PROFORMA
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1
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Name of the
Individual
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:
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2
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Designation
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:
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3
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Name of the Present
Station
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:
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HUD:
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4
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Date from which
working in the present station
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:
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5
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Length of service
in the present Station
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:
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6
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Whether any DA is
contemplated or Pending
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:
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7
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Place of Choice (to
be filled at the time of Counselling)
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:
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HUD:
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Signature
of the Individual.
Certified
that the above particulars of the individual has been verified with the Service
Register of the individual concerned.
Signature of the DDHS/Block Medical
Officer.
/true copy forwarded by order/
Superintendent
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