Finance Department, Government of Andhra Pradesh

Outsourced Employee Details Note : Please read the Guidelines sent by Department before filling the form, in CAPITAL LETTERS in blue/ black ball point pen only. (Please avoid Short Forms and Abbreviations) 1.Key Employment Details 1.1 Surname(ఇంటి పేరు) 1.2 Name

1.3 Gender

Male

Female

1.4 Father / Husband

Father

Husband

Father/Husband Name 1.5 Date of Birth

/

/

(DD/MM/YYYY)

1.6 Designation / Post 1.7 Marital Status

Single

Married

Divorced

Widow

Widower

1.8 Office in Which Employee is Working: 1.9 Aadhar No 1.10 EPF No 1.11 Remuneration per Month 1.12 Commission Payable to the Agency

Amount

Percentage (%)

for the Post: 1.13 Head of Account 1.14 Personal Mobile No. 1.15 Personal E-mail 1.16 Community:

SC

ST

Minority

BC –A

BC-B

BC-C

BC-D

BC-E

Others 2. Agency Details

2.1 Contract Start Date:

/

/

(DD/MM/YYYY)

2.2 Contract End Date

/

/

(DD/MM/YYYY)

2.3 Contract Ref No 2.4 Sanction Order Number & Date 2.5 Agency Name 2.6 PAN 2.7 Registration Number Registered with Labour Department: 2.8 Service Tax No 2.9 Landmark 2.10 Street/ Road / Lane 2.11 Area/ Locality / Sector 2.12 District 2.13 Mandal 2.14 Village / Town / City 2.15 Pin Code 2.16 Telephone

(STD Code-Telephone No : 040-292010)

2.17 Mobile

Page 1 of 2

Finance Department, Government of Andhra Pradesh 2.18 E-mail 2.19 Bank Name 2.20 District of the Bank Branch 2.21 Bank Branch Name 2.22 Bank A/C No 2.23 IFS Code

DECLARATION* The above information is true to the best of my knowledge. I agree to share details of self and family with Government of Andhra Pradesh. I am aware that declaration of wrong details will entail disciplinary action against me.

________________________ Employee’s Signature

________________________ DDO’s Signature

Date:

Date:

Page 2 of 2

Page 1 of 2 Outsourced Employee Details

BC-E. Minority. Others. 2. Agency Details. 2.1 Contract Start Date: /. /. (DD/MM/YYYY) ... Labour Department: 2.8 Service Tax No ... Employee's Signature. Date: ...

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