TRANSFER CUM OPTION APPLICATION


TRANSFER CUM
OPTION APPLICATION

1

Name

:

2

Designation

:

3

Date of Birth

:

4

Date of Retirement

:

5

Gender                                

:

6

Marital Status

:

7

Length of total service as Government Servant

:

8

Date of Joining in the Present Cadre and station where joined

:

9

Date from which working in the present station (Service in all cadres
at a station will be counted while calculating the period of stay)

:

10

Present Place of Working

:

11

ITDA/ NON-ITDA

:

12

Total length of service in the present Station as on 01.06.2016
(DD/MM/YYYY)

13

Exceptions

a.

Whether claiming exception under Employees with disabilities of 40% or
more as certified by a competent authority as per “persons with disabilities.

Nature of Disability

:

Percentage of Disability  

:

Competent authority who certified the
Disability

:

b

Whether claiming exception on spouse case, if yes furnish the
following with relevant documentary evidences :

a)      Name of the Spouse

:

b)     Designation

:

      c)  Department in which he / she is

           working:

          (i) Government

          (ii) Government under
taking /University

          (iii) Local bodies

      d) Present Place of
Working

:

:

c

Whether
claiming exception under Employees having mentally challenged children to a
place where medical facilities are available

Details thereof relating to the exception claiming

:

d.

Whether claiming exception under Widow employee appointed on
Compassionate appointments.

Details thereof relating to the exception claiming

:

e

Whether claiming transfer on Medical Grounds, if yes:

a)      Name of the Patient

:

b)  
Relationship with the applicant

:

      c)   Disease (As specified in G.O)

            (i) Cancer

            (ii) Open Heart
Operations,

            (iii) Neurosurgery,

            (v) Kidney
transplantation.

:

15

Are you an office bearer of recognized employees union? (in case of
President / General Secretary)

(i) Name of the Union

(ii) Regd.No.

:

16

Place of preferences/ options of applicant for transfer

:

(a)

:

(b)

:

(c)

:

            I,
_________________________ hereby declare that the particulars furnished above
by me are correct to the best of my knowledge and belief, if any information is
proved incorrect now or in future my candidature may be cancelled, besides
liable for any disciplinary action as per rules.

Signature of the Applicant

Designation


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