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Annexure A Application for re-engagement in Mumbai Division, Central Railway (Notification No BB/P/Loco/558/Re-engagement Dated 05.12.17) To, Divisional Railway Manager (P) Loco Section Mumbai Division Central Railway

Affix recent passport size colour photograph with signature across the Photo

I hereby apply for re-engagement as _____________ in___________Department on Mumbai Division, Central Railway / Western Railway on daily remuneration basis, on terms and conditions mentioned in the said notification. My service particulars are as below.

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1. Name: __________________________________________________________ 2. Designation at the time of retirement : __________________________________

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3. Division/ Unit / Department from where retired: ___________________________ 4. Date of Birth : _____________________________________________________ 5. Date of retirement : ________________________________________________ 6. Retirement on Superannuation/VRS/LARGESS/ or any other retirement(specify) : _____________________________

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7. Address for correspondence: _________________________________________ _________________________________________ _________________________________________

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8. Tel No : _________________________________,________________________ 9. Last Pay Drawn – Pay Band Rs ____________________ GP_______________ 10. P P O No ______________________________ Date______________________

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11. Enclosure (copy of documents) : ______________________________________ a) Service Certificate

b) Pension Identity Card c) Pension Payment Order

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I declare that the information furnished above is true to the best of my Knowledge and I am liable for punitive action if found false / incorrect. I also declare that I have gone through the terms and conditions stipulated in the Notification and I shall abide by them. I have not retired under SRRS/ LARGESS Signature of the Applicant Name:-

Date: - ___________________

Place:- ____________________

Central Railway Retired Staff Recruitment [email protected] ...

b) Pension Identity Card. c) Pension Payment Order. I declare that the information furnished above is true to the best of my Knowledge and. I am liable for punitive action if found false / incorrect. I also declare that I have gone. through the terms and conditions stipulated in the Notification and I shall abide by them. I. have not ...

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