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The document is an employee enrollment application for Keshappa, who joined on 10/08/2023, with personal and family details including identification and address information. It includes a declaration regarding the sharing of Aadhar data and the accuracy of the information provided. Keshappa's current pay is 19,000, and he has a wife and two children listed as dependents.

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Hussain Yadav
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52 views2 pages

Print Application

The document is an employee enrollment application for Keshappa, who joined on 10/08/2023, with personal and family details including identification and address information. It includes a declaration regarding the sharing of Aadhar data and the accuracy of the information provided. Keshappa's current pay is 19,000, and he has a wife and two children listed as dependents.

Uploaded by

Hussain Yadav
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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EMPLOYEE ENROLLMENT APPLICATION

PERSONAL DETAILS

Aadhar ID/Enrollment ID :
Employee ID : 2402559 Applicant Type : Employee
402988740124

Name : KESHAPPA Date Of Birth : 05/10/1971 Gender : Male


Marital Status : Married Community: BC Date of Joining : 10/08/2023
Disabled: N Disability: -NA- Disability Percent: -NA-

ADDRESS DETAILS
Residential Address:
House No: 1-3/1 Street No: BC COLONY State: Telangana
District: VIKARABAD Mandal/Municipality: DOULATHABAD Location: GUNDEPALLE
Email: keshanna2000@gmail.com Mobile Number: 8618393447
Office Address:
House No: 1-11 Street No: ZPHS HASNABAD State: Telangana
District: VIKARABAD Mandal/Municipality: KODANGAL Location: HASNABAD
Email: -NA- Mobile Number:

IDENTIFICATION DETAILS
Ration Card No: -NA-
Identification Marks 1: A MOLE UNDER THE LEFT EAR
Identification Marks 2: -NA-

POSTING DETAILS
HOD: Director School Education State: Telangana District: VIKARABAD
DDO Code: HM ZPHS HASNABAD
Service: AP Last Grade Service Category: Category 3
KDL(24020308019)

PAY DETAILS
Pay
Pay Grade: I PRC: 2021 Current Pay: 19000 Source: GOTG
PRC

Family Member Details

Aadhar/Enrollment Date Of Disability


Name Gender Relationship Disabled Disability
No Birth Percent

SANDHYA
497837911626 F Daughter 06/08/1999 N --NA-- --NA--
RANI
282523474927 ANJANA F Wife 04/06/1976 N --NA-- --NA--
SUNIL
347016347002 M Son 28/02/2001 N --NA-- --NA--
KUMAR
DECLARATION
I declare that

I have no objection in sharing Aadhar data of my family.


I am liable for disciplinary action for declaring ineligible family as dependents, and
I declare that the above information is true to best of my knowledge and submitting to Aarogyasri Health Care Trust for issue of
Health cards under beneficiary. I am liable for disciplinary action for declaring ineligible family member if any as Dependents.

Place:
Date:
Signature of Employee

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