1) of the Railways Servants
(Discipline and Appeal) Rules-1968], in exercise of the powers conferred by Rule 4
proviso to Rule 5(1) of the RS (D&A) Rules, 1968, hereby places the said Sh.
……………………………………….under suspension with immediate effect/ with
effect from……………………………….
It is further ordered that during the period this order shall remain in force, the said
Sh…………………………. ……….. shall not leave the headquarters without obtaining
the previous permission of the competent authority.
Signature…………………………
Name …………………………….
(Design. of the suspending authority)
Copy to:
1. Sh…………………………………………………………………………...
(Name, Emp No.& Design. of the suspended Railway servant)
Orders regarding subsistence allowance admissible to him during the period of
suspension will issue separately.
2. FA&CAO
3. Chief OS: Pay Bill, Leave, Service Record Cell, Staff –I
4. Supdt./Pass & OS/DAR ,
5. SSE/_______ & Chief OS/________
6. CTK/DMW/PTA
STANDARD FORM NO. 02
STANDARD FORM FOR DEEMING A RAILWAY SERVANT
UNDER SUSPENSION, RULE 5 (2) OF THE RAILWAY SERVANTS
(DISCIPLINE AND APPEAL) RULES, 1968
No……………………………………………..
Railway…………………………………………
Place of Issue…………………………………..
Dated……………………………………………
ORDER
Whereas a case against
Sh.………………………………………………………………..,
(Name, Emp no. & designation of the Railway Servant)
in respect of a criminal offence is under investigation.
and whereas the said Shri ………………………………………………………….
was detained in custody on ……………………for a period exceeding forty-eight hours.
Now, therefore, the said Shri……………………………………………………………
is deemed to have been suspended with effect from the date of detention. i.e the
………………….., in terms of Rule 5 (2) of Rly. Servants (D&A) Rules, 1968 and
shall remain under suspension until further orders.
Signature…………………………
Name …………………………….
(Design. of the suspending authority)
Copy to:
1. Sh…………………………………………………………………………….
(Name, Emp. No.& Design. of the suspended Railway servant)
Orders regarding subsistence allowance admissible to him during the period
of suspension will issue separately.
2. FA&CAO
3. OS: Pay Bill, Leave, Pass, DAR, Service Record Cell, Staff-I or II / DMW/PTA
4. SSE__________OS________________
5 .CTK/DMW/PTA
STANDARD FORM NO. 03
STANDARD FORM OF CERTIFICATE TO BE FURNISHED BY
SUSPENDED OFFICIAL UNDER RULE 2043 (2)-R II
I,
………………………………………………………………………………,
(Name of the Railway Servant )
having been placed under suspension by Order No…………………….
………………………..dated……………………………………………
while holding the post of ………………do hereby certify that I have not
been employed in any business, profession, or vocation for profit/
remuneration /salary.
Signature……………………
Name of Railway Servant……………
Address…………………………….
STANDARD FORM NO. 04
STANDARD FORM OF ORDER FOR REVOCATION OF SUSPENSION
ORDER-RULE 5 (5) (C) OF RAILWAY SERVANTS (DISCIPLINE AND
APPEAL) RULES, 1968
No……………………………………………..
Railway…………………………………………
Place of Issue………………………………….
.
Dated……………………………………………
ORDER
Whereas the order placing Sh.…………………….. ……………………..
…….
(Name, & design of the Railway Servant.)
under suspension was made/was deemed to have been made
by……………………………. .On……………………………………
Now, therefore, the undersigned (the authority which made or is
deemed to have made the order of suspension or any other authority to
which that authority is subordinate) in exercise of the powers conferred by
clause (c) of sub-rule (5) of Rule 5 of the RS (D&A) Rules, 1968, hereby
revokes the said order of suspension with immediate effect/ with effect
from………….............
Signature…………………………
Name …………………………….
(Design. of the authority making this order )
Copy to:
1.Sh…………………………………………………………………………...
(Name, & Design. of the suspended Railway servant)
Address…………………………………………………………………………
2. FA&CAO
3. OS: Pay Bill, Leave, Pass, DAR, Service Record Cell, Staff / DMW/PTA
4. SSE/OS________________
5 .CTK/DMW/PTA
Mht+y yksdks vk/kqfudhdj.k dkj[kkuk] ifV;kyk
Ekkud QkeZ la –5
vkjksi&i= dk ekud QkeZ la –5
jsy lsod ¼vuq'kklu vkSj vihy½ fu;e] 1968 dk fu;e 9
Kkiu
la[;k%
fnukad%
1. v/kksgLrk{kjh }kjk jsy lsod ¼vuq'kklu vkSj vihy½ fu;e] 1968 ds
fu;e 9 ds varxZr
Jh
_________________________,›üß.‹´Ö.›ü²»µÖæ.,¯Ö×™üµÖÖ»ÖÖ, ds fo:} tkap
djus dk izLrko gSA vopkj ;k dnkpkj ds ykaNuksa dk lkj ftu ds
laca/k esa tkap fd;s tkus dk izLrko gS] vkjksi dh enksa ds layXu
fooj.k esa fd;k x;k gS ¼vuqyXud-I½A vkjksi dh izR;sd en ds
lEcU/k esa vopkj@dnkpkj ds ykaNuksa dk fooj.k layXu gS
¼vuqyXud-II½A mu nLrkostksa dh lwph vkSj vkxs lkf{k;ksa dh
,d lwph ftuds }kjk vkjksi dh ensa lefFkZRk fd;s tkus ds fy,
izLrkfor gS] Hkh layXu gS¼vuqyXud-III vkSj IV½A vuqyaXud –
III esa n'kkZ;s x;s nLrkostksa dh izfr;ka Hkh layXu dh tk jgh gSa
A
2. Jh ____________dks ,rn }kjk lwfpr fd;k tkrk gS fd ;fn og ,slk
okafNr djs rks bl Kkiu dh izkfIr ds 10 fnu ds Hkhrj dk;kZy;
?kaVksa ds nkSjku] os fdlh Hkh le; nLrkostksa dh layXu lwph
esa mfYyf[kr nLrkostksa ¼vuqyXud-III ½ dh tkap dj ldrk gS vkSj
m)j.k ys ldrk gSA bl iz;kstu ds fy, mls bl Kkiu ds feyus ij rRdky
v|ksgLrk{kjh ls laidZ djuk gksxkA
3. Jh ____________dks iqu% ,rn }kjk lwfpr fd;k tkrk gS fd ;fn og
okafNr djsa rks nLrkostksa dk fujh{k.k djus rFkk ekSf[kd tkap fd,
tkus dh fLFkfr esa tkap izkf/kdkjh ds le{k ekeyk izLrqr djus esa
viuh lgk;rk ds fy, fdlh vU; jsy deZpkjh@jsyos VªsM ;wfu;u ds fdlh
inkf/kdkjh tks jsy lsod ¼vuq'kklu vkSj vihy½ fu;e 1968 ds fu;e 9
¼13½ vkSj mlds uhps fVIi.kh, 1 vkSj ;k fVIi.kh-2 dh 'krksZ dks
iwjk djrk gks]dh lgk;rk ys ldrk gSA bl iz;kstu ds fy,] og jsy
deZpkjh ¼deZpkfj;ka ½@jsyos VªsM ;wfu;u ds inkf/kdkfj;ksa dh
lgk;rk ds fy, ukfer djus ls igys ojh;rk ds Øe esa ,d ;k vf/kd
O;fDr;ksa dks ukfer djsxkA
Jh ____________dks ukfer O;fDr ¼ O;fDr;ksa ½ ls bl vk'k; dk
fyf[kr opu ys ysuk pkfg, ds og@os vuq'kklfud dk;Zokgh ds
nkSjku mldh lgk;rk djus dk bPNqd gSa@ ds bPNqd gSA mDr
opuo/k esa dksbZ vU; ekeyk] ;kfn dksbZ gks] dk fooj.k Hkh fn;k
tkuk pkfg,] ftuesa ukfer O;fDr@O;fDr;ksa us igys Hkh lgk;rk dk
opuc/k fd;k Fkk mlds lkFk v/kksgLrk{kjh dks izLrqr fd;k tkuk
pkfg, A
4. Jh
____________dks ,rn }kjk funsZ'k fn;k tkrk gS fd ;fn og vius
cpko dh rS;kjh ds fy, nLrkostksa dk fujh{k.k djuk vko';d ugha
le>rk gks rks og bl Kkiu dh izkfIr ds 10 fnu ds Hkhrj vkSj ;fn og
nLrkostksa dk fujh{k.k djuk pkgrk gS rks nLrkostksa ds fujh{k.k
iwjk gksus ds ckn nl fnuksa ds Hkhrj vius cpko dk ,d fyf[kr dFku
¼tks v/kksgLrk{kjh ds ikl igqap tk,½ v/kksgLrk{kjh dks izLrqr djs
vkSj lkFk gh crk, fd %&
¼d½ D;k og pkgrk gS fd mldh ckr O;fDrxr :i ls lwquh tk,A
¼[k½ lkf{k;ksa] ;fn gksa] ds uke vkSj irs izLrqr djsa] ftUgasa og
vius cpko ds leFkZu esas cqykuk
pkgrk gSA
5. Jh ____________dks lwfpr fd;k tkrk gS fd vkjksi ds dsoy
mUgha enksa ds laca/k esa tkap dh tk,xh] ftUgsa Lohdkj ugha
fd;k x;k gSA vr% mls vkjksi dh izR;sd en dks fo'ks"k :i ls Lohdkj
;k vLohdkj djuk pkfg,A
6. Jh ____________dks vkxs lwfpr fd;k tkrk gS fd ;fn og iSjk -4 esa
fofufZnZ"V vof/k ds Hkhrj viuk fyf[kr izfrokn izLrqr ugha djrk gS
;k tkap izkf/kdkjh ds le{k O;fDrxr :i ls mifLFkr ugha gksrk gS ;k
jsy lsod ¼vuq'kklu vkSj vihy fu;e½ fu;e 1968 ds fu;e-9 ds
mica/kksa ;k mDr fu;e ds vuqlj.k esa tkjh fd, x,
vkns'kksa@funsZ'kksa dk ikyu djus esa vleFkZ jgrk gS ;k euk
djrk gS rks tkap izkf/kdkjh ,d i{kh; tkap dk fu.kZ; ns ldrk gSA
7. Jh ____________dk /;ku jsy lsok ¼vkpj.k½ fu;e]1966 ds fu;e-20
dh vksj vkd¤"V fd;k tkrk gS] ftlds varxZr dksbZ Hkh jsy deZpkjh
ljdkj ds v/khu vius ukSdjh ls lacaf/kr ekeyksa essa vius fgr esa
fdlh mPp izkf/kdkjh ij dksbZ jktuSfrd ;k vU; izdkj dk izHkko ugha
Mkysxk ;k Myokus dh dksf'k'k ugh djsxkA bu dkjokbZ;ksa ds
