For BARC Pensioners only
(P/IC/1/128 -Pens)
BHABHA ATOMIC RESEARCH CENTRE
Application for Issue of Identity Card - Pensioners
| Please affix Front Photo (3x4 cms
size) [Must be similar to PPO] |
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(Please use Capital Letters)
1. Name (Surname First)/ Title
(Dr./Shri/Smt/Kum/Prof etc) |
2. Post held at Retirement |
3. Pay Scale at Retirement |
4. Comp. Code No. and
Employee No. |
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| 5. Dtae of Birth |
6. Date of Retirement |
7. Last Pay Drawn |
8. Average Emoluments |
9. Qualifying Service
(Yrs/Month) |
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| 10. Place of work |
11. Pension Originally senctioned |
12. PPO Number |
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13. Blood Group (Optional)
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15. Sex
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Reason for applying
| First Pensioner ID card |
Yes/No |
| Any Other Reason (**) |
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Please also sign in the box
[In black ink]
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Please send my ID card (Choose One) by Regd. Dak/I
will collect it myself/through the person having
an authority letter from me. Enclosures:
1. Indian Postal Order of rs. 10/- bearing No.
................... dated .......... in favour of
AO, BARC issued by post office
(Name)..................
2. Xerox copy of page No. 3,5,8,9,10 of PPO
3. One clean photograph | front view |size 3x4 cm.
4. Original Temp. Entry permit No...............
Valid up to ..............
Date .............
..............................
(Signature of Applicant)
(**)
(1) Please keep acopy of this application for your
record. The ID card is issued only once. (2)
Please do not enclose original PPO (3) For Enquiry
Contact Ph #022-5593657 (4) Please allow 30 days
for despatch of ID Card (5)The Card will be sent
to the above address by Regd. Dak if no other
option is desired (6)This ID Card will not be
valid for emtry into BARC premises. (7) Where a
temporaryentry permit has been issued and not
surrendered, Without returning the Temp. Entry
Permit the ID Card will nit be issued. If lost
original police complaint should be produced.
To,
APO, S&MIS 3rd Floor, Central Complex,
BARC, Trombay, Mumbai 400085
For use in S&MIS Section, BARC
| Appl. / ID # |
Date of issue / despatch |
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(Signature of APO)
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