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APPLICATION FOR GRANT OF SPECIAL ALLOWANCE TO PHYSICALLY HANDICAPPED GOVERNMENT EMPLOYEES.
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1Name and Designation
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2Institution in which working
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3Date of commencement of Continuous Service
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4Nature of Disability whether blind or deaf and dumb or orthopeadically handicapped etc.
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Whether Medical Certificate is enclosed as insisted in GO (P) 364/80/Fin. Dt. 11-6-80
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6Date of Medical Certificate
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The Designation of the authority issued the Medical Certificatge.
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8. a
Whether the incumbent is enjoying Concession/Monthly Allowance etc. for engaging aid.
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b.
If availing any concession, mention the nature of consideration.
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c.
If he/she is in receipt of Special Allowance, mention the rate of per mensum.
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d.
Specify the option to choose either the special monthly allowances etc. which is being enjoyed by them or the benefit contemplated under the GO (P) 364/80/Fin. dtd 11-6-80:
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DECLARATION
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I, ……………………………………………………………………… do hereby declare that the above entries are true to facts. I prefer allowance contemplated under GO (P) 364/80/Fin Dated 11-6-80 to the monthly allowance etc. for engaging an Aid enjoying to me.
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Date: (Signature of the Applicant)
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Certified that the details furnished above are correct.
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Signature of the Head of Institution with Designation.
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www.sahakary.org
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