varxZr fuiVk, tkus okys fdlh ekeys ds laca/k esa mldh vksj ls fdlh
vU; O;fDr dk dksbZ vH;kosnu izkIr gksrk gS rks ;g eku fy;k tk,xk
fd ÁÖß ____________ ,sls vH;kosnu ls voxr gSa vkSj og mldh lgefr
ls gh izLrqr fd;k x;k rFkk jsy lsok ¼vkpj.k½ fu;e-1966 ds fu;e-20
ds mYya?ku ds fy, mlds fo:) dkjokbZ dh tk,xhA
8. Ñi;k bl Kkiu dh ikorh nsasA
layXud% vuqyaXud I ls IV
vuq'kklfud izkf/kdkjh ds gLrk{kj
uke%
inuke%
]Mh,eMCY;w@ifV;kyk
Jh
deZpkjh la0
dk;ZLFky%
irk%
]inuke%ü
vuqyXud I
Jh ________________, deZpkjh la0----------------------------inuke--------------------------dk;ZLFky---------------------------Mh-,e-MCY;w@ifV;kyk ds fo:) yxk, x,
vopkj ;k dnkpkj ds ykaNukas dk lkj (vkjksi dh ensa) A
vuqyXud II
Jh ________________, deZpkjh la0----------------------------inuke--------------------------dk;ZLFky---------------------------Mh-,e-MCY;w@ifV;kyk ds fo:) yxkbZ
xbZ vkjksi dh enkas ds leFkZu eas vopkj ;k dnkpkj ds ykaNukas dk
fooj.k A
vuqyXud III
mu nLrkostksaa dh lwph ftuds “}kjk Jh ________________, deZpkjh la0---------------------------inuke---------------------------dk;ZLFky--------------------------Mh-,e-MCY;w@ifV;kyk ds fo:) yxkbZ xbZ vkjksi dh ensa lefFkZr fd,
tkus ds fy, izLrkfor gSa A
vuqyXud IV
mu lkf{k;ksa dh lwph ftuds “}kjk ÁÖß ________________, deZpkjh la0---------------------------inuke---------------------------dk;ZLFky---------------------------Mh,e-MCY;w@ifV;kyk ds fo:) yxkbZ xbZ vkjksi dh ensa lefFkZr fd, tkus
ds fy, izLrkfor gSa A
STANDARD FORM NO. 05
STANDARD FORM OF CHARGESHEET
[RULE 9 OF RAILWAY SERVANTS (DISCIPLINE AND APPEAL) RULES, 1968]
NO.:
Date:
DIESEL LOCO MODERNISATION WORKS,
PATIALA
PLACE OF ISSUE: PATIALA
MEMORANDUM
1. The undersigned proposes to hold an inquiry against Shri_________________,
_____________, DMW/Patiala, Emp. No.___________under Rule 9 of the
Railway Servants (Discipline and Appeal) Rules, 1968. The substance of the
imputation of misconduct or misbehaviour in respect of which the inquiry is
proposed to be held is set out in the enclosed statement of Article of charges
(Annexure-I). A statement of imputations of misconduct or misbehaviour in
support of each Article of charge is enclosed (Annexure-II). A list of documents
by which, and a list of witnesses by whom, the Article of charges are proposed
to be sustained are also enclosed (Annexure-III & IV). Further, copies of
documents mentioned in the list of documents as per Annexure-III are enclosed.
2. Shri ______________ is hereby informed that if he so desires, he can inspect
and take extracts from the documents mentioned in the enclosed list of
documents (Annexure-III) at any time during office hours within 10 days of
receipt of this memorandum. For this purpose he should contact the
undersigned immediately on receipt of this memorandum.
3. Shri ________________ is further informed that he may, if he so desires, take
the assistance of any other Railway Servant/ an official of Railway Trade Union
[who satisfies the requirements of Rule 9 (13) of the Railway Servants
(Discipline and Appeal) Rules, 1968 and Note-I and/or Note-2 there under as the
case may be] for inspecting the documents and assisting him in presenting his
case before the Inquiring Authority in the event of an oral inquiry being held.
For this purpose, he should nominate one or more persons in order of
preference. Before nominating the assisting Railway Servant(s) or Railway
Trade Union official(s), Shri _____________________ should obtain an
undertaking from the nominee(s) that he (they) is (are) willing to assist him
during the Disciplinary proceedings. The undertaking should also contain the
particulars of other case(s) if any, in which the nominee(s) had already
undertaken to assist and the undertaking should be furnished to the undersigned
along-with the nomination.
4. Shri _________________is hereby directed to submit to the undersigned a
written statement of his defence (which should reach the undersigned) within 10
days of receipt of this memorandum, if he does not require to inspect any
documents for the preparation of his defence, and within 10 days after
completion of inspection of documents if he desires to inspect documents, and
also
(a) To state whether he wishes to be heard in person and
(b) To furnish the names and addresses of the witnesses if any, whom he
wishes to call in support of his defence.
5. Shri __________________ is informed that an inquiry will be held only in
respect of those Article of Charges as are not admitted. He should, therefore,
specifically admit or/deny each article of charge.
6. Shri __________________ is further informed that if he does not submit his
written statement of defence within the period specified in para 4 or does not
appear in person before the inquiring authority or otherwise fails or refuses to
comply with the provisions of Rule 9 of the Railway Servants (Discipline and
Appeal) Rules, 1968, or the orders/directions issued in pursuance of the said
Rule, the inquiring authority may hold the inquiry ex parte.
7. The attention of Shri _______________ is invited to Rule 20 of the Railway
Services (Conduct) Rules, 1966 under which no Railway servant shall bring or
attempt to bring any political or other influence to bear upon any superior
authority to further his interests in respect of matters pertaining to his service
under the Government. If any representation is received on his behalf from
another person in respect of any matter dealt within these proceedings, it will be
presumed that Shri _______________ is aware of such a representation and that
it has been made at his instance and action will be taken against him for
violation of Rule 20 of the Railway Services (Conduct) Rules, 1966.
8. The receipt of this memorandum may be acknowledged.
DA: Annexure-I to IV
(
)
Design. of the DA
DMW/Patiala
& Disciplinary Authority
To
Shri ________________,
Design._____________, Emp. No._________
Place of work___________
DMW/Patiala.
Annexure-I
Statement of article of charges framed against Shri ________________, ____________,
Emp. No.______________.
Article-I
(
)
Design. of the DA
DMW/Patiala
& Disciplinary Authority
Annexure-II
Statement of imputations of misconduct/misbehaviour in support of the article of
charges framed against Shri ________________, ____________, Emp.
No.______________.
Article-I
(
)
Design. of the DA
DMW/Patiala
& Disciplinary Authority
Annexure III
List of relied upon documents by which the articles of charge framed against
against Shri ________________, ____________, Emp. No.______________.
are proposed to be sustained
(
)
Design. of the DA
DMW/Patiala
& Disciplinary Authority
Annexure-IV
List of witnesses by whom the articles of charge framed against Shri
________________, ____________, Emp. No.______________ are proposed to be
sustained
Shri
(
)
Design. of the DA
DMW/Patiala
& Disciplinary Authority
STANDARD FORM NO. 07
STANDARD FORM OF ORDER RELATING TO APPOINTMENT OF
INQUIRY OFFICER/ BOARD OF INQUIRY [RULE 9 (2) OF RAILWAY
SERVANTS (DISCIPLINE AND APPEAL) RULES, 1968]
No……………………………
Railway………………………
Place of Issue…………………
Dated…………………………
ORDER
Whereas an Inquiry under Rule 9 of the Railway Servants (Discipline and
Appeal) Rules, 1968 is being held against Shri_____________________________
(Name, Emp no. & design of the Railway Servant)
AND WHEREAS the undersigned considers that a Board of Inquiry/ an Inquiry
Officer should be appointed to inquire into the charge framed against him.
