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State of Uttar Pradesh - Section

Section 18 in U.P. Zila Panchayat Employees' Retirement Benefit Rules, 1972

18. [ Descriptive roll of the applicant] [If not known exactly it must be stated on best information or estimate.]:..........................

(i)Date of birth (by Christian era)..............................................(ii)Height.........................................:.......(iii)Personal marks if any, on the hand, face, etc............(iv)Signature or left hand thumb and finger impressions.
Small Finger Ring finger Middle finger Index finger Thumb
Signature of applicant.Signature of Head of Office/DepartmentNotes-(1) The descriptive roll and signature/thumb and finger impressions accompanying the application for family pension should be, in duplicate and attested by two or more persons of respectability in the town, village or pargana in which the applicant resides.
(2)If the applicant belongs to a category mentioned in item 13 he should furnish proof of his dependence on the deceased officer/pensioner for support.
(3)If the applicant is a minor brother of the deceased officer/ pensioner, the statement against item 16 should be supported by a certificate of age (in original) with two attested copies showing the date of birth of the applicant.The original will be returned to the applicant after the necessary verification.History of Service(Showing interruption) of.......... Dale of birth
Estabment Appointment Pay Acting allowance Date of beginning Date of ending Period reckoned as service Period not reckoned service Remarks How verified Remarks by the officer
1 2 3 4 5 6 7 8 9 10 11
Y.M.D. Y.M.D.Total period of service
Third Page
(A)Remarks by Head of Office/Department