Reports received by our CHQ that the Form (Annexure) for data collection from GDS under health facilities scheme is yet to be supplied in many Divisions in all the Circles.
As per the Directorate instructions issued on the subject vide its letter dated 28-05-2013, all the data collected from GDS should reach Directorate by 30-06-2013.
It is being detained for the reasons well known and the Divisional Secretaries, Circle Secretaries, Office bearers are requested to provide the information available to all GDS in their respective units and enroll them in the scheme with in the stipulated period.
(The detailed letter of the Directorate is published in our website on 18-06-2013)
Format of the Form (Annexure) is published here under for ready use of GDS:
Worker Name (GDS Name)
|
|||||
Caste
|
|||||
Minority ( as per State List) indicate yes/No
|
|||||
Gender (indicate Male or Female)
|
|||||
Age
|
|||||
Fataher’s Name
|
|||||
Phone No.
|
|||||
Present Post held
|
|||||
Name of District
|
|||||
Mandal name:
Sub District or Tehsil or Taluka or Block name
may be given
|
|||||
Panchayat Name:
Panchayat Name in case of
Or
Ward No. in case of village where Gram Panchayat
does not exist – Village name ( No. of Ward)
Or
Name of Municipal Committee in case of urban
areas i.e. Name of Municipal Committee (MC) or Town Council (TC)
|
|||||
Village Name
Village Name in case of
rural areas
Or
Ward Number in case of
Urban areas – Ward (No.)
|
|||||
Present Residential
address
|
|||||
Permanent residential
address
|
|||||
Beneficiaries dependent
details
|
|||||
S.No.
|
Name
|
Age
|
Gender
|
Relationship
with GDS
|
|
1
|
|||||
2
|
|||||
3
|
|||||
4
|
|||||
Date of regular
appointment to the GDS Post :
|
|||||
This
is to certify that the particulars mentioned above are true to the best of my
knowledge and the beneficiaries dependent details mentioned above are only
related to my members of family as defined in Rule 3 (h) of GDS (Conduct and
Engagement) Rules, 2011.
Signature of GDS
Beneficiary
Dated :……………
//copy//