NOW, THEREFORE, the undersigned, in exercise of the powers conferred by
sub-rule (2) of the said Rule, hereby appoints a Board of Inquiry consisting of:Name of Member (S/Shri)
Designation
1. ____________________
2. ____________________
3. _____________________
OR
Shri……………………………………………………………………………………
(Name & design of the Inquiry Officer)
as Inquiry Officer to Inquire into the charges against the said
Shri………………………………...
Signature…………………………
Name …………………………….
(Design. of the Disciplinary authority)
Copy to:
Shri ……………………………………………………………………
(Name, Emp No.& Design. of the Railway servant)
Copy to: 1.
Shri………………………………………………………………
(Name, & Design. of the Member)
2.
Shri………………………………………………………………
(Name, & Design. of the Member)
3.
Shri………………………………………………………………
(Name, & Design. of the Member)
4.
Shri………………………………………………………………
(Name, & Design. of the Inquiry Officer)
CHANGE OF INQUIRY OFFICER
STANDARD FORM OF ORDER RELATING TO APPOINTMENT OF
INQUIRY OFFICER( IN PLACE OF INQUIRY OFFICER ORIGINALLY
APPOINTED ) ORDER RULE 9 (2) OF RAILWAY SERVANTS
(DISCIPLINE AND APPEAL) RULES, 1968]
No…………………………………
Railway………………………----Place of Issue ……………..
Dated…………………………………
ORDER
Whereas an Inquiry under Rule 9 of the Railway Servants (Discipline and
Appeal) Rules, 1968 is being held against Sh./Smt.----------------------------------------------------------------(Name, Emp no. & design of the Railway Servant )
WHEREAS Sh…………………………………...
(Name & design of the authority who was holding Inquiry) was appointed Inquiry
Authority to Inquiry into the charges against Sh. .Smt.
……………………………………………
(Name & design of the Railway Servant facing Inquiry)s vide order
No…………………….
dated ……..
AND WHEREAS Sh……………………………
(Name of previous Inquiry Officer ) after having heared and recorded the whole /part of
the evidence has since been transferred/ is not available and it is necessary to appoint
another officer as Inquiring Authority to inquire into the charges against
Sh………………………………….
NOW THEREFORE, the undersigned, in exercise of the powers conferred by
sub-rule (2) of the said Rule, hereby appoint
Sh………………………………………………...
(Name and design. of the new Inquiry Authority ) as Inquiry Authority to on quire into
the charges framed against the said Sh………………………………………….
(Name & design of the Railway Servant facing Inquiry) vice
Sh…………………………….
(Name of previous Inquiry Officer ).
Signature…………………………
Name …………………………….
(Design. of the Disciplinary authority)
Copy to:
1.
Shri……………………………………………………………….
(Name, Emp No.& Design. of the Railway servant)
2. Shri…………………………………………………………………………
(Name, & Design. of the Inquiry Officer)
FORM NO. 08
STANDARD FORM FOR APPOINTMENT OF PRESENTI NG OFFICER
[ SUB -RULE (9) (c) OF RULE 9 OF RAILWAY SERVANTS
(DISCIPLINE AND APPEAL) RULES, 1968]
No……………………………
Railway………………………Place of Issue ……………….
Dated…………………………
ORDER
Whereas an Inquiry under Rule 9 of the Railway Servants (Discipline and
Appeal) Rules, 1968 is being held against Sh.------------------------------------------------(Name, Emp no. & design of the Railway Servant )
And whereas the undersigned considers it necessary to appoint a person to
present the case in support of the charges before in Inquiring Authority.
Now, therefore, the undersigned in exercise of the powers conferred by sub-rule
(9) (c ) of Rule 9 of the RS (D&A) Rules, 1968 hereby appoints Sh………………….
as Presenting Officer to present the case in support of the charges before the Inquiring
Authority.
Signature…………………………
Name …………………………….
(Design. of the Disciplinary authority)
Dated…………………
Copy to: forwarded for information to :
Shri…………………………………………………………………………...
(Name, Emp No.& Design. of the Railway servant)
Signature…………………………
Name …………………………….
(Designation )
No…………………………………………………..
Copy forwarded for information to:
1. Shri……………………………………………………………………………
(Name, & Design. of the Inquiry Officer)
2.Shri………………………………………………………………
(Name, & Design. of the Presenting Officer)
Signature…………………………
Name …………………………….
(Designation )
ekud QkeZ -11
NksVh 'kkfLr;ka vf/kjksfir djus ds fy, Kkiu ;k vkjksi dk ekud
QkeZ
jsy lsod (vuq'kklu ,oa vihy ) fu;e] 1968 dk fu;e 11
laMht+y jsy batu vk/kqfudhdj.k dkj[kkuk, ifV;kyk
tkjh fd;s tkus dk LFkku :- ifV;kyk
rkjh[k :
Kkiu
1.
Jß_____________________,deZpkjh la._______inuke_______________•úÖê ,rn~ }kjk ÃÖæד֟Ö
׍úµÖÖ •ÖÖŸÖÖ Æîü וú v/kksgLrk{kjh }kjk jsy lsod (vuq'kklu
vkSj vihy ) fu;e 1968 ds fu;e 11 ds vUrxZr muds fo:)
dkjZokbZ djus dk izLrko gSA dnkpkj ;k vopkj ds
vkjksiksa dk fooj.k, ftu ij mi;qZDr dkjZokbZ fd, tkus dk
izLrko gS, layXu gS A
2.
3.
Jß____________________ dks ,rn~ }kjk vH;kosnu djus dk volj fn;k tkrk gS,
tks og bl izLrko ds lacaU/k esa djuk pkgs] ;fn dksbZ’
vH;kosnu fd;k tkuk gS rks v/kksgLrk{kjh dks izLrqr fd;k
tkuk pkfg, A rkfd og bl Kkiu ds izkIr gksus ds 10 fnu ds
Hkhrj igqap tk;s A
;fn Jß ___________________ iSjk la. 2 esa fofufnZÂV vof/k esa viuk
vH;kosnu”” izLrqr djus esa vlQy jgrs gS rks eku fy;k tk,xk
fd mudks dksbZ vH;kosnu ugha djuk Æî, ŸÖ£ÖÖ Jß___________________ ds
×ü¾Öºþ«ü ‹ú ¯ÖÖßµÖ †Ö¤êü¿Ö ¯ÖÖ׸üŸÖ ú¸ü פüµÖÖ •ÖÖ‹•ÖÖ A
4.
Jß___________________‡ÃÖ Kkiu úß ¯ÖÖ¾ÖŸÖß ¤ëü A‘’
lyaXu: mijksDr vuqlkj’’
üÆüßÖÖ•Ö¸ü_________________________
uke_________________________
(ÃÖ•Ö´Ö izkf/kdkjh •úÖ uke
vkSj inuke)
,ao
vuq'kklfud izkf/kdkjh
Jß ___________________•úÖê
(¸êü»Ö ú´ÖÔ“ÖÖ¸üßü dk uke, inuke vkSj ü •úÖµÖÖÔ»ÖµÖ)
STANDARD FORM NO.11
STANDARD FORM OF MEMORANDUM OF CHARGE FOR IMPOSING MINOR
PENALITIESRULE 11 OF RAILWAY SERVANTS (DISCIPLINE AND APPEAL) RULES, 1968.
NO:--------------------------------------------DIESEL LOCO MODERNISATION WORKS
PLACE OF ISSUE: PATIALA
DATE:
MEMORANDUM
1. Shri_______________________________/DMW/Patiala is hereby informed
that the undersigned proposes to take action against him under Rule 11 of the
Railway Servants (Discipline and Appeal) Rules, 1968. A statement of the
imputation of misconduct or misbehavior on which action is proposed to be
taken as mentioned above, is enclosed.
2. Shri_______________________________is hereby given an opportunity to
make such representation, as he may wish to make, against the above proposal.
The representation, if any, should be submitted to undersigned so as to reach
within ten days of receipt of this memorandum.
3. If Shri_____________________________ fails to submit his representation
within the period specified in para 2, it will be presumed that he has no
representation to make and orders will be liable to be passed against
Shri___________________________ex parte.
4. The receipt of this
Shri_________________
Memorandum
should
be
acknowledged
by
(
)
(Signature of the DisciplinaryAuthority )
Designation________________
&
Disciplinary Authority
To
Shri_________________________
(Name, Designation Emp. no. and place of work of the Railway Servant)
RULE-14 (i) of RS(D&A)Rules, 1968
FORM OF MOMORANDUM TO BE ISSUED TO AN EMPOLOYEE CONVICTED
IN A CRIMINAL CHARGE AND ACTION IS PROPOSED TO BE TAKEN UNDER
RULE 14(i) OF RAILWAY SERVANTS (DISCIPLINE AND APPEAL) RULES,
1968.
No……………………………………………..
