ANNEXURE
Form of application to take up commercial employment withintwo years after retirement.
(See sub-regulation (6) of regulation 4)
1. Name of applicant :
2. Date of retirement :
3. Particulars of posts :
held during the five :
years immediately :
preceding retirement :
Department | Post held | From | To |
Pay-scale Rs. | |||
(i) | |||
(ii) | |||
(iii) |
4. Pay and allowance :
drawn immediately :
before retirement :
5. Retirement benefits
(i) if governed by :
contributory provident :
fund scheme :
(a) amount of the Boards :
ordinary contribution :
with interest thereon :
(b) amount of the Boards :
special contribution. :
(ii) if governed by pension scheme -
(a) amount of pension :
(expected/sanctioned)
(If a part of pension has
been commuted, details
thereof should be
mentioned)
(b) amount of death-cum- :
retirement gratuity
(expected/sanctioned)
6. Particulars of proposed employment
(a) Name and address of company/ :
co-operative society/firm/
individual employer
(b) Had applicant any dealings :
with the company/co-operative
society/firm/individual employer
during the period of his
employment under the Board?
If so, the period and nature of
such dealings.
(c) Nature of the position offered :
(d) Was the position advertised ? :
If not, how was offer made ?
(e) Duties of the position offered :
(f) Does the proposed employment :
involve work of maintaining
liaison or contact with the
offices and employees of the
Board
(g) Remuneration offered :
(h) If proposed employment :
involves setting up of a
private practice,
particulars thereof
7. Any other information which :
the employee desires to
furnish
Place :
Date :
Signature of applicant