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L (To be attested by the Gazetted Officer/Bank Manager or Notary. Name of Individual : (S/o,D/o,W/o,H/o) 2. Date of Birth/Age : 3. P.P.O.No. 4. Name of Bank and Branch: 5. Bank Account No. : : OLD: NEW: 6. Employee Particulars (Applicable if Re-Employe after retirement/ Appointed on Compassionate Grounds) : a. b. Date of Employment / Re-Employment: c. What is the D.A. being drawn d. 7. Name of Office : Date from which D.A. is drawn Re-Marriage Particulars if any a. Dat.

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