Date……………………………………………
MEMORANDUM
(1)
Sh………………………………Designation…………………Emp. No.………
(under suspension) is informed that on a careful consideration of the
circumstances of the case in which he was convicted on………………on a
criminal charge, the undersigned considers that his conduct which has led to his
conviction, is such as to render his further retention in public service,
undesirable. The undersigned has, therefore, provisionally come to the
conclusion that:
Sh…………………………………………….is not a fit person to be retained in
service and so the undersigned, in exercise of power conferred by Rule 14 (i) of
the Railway Servants (Discipline and Appeal) Rules, 1968, proposes to impose
on him the penalty of removal /dismissal from service.
(2)
Sh. ………………………………………. is hereby given opportunity of
making representation against the proposed penalty. Any representation, which
he may wish to make on the penalty proposed, will be considered by the
undersigned before passing final orders. Such representation, if any should be
made in writing and submitted so as to reach the undersigned not later than 15
days from the date of receipt of this memorandum by
Sh……………………………………… . if no representation is received from
him within the stipulated time, it will be presumed that he has no representation
to make and final orders will be liable to be passed against him ex parte.
The receipt of this memorandum should be acknowledged by
Sh………………………..
Signature
Name:
Designation:
& Disciplinary Authority
To……………………………………………
………………………………………………
Annexur
e-“B”
Progress Monitoring Sheet for each major Penalty Case Salient Particulars
S.No. of case as entered in master register__________________
Telephone No
Name & Design of C.O.
Name & Design of D.A.
Name & Design of I..O.
Name & Design of P.O.
Target date as
per model
schedule
1.
2.
3.
4.
5
6.
7.
8.
9.
10.
11.
12.
13.
14.
Issue of charge sheet
after receipt of advice
Service of Charge sheet
Inspection of RUDs.
Submission of written
defence with list of
witnesses
Decision to hold the
inquiry after receipt of
the defence (Step 4)
Nomination of IO/PO
Appointment of IO/PO
Completion of Inquiry
and submission of
report.
Obtaining CVC’s
second stage advice
after receipt of inquiry
report
Supply of copy of
inquiry report to the
charged official
C.O’s submission of
final defence
Submission of cases of
Disciplinary Authority
Decision by
Disciplinary Authority
Issue of NIP
Actual
date
Remarks for
delays
Forms connected with Recruitment section
टी.ए.डी.के,के पद पर एवजी के रुप में नियुक्ति हे िु आवेदि पत्र
आवेदक का नाम
कृपया संबंधिि अधिकारी
(ब्लॉक लर म म)
से
सत्यापितपि
टोटोराट
धिपकाएं
पिता/ितत का नाम
जन्म तति
स् ायी िता
शरक्षिक योग्यता (्रममा
ि्र क
सत्यापित ्रमतत सलग्न कम)
यदद अनु.जातत /अनु.
ज.जा.
/अ.पि.जा. के उम्मी दवाम ं त तो
्रममा
ि्र क सत्यापित ्रमतत
सलग्न कम)
माष्‍टरीयता
1. मे लवे म) क गई िूवव सेवा,
यदद
ं र
पववम
तो,
के
सम्िू व
(जरसा एवजी लेबम
कार्व म) दशावया गया ं र
2. यदद िं ले से मे लवे
म)
एवजी के रुि म) सेवामत ं र
तो
अिने
सम्िू व
पववम
तनयोक्ता
द)
का
(जरसा
एवजी लेबम कार्व म) दशावया
गया ं र
घोष ा
मत एतद् द्वामा घोष ा कमता ं ू कक मत र्ी .एम.र्ब््यू म) ककसी ी मे लवे अिाकामी के सा
ी.ए र्ी के के िद िम एवजी के रुि म) के काम कमने के ललए अिनी सं मतत बबना ककसी शतव दे ता ं ू , मुझे
मालूम ं र कक एवजी के रुि म) काम क
आमम्म्मक अविा केवल 3 मां क ं ोगी , जो मेमे अच्छे
कायवतनष्‍टिादन को ‍यान म) मेते ं ुए ्रमत्येक 3 मां के कायवकाल के उिमान्त ब़ााई जा सकती ं र
मत
यं ी घोष ा कमता ं ू कक आगे ीएर्ी के क तनयम्ु क्त इत्यादद सबाी ददनाक 05.03.2012 के िरमि्र स. र्ी एम र्ब््य/ू िी /आम /05/ ीएर्ी के के अतगवत जामी नी तत के तनयमों क
मं ूगा
िालन कमने के ललए बा‍य
मत यं ी स्वी काम कमता ं ू कक यदद मत ीएर्ी के के िद िम एवजी के रुि म) कायव कमने का
अतनच्छुक या अनुियुक्त िाया जाता ं ू एव मेमा कायव तनष्‍टिादन असतोषजनक िाया जाता ं र तो
र्ी .एम.र्ब््यू ्रमशासन द्वामा बबना ककसी नोद स ददये मेमी सेवाए समा‍त ककये जाने का मत उत्तमदायी ं ूगा औम इस सबा म) आगे यं ी स्वी काम कमता ं ू कक मे लवे म) समं ू ‘घ’ के िद िम ककसी वरकम््िक तनयुम्क्त के ललए ककसी ्रमकाम का कोई अिाकाम/दावा नं ी मेगा
ू
आवेदक के ं स्तािम
ी संबंधिि अधिकारी का प्रमाण पत्र एवं संस्िुनि
मत
लसफारमश
ि्र ु /ि्र ु ी /ित्नी कमता
ं ू
कक श्री /श्री मती /कुमामी----------------------------श्री ---------------------------- को मेमे आवास िम ीएर्ी के
के िद िम
एवजी के रुि म) तनयक्
ु त ककया जाए
अिने सा
इन्ं )
ीएर्ी के के िद िम एवजी के
रुि म) मेने के ललए मत एतद् द्वामा बबना शतव अिनी सं मतत दे ता ं ू मत ददनाक
05.03.2012 के िरमि्र स.र्ी एम.र्ब््यू/िी रआम/05/ ीएर्ी के
के अाी न जामी नी तत के
तनयम
सबा ं र
िालन कमने के ललए बा‍य मं ूगा
मत आगे घोष ा कमता/ कमती ं ू कक उक्त ्‍यम्क्त से मेमा कोई सबा नं ी ं र/
अिाकामी के ं स्तािम
नाम त ा मों म सदं त
Forms connected with ACR cell
ANNUAL STATEMENT OF IMMOVABLE PROPERTY AS ON Ist JANUARY________.
1.
2.
3.
4.
5.
Name of
District
Of Sub
Division
Taluk &
Village
In Which
Property
Is situated
Name of official(in full) and Designation:________________________
Deptt which to belong & Trade .if any. ________________________
Emp. No
________________________
Place of Posting
________________________
Present Pay Scale &Grade Pay
________________________
Name& Detail
Of Property.
Housing
& other
buildings
Land
Present
Value
If not in
own name
state in
whose
name held
& his /her
relationship
to Govt.
servant
How acquired ,
whether purchase
lease @ mortgage
inheritance, gift or
otherwise, with date
of acquisition and
name with details of
persons from whom
acquired
Annual
Income
of the
property
Remarks
Signature---------------Date---------------Inapplicable clause to be struck out.
In case where it is not possible to assess the value accurately ,
the approximate value in relation to present condition may be indicate.
@ includes short term lease also.
Signature & Designation of the forwarding officer
DMW/Patiala
Forms available in Welfare section
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1.
2.
3.
4.
5.
6.
7.
8.
9.
10
11
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ysu nsu dh izLrkfor rkjh[k ls
de ls de 30 fnu igys
izLrqr fd;k tkuk pkfg, A
APPLICATION FOR ISSUE OF ‘ NO OBJECTION CERTIFICATE’ FOR OBTAINING A
PASSPORT
______________________________
______________________________
______________________________
______________________________
______________________________
(THROUGH PROPER CHANNEL)
Sir,
Sub: Request for issue of ‘No Objection Certificate” for obtaining passport.
I wish to obtain a passport for visiting_____________________. I request that I
may kindly be granted ‘NO OBJECTION CERTIFICATE’
To enable me to produce it before the appropriate passport Issuing Authority. The
details of my Bio-data and other particulars are given below:1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Name
:______________
Father’s Name
:______________
Designation
:______________
Date of Birth
:______________
Date of Apptt. in Rlys.
:______________
Grade and Rate of Pay
:______________
Division/Branch in which working.
:______________
Station of posting
:______________
Present Residential Address
:______________
Permanent address
:______________
Place of residence during the last 02 years.
:______________
Countries for which passport is required
:______________
Reasons for getting a passport.
:______________
I declare that :a) I will abide by the provisions of Indian Passport Act India Custom Act and any
other Acts of the Government of India.
b) I will not request for release of foreign exchange from Railways and will make my
own arrangement for finance as and when I intend to visit abroad.
c) I will get the approval and sanction of leave from the appropriate competent
authority every before proceeding abroad.
d) I understand that the issue of passport will be subject to clearance from the Civil
Authorities. Income Tax Department etc.
e) I will not undertake to pursue any study or training while abroad without prior
permission of the Railway Administration.
f) I will not indulge in any of activity which may be prejudicial to the interests of my
country or any other country and my activities during visit/stay abroad will not
affect the friendly between my country and any other country/countries.
g) I will obey the general conditions laid down by the Government of India from time
to time in this connection.
