Submission of Family Declarations for obtaining Privilege Passes

Note

No. B/C 19/Staff/Family Declarations/2023

Dt.20/12/2022

Sub: Submission of Family Declarations for obtaining Privilege Passes.

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All the staff members are requested to please submit their ‘Family Declarations’ for obtaining Privilege Passes during the forthcoming calendar year of 2023. The Family Declarations are to be submitted in the revised format, a copy of which is enclosed herewith. Submission of ‘Family Declarations’ before the end of the current calendar year i.e., 31/12/2022 will facilitate getting of Privilege Passes from 01/01/2023 without encountering any hurdles.

Further, it is also requested to please check up all their respective details I data available now in HRMS and ensure the data is corrected I updated if found necessary.

Encl: One Format.

Sd/-
KVR NAGESWARA RAO
Ch.OS/Commercial Sr.DCM/0/BZA

PF.No: HRMS ID:

DECLARATION FOR FAMILY MEMBERS AND DEPENDENTS REQUIRED FOR ISSUE OF PASSES & PTO’S AS DEFINED UNDER IRCA CONFERENCE YEAR – 2023

1	Name of the Employee in Full	:
2	Designation	:
3	Office/Station	:
4	PF No. /B U No.	:
5	Pay Band /Level	:
6	Present Basic Pay	:
7	Date of Birth	:
8	Date of Appointment	:
9	My father is alive/not alive	:
10	Previous pass account maintained in the Office.	:
11	I am Married /Un-married	:
12	Mobile No.	:

Details of family members/Dependent Relatives for whom Pass / PTO’s required.

S.no	Name	Relationship	Date of Birth	Aadhar no.
01

DEPENDENT RELATIVES:-

(Attendant if any)

NOTE: Date of Birth to be furnished invariably for son 21 years and above.

I hereby declared that all the above mentioned members residing with and are wholly dependent on me.

Passport Size photo

Self

DEPENDENT RELATIVES:-

Passport Size photo

No Brothers / Sisters of mine working in the Railway are obtaining privileges /PTO’s for the above dependent members.
The un – married Daughters / Sisters mentioned above who are working in Railway are not avail privilege passes / PTO’s in their
The above dependents (as showing in “B” above) are not having any independent source of Income or more / that 15% of my implements or /- per month which ever is more inclusive of temporary increase in pension and pension equivalent of DCRG benefits from time to time

Witness:

1. Signature:
Name :
Designation:
T.No :

2. Signature:
Name :
Designation:
T.No :

Signature:

Name of the Employee:

Designation: … … … … …, T.No … … … …

Date:

ATTESTED BY IMMEDIATE
SUPERVISOR

Eligible members as defined under IRCA conference

a) Family Members:

Wife/Husband unmarried and widowed Daughters/Sons under 21 years student son 21 year above, subject to production bonafide certificates form one recognized educational Institutes every academic year beginning in July.

Dependent Relations:-

Applicable when father is not alive , Widowed mother , un-married and widowed sisters not having any brothers above 21 years, brothers under 21 years above subject to production of bonafide certificate from the recognized educational Institutes every academic year beginning in July.

C) Attendant:-

Means, one employee on a salary in the service of the personal service of the employee i.e whole time domestic servant such as cook, Ayah but does not include a tutor, Dhobi etc, or any relative or the employee in the capacity of servant.

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