Yours faithfully,
Signature of the Applicant
with Name below the signature
Station:______________
Dated :_______________
DECLARATION
( To be attached with the form for NOC for passport)
I am applying for issue of NO OBJECTION CERTIFICATE for obtaining
passport/visiting abroad vide my application dtd.______________________.
I hereby declare that the following loans/advances are outstanding against
SN
Item
Amount taken
me.
Outstanding amount
approx.
1.
House Building Advance
2.
Scooter/Car
3.
PF Advance
4.
NZRE Loan
5.
Any other loan
In terms of Section 6(2) of the Passport Act, 1967, I further declare that :a)
b)
I am a citizen of India.
I shall not engage outside India in any activity prejudicial to the sovereignty and
integrity of India.
c)
My departure from India shall not be detrimental to the security of India
d)
My presence outside India shall not prejudice the friendly relations of India with
any foreign country.
e)
During the period of five years, I have not been convicted by a court in India for
any offence involving moral turpitude and I have not been sentenced in respect
thereof to imprisonment for not less than two years.
f)
A warrant or summons for the appearance or a warrant for the arrest, has not been
issued against me by a court under any law for the time being in force or that an
order prohibiting the departure from India has not been made by any such court.
g)
I have not been repatriated, (and in the event of repatriation, the expenditure
incurred in connection with such repatriation has already been reimbursed by me)
Four Passport size photographs alongwith form (two photos pasted on the forms) are also
sent herewith.
Place: Patiala
Dated: _______
(Signature of applicant)
Name
:_______________
Design & Trade_________
Emp.No._______________
INDIAN RAILWAY
DMW/PATIALA
Para G 1536(1)
FORM OF AGREEMENT TO BE EXECUTED BEFORE DRAWING ADVANCE
FOR THE PURCHASE OF MOTERVEHICLE/SCOOTER/MOPED/COMPUTER.
An agreement made on_____________________day of ______________two
thousand __________________ between ______________________________ EMP.NO.
__________________of_______________________________ here in after called the
borrower which expression shall include his heir administrators executor and legal
representative) or the one part and the President Of India (hereinafter called the President
which express shall include his successors and assignees on the other part. Whereas the
borrower has under the provisions of the Indian Railway General. Code Vol. (hereinafter
referred to as the said code which expression shall include any amendments thereof for the
time
being
in
force)
applied
to
the
President
for
a
loan
of
Rs._______________(________________________________________) only. For the
purchase of an Car/Scooter /Moped/Computer and whereas terms and conditions hereafter
contained is hereby agreed between the party to that in consideration of the sum
Rs.______________(Rs.______________________ ) to be paid by the President to the
borrower the borrower hereby agrees with the President (i) to pay the said loan by monthly
deduction from his salary as provided to the said deductions and (ii) within one month from
the date of payment of the said sum to expend the full amount of the said loan in purchase
of a Car/Scooter /Moped/Computer if the actual price paid is less than the loan to repay the
difference to the President forthwith and (i) or execute a document, Hypothecations the said
vehicle/Computer to the President as security for the amount to be lent to the borrower as
aforesaid and interest in the form provided by the said code and (ii) hereby lastly agreed
and declared and if the vehicle/computer has not been purchased and hypothecated as
aforesaid within one month from the date of payment of the said sum . If the borrower
within that period becomes insolvent quits the service of the Govt. or dies the whole
amount of the loan and the interest executed therein shall immediately become due and
payable.
In
witness
where
of
the
borrower
and____________________________________________for and on behalf of the President
have herein to set their hands the pay and year first before written.
(Signature by the said in the presence of)
borrower)
(Signature and Designation of
1.______________________________
2.______________________________
Signature of the witness Name & Design.
Signature & Designation of Controlling Officer
(with seal)
Name & Design._____________
For & on behalf of President of India
layXud d
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ls ekpZ 2008 rd dk izfrekg----------------: dk f'k{kk 'kqYd ds :i
esa Hkqxrku fd;k gSA
1. f'k{kk 'kqYd
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To,
The Chief Admn. Officer,
Diesel Loco Modernization Works,
Patiala
Sub: Advance increment for undergoing sterilization operation.
Ref: Rly. Bd’s letter No. 80/H/FW/7/1 dtd. 19.09.80 Office Memorandum
No. 7(39)-E/III/79 dtd. 04.12.79 admissible since 04.12.79.
Sir,
1. I/My wife have/has undergone Vasectomy/Tubectomy operation at
_____________________________________ on _________ it is, therefore,
requested that I may kindly be granted on advance increment as admissible under
the letter quoted.
2. It is certified that my wife Smt. ____________________ is not pregnant on date.
3. It is certified that I have two/three living children only.
4. Our ages at the time of operation was ________ and _________ for me and my
wife respectively.
5. In case I/my wife has to opt for re-canalization for any reason what so over, I under
take to report this fact to the notice of Railway Admn. immediately.
6. The necessary sterilization certificate issued by Dr.________________
Design__________ Station_____________ is attached herewith.
DA: One
Yours faithfully
(Signature LTI/RTI of the employee.
N.B. 1. Para 2 is only applicable
(Name in Block letter.)
to male employees.
____________________
2. Strike out which is not applicable. Design__________
Station:______________
Forwarded to CPO with the remarks that the undertaking given by the employee
Sh./Smt.___________________Son/wife______________ Design____________
Department_____________ Station___________ to the best of my knowledge and
relief.
Date:__________
Inch.)
(Sign. Senior Subordinate/Officer
STERLIZATION CERTIFICATE
A. I/Dr. ____________________________ Design_____________
Station_________________
Hereby certify that I have conducted Vasectomy/Tubectomy operation on Sh.Smt.
___________________ S/O/W/O _______________ Design__________________
Station______________________on _______________ dt._________________
(Signature of Surgeon)
Name _________________
Station:_________________
Dated:______________
B.
Examined Smt._____________________W/O
Sh.________________________certified that
she is not pregnant on date.
(Signature of Gynecologist)
Name: _______________
Design:________________
Station :________________
C. A sperm count has been done at ________________ vide LB
No._______________ and its result
is _____________________.
D. I, Dr. ________________________ Design_____________
Station______________________
Hereby certify that Sh./Smt.____________________ W/O/Son of
_______________________
Under went Vasectomy/Tuboctomy operation and on the basis of the Report given
at Para B/C above, it is further certified that Vasectomy/Tubectomy Operation has
been completely successful.
NqVVh dk vkosnu i=
fnukad %------------------------deZpkjh dk uke
%---------------------------------------
--inuke
%------------------------------------------
deZpkjh la0
%------------------------------------------
foHkkx
%------------------------------------------
NqV~Vh dh fdLe
%---------------------------------------
---fnukad ----------------------------ls ---------------------------- ( dqy------------- fnu )
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%--------------------------------
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%--------------------------------
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%---------------------------------------
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vkosnd ds gLrk{kj
vkosnu NqV~Vh jftLVj ds i`"B --------ds dze la0 ----- ij ntZ gS
dk;kZy; v/kh{kd
Lohd`fr vf/kdkjh
QkeZ%18(2)
vpy laifr ds ysu nsu ds lac/k esa dsUnzh; flfoy lsok vkpj.k
fu;e 1964 ds fu;e 18(2) ds varxZr iwoZ lwpuk nsus vFkok
iwoZ eatwjh izkIr djus ds QkeZ%
1.
2.
3.
4.
5.
6.
8.
9.
uke]inuke vkSj deZpkjh la0
osrueku vkSj orZeku osru
vkosnu dk iz;kstu ysu-nsu ds fy,
eatwjh@iwoZ lwpuk
D;k laifRr dk vf/kxzg.k fd;k tk jgk
gSSs ;k fuiVku dh laHkkfor frfFk
vf/kxzg.k@fuiVku dk <aax
d- LFkku dk iwjk irk vFkok
uxjikfydk]xyh u0 @ xko] rkYyqd ftyk
vkSj jkT; tgka fLFkr gS A
[kljk@[krkSuh u0] lkbt]IykV la0
[k- Hkwfe ds d`f"k ;ksX;] 'kq"d ;k
flfpar gksus dh fLFfr esa laifRr dk
fooj.k A
x- D;k QzhgksYM ;k iV~Vs ij gS \
?k- D;k vkosnd dk laifRr esa iwjk fgr
gS ;k vkaf'kd fgr vkf'kd fgr gksus dh
fLFfr esa ,sls fgr dh ek=k vo'z; lwfpr
djsa\
M- ;fn mDr ysu nsu vU; :Ik ls ljdkjh
dZepkjh ds uke esa ugha gSs rks
LokfeRo dk vkSj izR;sd lnL; ds fgLls
dk fooj.k nsa A
laifRr dk fodz;@dz; ewY; ;fn migkj
esaa feyh gSs rks mldk cktkj ewY;
edku dh dqy ykxr a
vf/kxzg.k ds ekeys esa foRr
?kksf"kr@foRr iks"k.k ds fy, izLrkfor
L=ksr crk,&
d- oS;fDrd cpr
[k- vU; L=ksr C;kSjk nsa A
10
11
12
13
laifRr ds ekeys esa D;k mlds
vf/kxzg.k ds visf{kr eatwjh yh xbZ
Fkh@lwpuk nh xbZ Fkh (eatwjh
ikorh dh ,d izfr layXu djsa )
d-ikVhZ dk uke vkSj irk ftl ds lkFk
ysu nsu fd;k tkuk gSsA
[k- D;k ikVhZ vkosnd dk fj'rsnkj gS
;fn gka rks fj'rk crk,a \
x- D;k vkosnd us viuh ljdkjh gSfl;r
esa fdlh le; ikVhZ ls dksbZ ysu nsu
fd;k gSs ;k fudV Hkfo"; esa dksbZ
ysu nsu djus dh laHkkouk gSA
?k-ysu&nsu dh O;oLFkk dSls dh
xbZ gS (fdlh dkuwuh fudk; }kjk
vFkok fdlh izkbosV ,atsaV }kjk
vFkok foKkiuksa }kjk ;k fe=ksa ;k
lacf/k;ksa }kjk iwjk fooj.k nsa)
;fn migkj }kjk vf/kxzg.k fd;k x;k gSs
rks D;k dsUnzh; flfoy lsok (vkpj.k)
fu;e 1964 ds fu;e 18 ds varxZr Hkh
eatwjh dh vko';drk gS A
dksbz vU; lqlaxr rF; ftldk vkosnd
mYys[k djuk pkgsA
?kks"k.kk
eSa------------------------------,rn }kjk lwfpr djrk gWaw
@djrh gWaw fd mij fn;k x;k C;kSjk lgh gS eSa ;g vuqjks/k
djrk gWaw fd eq>ss mi;qZDr laifRr esa mlds dh vf/kxzg.k
djus dh vuqefr nh tk,] ftldk uke miZ;qDr en &11 esa fn;k x;k
gS A
vFkok
eSa--------------------------------------,rn }]kjk mi;qZDr laifRr
vf/kxzg.k vkSj fuiVku dh lwpuk nsrk gwWaA eSa ;g
?kks"k.kk djrk gWwa fd mi;qZDr elkSnk lgh gS A
LFkku
gLrk{kj
Rkkjh[k
inuke
fVIi.kh% 1. mi;qZDr QkeZ esa ] fofHkUu Hkkxksa dk
vis{kkuqlkj iz;ksx djsa A
2. tgka iwoZ eatwjh ekaxh xbZ gks] ogka vkosnu ysu
nsu dh izLrkfor rkjh[k ls de ls de 30 fnu igys izLrqr fd;k tkuk
pkfg, A
APPLICATION FOR ISSUE OF ‘ NO OBJECTION CERTIFICATE’ FOR OBTAINING A
PASSPORT
______________________________
______________________________
______________________________
______________________________
(THROUGH PROPER CHANNEL)
Sir,
Sub: Request for issue of ‘No Objection Certificate” for obtaining passport.
I wish to obtain a passport for visiting_____________________. I request that I
may kindly be granted ‘NO OBJECTION CERTIFICATE’
To enable me to produce it before the appropriate passport Issuing Authority. The details
of my Bio-data and other particulars are given below:1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Name
:______________
Father’s Name
:______________
Designation
:______________
Date of Birth
:______________
Date of Apptt. in Rlys.
:______________
Grade and Rate of Pay
:______________
Division/Branch in which working.
:______________
Station of posting
:______________
Present Residential Address
:______________
Permanent address
:______________
Place of residence during the last 02 years.
:______________
Countries for which passport is required
:______________
Reasons for getting a passport.
:______________
I declare that :a) I will abide by the provisions of Indian Passport Act India Custom Act and any other
Acts of the Government of India.
b) I will not request for release of foreign exchange from Railways and will make my
own arrangement for finance as and when I intend to visit abroad.
c) I will get the approval and sanction of leave from the appropriate competent authority
every before proceeding abroad.
d) I understand that the issue of passport will be subject to clearance from the Civil
Authorities. Income Tax Department etc.
e) I will not undertake to pursue any study or training while abroad without prior
permission of the Railway Administration.
f) I will not indulge in any of activity which may be prejudicial to the interests of my
country or any other country and my activities during visit/stay abroad will not affect
the friendly between my country and any other country/countries.
g) I will obey the general conditions laid down by the Government of India from time to
time in this connection.
Yours faithfully,
Signature of the Applicant
with Name below the signature
Station:______________
Dated :_______________
dEI;wVj@LdwVj@eksisM@eksVj lkbZfdy [kjhn gsrq
vfxze /kujkf'k ds fy, vkosnu i=
1.
2.
3.
4.
5.
6.
7.
8.
9.
10
11
12
13
uke] vkSj deZpkjh la0
inuke
ftyk ,oa LVs'ku
ewqy osru
fu;qfDr dh rkjh[k
iqf"Vdh rkjh[k
iqjkus@u;s
LdwVj@dkj@dEI;qVj@eksisM dk
izR;kflr ewY;
visf"kr vfxze /kujkf'k
Bsds ds ekeys esa vf/kof"kZrk ;k lsok
fuo`fRr dh rkjh[k&
okfNr fdLrksa dh la[;k ftuesa jkf'k
ykSVkuh gSA
;fn igys dHkh dksbZ okgu@dEI;wVj
[kjhnus gsrq vfxze fy;k x;k gS rks
vfxze ysus dh rkjh[k
;fn vfxze fy;k gS rks cdk;k vfxze jkf'k
rFkk C;kt
fuEu esa ls D;k dz; fd;k tk jgk gSA
d- u;k@iqjkuk LdwVj
@dkj@dEI;wVj@eksVjlkbZdy
[k- ;fn eksVj
dkj@LdwVj@dEiwVj@eksVj lkbZfdy
fdlh O;fDr ds ;k vU; fu;fer ;k izfrf"Br
Mhyj ;k ,tsUV ds ek/;e ls [kjhnk tkuk gS
rks D;k dsUnzh; lsok
( vkpj.k) fu;eks 1965 ds fu;e 25(2) ds v/khu
igys l{ke izkf/kdkjh ls Lohd`r izkIr dh
gsA
;fn vf/kdkjh vodk'k ij gS ;k vodk'k ij tkus
okyk gS rks
d- NqV~Vh vkjEHk gksus dh rkjh[k
[k- NqV~Vh lekIr gksus dh rkjh[k
-----------------------------------------------------
---------------------------------------------------
-------------------------------------------------
14.
15.
D;k okgu@dEI;wVj ds fy, ckrphr ;k
vkjfEHkd iM+rky dh tk jgh gSA rkfd
vfxze jkf'k izkIr djus ds ,d ekg ds vUnj
eksVj@dkj@LdwVj@eksisM@dEI;wVj
dh fMyhojh dh tk ldsA
D;k djkj 1536(I) QkeZ Hkh Hkjdj layXu
fd;k x;k gSA
izekf.kr fd;k tkrk gS fd mij nh xbZ lwpuk iw.kZ ,oa lR; gSA
izekf.kr fd;k tkrk gS fd eSus ftl vfxze ds fy, vkosnu fd;k gS
ml LdwVj@dkj@dEI;wVj@eksisM dh liqnZxh ugh yh gS]
eSa vfxze ysus dh rkjh[k ls ,d ekg chrus ls igys ;k [kjhn dh
lekfIr ls igys lacaf/kr iwjk dj ywaxkA
vkosnd ds gLrk{kj
?kks"k.kk
1. izekf.kr fd;k tkrk gS esjh jk; esa Jha-----------------------------
--------------inuke ------------------------ dks okgu dk vf/kxzg.k
djuk vius dk;kZy;k/khu drZO;ksa ds fu"iknu ds fy, mi;ksxh
jgsxkA
2. eSa iw.kZr% larq"V gwW fd os vfxze ykSVkus dh {kerk
j[krs gSaA
foHkkxk/;{k ds gLrk{kj
Mh ,e MCY;w@ifV;kyk
mi eq[; dkfeZd vf/kdkjh]
Mh0 ,e MCY;w@ifV;kyk
fo"k;% ------------------------ R;kSgkj vfxze ds fy, jkf'k -------------------:I;s eatwjh djus
gsrq vkosnuA
egksn;]
fuosnu ;g gS fd eq>s -------------------------------- R;kSgkj
eukus ds fy, R;kSgkj 1500/- :i;s dks vko';drk gSA vr%
izkFkZuk gS fd eq>s 1500/- :i;s R;kSgkj vfxze nsus dh d`ik
djsaA bl jkf'k dh dVkSrh esjs osru ls 10 cjkcj fd'rksa esa
dj ysaA eSusa o"kZ ----------------esa R;kSgkj vfxze ugha
fy;k gSA esjk lsok fooj.k fuEufyf[kr gS%&
1.
vkosnd dk uke
%----------------------------------------2.
vkosnd ds firk@ifr dk dk uke
%----------------------------------------3.
fVdV la0
%----------------------------------------4.
deZpkjh la0
%----------------------------------------5.
LFkk;h@vLFkk;h
%---------------------------------------6.
inuke
%---------------------------------------7.
fu;qfDr dh rkjh[k
%---------------------------------------8.
osrunj (:i;s )
%---------------------------------------9.
osrueku (:i;s )
%---------------------------------------10. dk;ZLFky@foHkkx
%---------------------------------------11. fdl eghus ls fiNys R;kSgkj vfxze vc rd dVrh jghA
flQkfj'k ds lkFk vxzsf"kr fd;k tkrk gSA
gLrk{kj@dk;kZy; eksgj
Rkkjh[k
DeZpkjh ds gLrk{kj
inuke-------------------------------------fVdV la0-------------------------------deZpkjh la0 ---------------------------
APPLICATION FOR ISSUED OF ‘ NO OBJECTION CERTIFICATE’ FOR
GOING ABROAD FOR SANCTION OF LEAVE TO BE AVAILED OF OUTSIDE
______________________________
______________________________
______________________________
______________________________
______________________________
(THROUGH PROPER CHANNEL)
Sir,
Sub: Request for issue of ‘No Objection Certificate” for obtaining passport.
I am in possession of passport No.__________ issued by___________which I
have obtained on the basis of ‘NO OBJECTION CERTIFICATE’ issued by you vide
No.___________________________dated ___________. The passport is valid
upto____________.
I wish to proceed to _______________ for the purpose of
_______________________________ ___________ I request that I may kindly be granted
permission for the same.
My application for sanction of leave from _______To ________ is enclosed herewith.
My Service particulars and other details are given below:1. Name
:______________
2. Father’s Name
:______________
3. Designation /Emp. No.
:______________
4. Date of Birth
:______________
5. Date of Apptt. in Rlys.
:______________
6. Grade and Rate of Pay
:______________
7. Office/Shop in which working.
:______________
8. Place of posting
:______________
9. Present Residential Address
:______________________
_______________________
________________________
10. Permanent address
:_______________________
________________________
________________________
11. Place of residence during the last 02 years. :______________________
12. Places to visit abroad with names of the countries__________________
13. Duration of visit From__________ to_________
14. Address while abroad
:_______________________
________________________
________________________
15. Estimated expenditure
:___________________
16. Source of funds
:___________________
17. If the transaction for the source of funds requires the prior sanction of the competent
authority, as per the Railway Service (Conduct) Rules, 1966 (Rule 18), sanction particulars of
the same.
I declare that :a. I will not request for release of foreign exchange from Railways and will make
my own arrangement for the foreign exchange required for the trip.
b. I will not overstay abroad except with the prior approval of the competent
authority.
c. I will make my own arrangements to get my leave salary and other allowances
while abroad. I understand that those amounts will be paid only in Indian
Rupees.
d. I will not seek any financial assistance from any foreign
country/Institution/Agency from my country.
e. I will not persue any study or training while abroad without prior permission of
the Administration.
f. I will not take up any employment or activity of profit while abroad.
g. I will not indulge in any activity which may be prejudicial to the interests of my
own country or any other foreign country and my activities during my visit/stay
abroad will not affect the friendly relations between my country and any other
country/countries.
h. I will inform any change of address which may take place during my stay
abroad to the Railway Administration.
i. I will not cater late any contractor marriage with a person other than Indian
nationality without prior permission of the Government.
j. I will adhere to the provisions of Rule 18 of the Railway Service (Conduct )
Rules, 1966 in case I enter into any transaction for movable property.
k. I clearly understand that I am liable for action under D&AR Rules in case I
violate of the above provisions or any conduct unbecoming of a Railway
Servant while I am abroad.
Yours faithfully,
Signature of the Applicant
with Name below the signature
Station:______________
Dated :_______________
DMW/Patiala
No.359-E/1/DMW
Dated: …………..
To
……………………………………
……………………………………
……………………………………
Dear Sir,
Sub.:- Reservation of accommodation in Holiday Home
at…………………………..…w.e.f. ………………
to………………….
Enclosed please find an application on the prescribed proforma from
Sh…………………………………………Emp.No………………………
…....
Design……………………………… of DMW/Patiala, for the
reservation of accommodation in Holiday Home for the above period.
The request may kindly be considered and an intimation of the booking
may please be sent to the applicant at the address indicated in the
request..
Asstt Personnel Officer
DMW/Patiala.
DMW/PATIALA
APPLICATION FORM FOR RESERVATION OF ACCOMMODATION
IN THE HOLIDAY HOME AT______________________________________
1.
Name of the employee
i) Designation
ii) Class
_____________________
_____________________
_____________________
2.
3.
4.
Place of work
Shop/office
Reservation required
From________To_________
5.
State, if accommodation is accepted at short
notice if accommodation is not available for
the dates applied for.
6. State, if alternative dates are acceptable in
case accommodation is not available for the
dates
Applied for.
7. State, if accommodation of the above holiday
Home was availed in the previous years, if
yes
Give year
8. Date of Appointment
9. Rate of pay
10. Employee No.
(Signature of applicant)
Despatched in a booked cover
Date:__________
(Signature & Designation of immediate Supervisor
Date:____________
DMW/PATIALA
APPLICATION FORM FOR PURCHASE OF CYCLE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
1.
Name of the employee
2.
Father’s Name
3.
Emp. No.
3.
Designation
3.
Shop/office
4.
Date of Appointment
5.
Date of Confirmation
6.
Date of Retirement
7.
Rate of Pay (Substantive & officiating)
P.F. No.
Place of residence with complete address of
Rly. qtr. If allotted.
Distance between office and Residence
Amount of advance applied for
Approximate cost of cycle to be purchased.
I do hereby declare that in the event of the advance being sanctioned. I
shall purchase the bicycle within one month from the date of the advance. The
bicycle thus purchased will be subject to inspection of Sub-ordinate Incharge. I
shall continue to get my bicycle inspected by the subordinate incharge monthly
till the advance is repaid.
I further certify that I have not taken any advance for same purpose during
the last five years.
(Signature of applicant)
Designation:___________
Emp. No._____________
Recommendation of the Branch, Office. Section/Branch__________ the grant of
advance is recommended .
Signature________________
Design:_________________
______________________
Subordinate Incharge.
FORM
SET
FOR
RETIREMENT
201/Gen./Form No. 6.
STATEMENT SHOWING THE DETAILS OF THE FAMILY FOR THE PURPOSE
OF FAMILY PENSION SCHEME, 1964
NAME (IN BLOCK LETTERS)
______________________________
DESIGNATION :
_____________________________
BRANCH
_____________________________
OFFICE
_____________________________
DATE OF APPOINTMENT
_____________________________
DATE OF BIRTH
_____________________________
Details of Family.
SN. Name(S/Shri)
Relationship with Date of birth (by Remarks
the Rly. servant
Christian Era)
I declare that the information given above, is correct.
Signature _________________
Witness
(Signature )____________________
(Name in Block
letters)________________________
Design:_______________________________
Office/Shop
:_______________________________
Station:____________
Date: ______________
Form No. 07
I hereby declare that I have neither applied for not received any ordinary
gratuity pension and or/death-cum-retirement gratuity in respect of any portion of
the service included in this application and in respect of which ordinary gratuity
pension and or death-cum-retirement gratuity is claimed herein nor shall I submit
an application hereafter without quoting a reference to this application to the
order which may be passed thereon.
Signature of witness
Designation
Signature
Designation
(of a Rly. Servant)
Station
Dated:__________
2._________________
Designation_____________
Station:__________
Attested
Signature
Official Stamp
Dated:__________
NOTE: If the applicant already received a gratuity/death-cum-retirement
gratuity or is in receipt of an ordinary pension the certificate should be
suitability modified so as to include the following particulars:a)
Nature and amount of ordinary gratuity/pension and/or death-cumretirement gratuity.
b)
The period of service is in respect of which it is paid &
c)
By whom it is paid.
GENL 203.
FORM NO. 08
SPECIMEN SIGNATURE OF THE APPLICANT
Specimen Signature of Sh. _______________________________
1.________________________________
2.________________________________
3, _______________________________
Signed before me.
Office:____________________
Station:____________________
Dated:_________________
_______________________
(Signature and Designation of the
Subordinate/Gazetted Officer
GENL. 204
Form No. 9
THUMB AND FINGER IMPRESSION OF THE APPLICANT.
Thumb and finger impression of (Name)
Sh._______________________S/O
Sh. _______________________________.
Last Designation on ___________________ Station__________________.
THUMB
FINGER
MIDELE FINGER
FORE FINGER
RING FINGER
LITTLE
Personal marks of identification (Not less than four)
1._______________________________________________
2._______________________________________________
3.._______________________________________________
4._______________________________________________
Height:____________
Attested__________________
Signature:________________
Station:_______________
Dated:_________
Name & Design. Of the
Subordinate Incharge______________
Gazetted Officer_______________
Office Stamp.
FORM NO. 10
(SEO - 1009-M.R.P.R.)
PERMANENT ADDRESS AND MODE OF PAYMENT.
Permanent address of the Railway servant after termination of
service and mode of payment of gratuity/death-cum-retirement gratuity and
pension.
1.
Address
:_______________________________
___________________________________
____________________________________
2.
Mode of payment
_______________________________
_______________________________
i)
a. Gratuity
_______________________________
b. Death-cum-retirement
Gratuity
_______________________________
ii)
Name of treasury bank
or P.O. which pension
will be drawn
______________________________
S.B.F Account No.__________
Sign. & Design. of
the employee (in full)
GENL. 206
Form No. 14 (See Para 1034)
APPLICATION FOR THE GRANT OF DEATH-CUM-RETIREMENT
GRATUITY/RESIDUARY GRATUITY TO THE NOMINEE/FAMILY OF
SH./SMT____________________________________________DESIGN________________
_____ IN THE OFFICE/DEPARTMENT/MINISTRY OF
____________________________
1.
2.
3.
4.
5.
6.
7.
Name of applicant
Relationship of deceased Rly. servant/Pensioner
Date of birth
Date of retirement if the deceased was a pensioner
Date of death of the Rly. servant/pensioner
(a) Name of Station at which and official in
_______________________
In whose presence, the payment of death-cum retirement
gratuity is desired.
_______________________
(b) Name of the Treasury/Sub-treasury at which payment of
residuary gratuity is desired.
________________________
Full address
8.
9.
Signature of the thumb impression of the applicant
Attested by
10.
i.
Name
Full address
Signature
ii.
Name
Full address
Signature
Witness:
i.
Name
Full address
Signature
ii.
Name
Full address
Signature
Signature in the case of literate person and thumb impression in the case of illiterate person
who can not sign. Their names.
Attestation should be done by two or more persons of respectability in the two, village or
paragana in which the applicant resides.
GOVT SERVANTS LETTER OF AUTHORITY AND UNDERTAKING
I hereby authorizes_________________________________ have my monthly
pension and credit the same to my saving account (Pension) on the first working
day of every month as particulars given below:
Name in Full
:_________________________________________
Particulars of Public Sector Bank
:________________________________________
Name
:________________________________________
Amount of Pension per month
:______________________
( in words)
Design., Office & Rly. at the
:_______________________
time of retirement.
I, agree to undertake that my amount excess/wrong payment to pension, if credit
to my above Saving accounts(Bank) may be recovered or withdrawn from the
said Saving Bank Account by the
____________________________________________.
The authority shall remain enforce until due notice in writing of its renovation is
given by me.
1. Name :_______________
Name:______________________
Address:__________________
Name_________________
_________________________
Address_______________________
_________________________
_____________________________
_________________________
_____________________________
Father’s
Dated:____________________
Name :_________________________
Address :_______________________
_______________________________
_______________________________
Dated:________________________
Form No. 19
See Para 1038(1)
Application for family Pension from the family of late
Sh.________________________________Name_______________(Design)
In the office/department/Ministry of ___________________ who was governed by the
family Pension scheme for Railway Employees 1964.
1.
2.
3.
4.
5.
Name of the applicant
Relationship to the deceased Railway
Servant.
Date of death of the Railway Servant
Name and ages of surviving members
of family of the deceased.
1.Widow______________________ Name & Date of birth by Era.
2. Widower
(1)______________________
(2)__________________
6.
Sons below 18 years of age
7.
Unmarried daughter below 21 years of(1)______________________
age
(2) ________________
(3) and so on ________________
8.
Sons below 18 years of age
9.
(1)_________________________
(2) and so on ________________
(3) and so on ________________
(1)_________________________
(2) and so on ________________
(3) and so on ________________
Name of Treasury/Sub-Treasury at
which payment is desired.
10. Descriptive roll of the applicant or
Sh/Smt_____________the natural
guardian of the applicant where the
applicant is minor.
(1) Date of birth (by Christian Era)
(2) Height
(3) Personal marks of identification
if any on the hand, face.
Small finger
Ring finger
Middle Finger
Index finger
Thumb finger
The copies of photograph in passport size ( 2”x3”) of the applicant
Guardian with his/her signature on the back..
Full address of the applicant/Guardian_____________________
Certified that the information given above is correct.
Signature______________
Attested by _____________
Witness :
1.________________________________ 1.___________________________
2.________________________________ 2.___________________________
The name of sons/daughters from different wives should be indicated
separately.
The description roll and signature/thumb and finger impression accompanying
the applicant should be in duplicate and attested by two or more persons of
respectability in the town., village or which the applicant resides.
PROFORMA SHOWING INFORMATION IN RESPECT OF DECEASED RAILWAY
EMPLOYEES FOR APPOINTMENT OF DEPENDENTS ON COMPASSIONATE
GROUNDS.
1.
2.
3.
4.
5.
6.
7.
16.
Name & Design ( In full)
Date of Birth
Date of Death
Date of Appointment
Caste/Community
Pay & Scale of pay
Any special consideration extended or
admissible to the family of the deceased from
staff benefit funds.
Information about the ages and occupation of
the family of the deceased employee starting
whether any of the children of the deceased is
an earning member
Amount of P.F. (Compulsory)
Bonus
Gratuity
compensation if death on duty paid to the
dependants of the deceased or family pension
admissible.
Any other sources of income of the family
giving full details of the property and state of
the deceased.
Cause of death of the employee
Date of Death
Whether the employee dies while in service or after
retirement
Did the employee hold any Insurance Policy if
so, for what amount.
Date of birth, qualification etc., of the widow
department recommended for recruitment.
Full postal address
17.
Recommendations.
8.
9.
10.
11.
12.
13.
14.
15.
Certify that Sh. _________________________S/)_______________________ was
employed as ________________________ expired on _____________ leaving behind
the following members of his family.
Details of
Members
Name
Age
D.O.B
Whether dependent
on the deceased or
non if dependent
whether wholly or
partially.
Whether in
straitened
circumstances.
1.Widow
2. Children
each widow or
deceased wife
( To be shown
separately)
1.
2.
3.
4.
5.
6.
7. (a)
Widow(s) of
predeceased son
7. (b)
Children of predeceased son
8.
Any other member of the
family viz. father, mother,
brother sister (Grand)
parental parteners,
specifying his or
her relationship with the
deceased.
1.
2.
3.
Certified that the deceased has left no other member of or member except those mentioned
above.
Signature /RTI of the widow
Signature of the senior subordinate
Signature of the Magistrate or
Gazetted Officer (Railways) with Stamp
ANNEXURE
1.
Particulars of all dependent family members of the Railway Servant (If some are
employed their income and whether they are living together or separately).
SN Name(s)
1
Relationship
with the
Government
Servant
2
II.
1.
2.
3
Age
4
Address
5
Employed or not ( if
if employed
particulars of
employment and
emoluments.
6
DECLARATION/UNDERTAKING
I hereby declare that the facts given by me above are correct , to the best of
my knowledge. If any of the facts herein mentioned are found to be
incorrect or false at future date, my services may be terminated.
I hereby also declare that I shall maintain properly the other family
members who have been dependent (details given above) on Railway
Servant mentioned against –1(a) or Part-A of this form and in case it is
prevalent any time that the said family members are being neglected or not
being properly maintained by me, further during the period of their
dependency my appointment may be terminated.
Date:________
Signature of the Candidate.
Name _________________
Address:_______________
_______________________
_______________________
I have verified that the facts mentioned above by the candidate are correct.
Date:________
Signature of the APO
INDIAN RAILWAY
DMW/PATIALA
Para G 1536(1)
FORM OF AGREEMENT TO BE EXECUTED BEFORE DRAWING ADVANCE FOR
THE PURCHASE OF MOTERVEHICLE/SCOOTER/MOPED/COMPUTER.
An agreement made on_____________________day of ______________two thousand
__________________
between
______________________________
EMP.NO.
__________________of_______________________________hereinafter called the borrower
which expression shall include his heir administrators executor and legal representative) or the
one part and the President Of India (hereinafter called the President which express shall
include his successors and assignees on the other part. Whereas the borrower has under the
provisions of the Indian Railway General. Code Vol. (hereinafter referred to as the said code
which expression shall include any amendments thereof for the time being in force) applied to
the
President
for
a
loan
of
Rs._______________(________________________________________) only. For the
purchase of an Car/Scooter /Moped/Computer and whereas terms and conditions hereafter
contained is hereby agreed between the party to that in consideration of the sum
Rs.______________(Rs.______________________ ) to be paid by the President to the
borrower the borrower hereby agrees with the President (i) to pay the said loan by monthly
deduction from his salary as provided to the said deductions and (ii) within one month from
the date of payment of the said sum to expend the full amount of the said loan in purchase of a
Car/Scooter /Moped/Computer if the actual price paid is less than the loan to repay the
difference to the President forthwith and (i) or execute a document, Hypothecations the said
vehicle/Computer to the President as security for the amount to be lent to the borrower as
aforesaid and interest in the form provided by the said code and (ii) hereby lastly agreed and
declared and if the vehicle/computer has not been purchased and hypothecated as aforesaid
within one month from the date of payment of the said sum . If the borrower within that
period becomes insolvent quits the service of the Govt. or dies the whole amount of the loan
and the interest executed therein shall immediately become due and payable. In witness where
of the borrower and____________________________________________for and on behalf of
the President have herein to set their hands the pay and year first before written.
(Signature by the said in the presence of)
borrower)
(Signature and Designation of
1.______________________________
2.______________________________
Signature of the witness Name & Design.
Signature & Designation of Controlling Officer
(with seal)
Name & Design._____________
For & on behalf of President of India