Finance Department, Government of Andhra Pradesh

Regular 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)


Page 1 of 4
1.Key Employment Details
1.1 Unique Employee ID
provided by DTA/PAO

1.2 Employee Category Regular Re-Employed Deputation
(Please provide the 1.2.1 Deputed from Department if Deputation is selected)
(Please provide the 1.2.2 Re-employed is selected)
1.2.1 Deputed From Department
1.2.2 Previous Employment Department:
1.3 Surname ( )

1.4 Name



1.5 Gender Male Female
1.6 Father / Husband Father Husband
Father / Husband Name
1.7 Date of Birth / / (DD/MM/YYYY)
1.8 Marital Status Single Married Divorced Widow Widower
1.9 Place of Birth District
Mandal
Village




1.10 Post/Designation at first appointment
1.11 Date of Entry into Service / / (DD/MM/YYYY)
1.12 Place of Initial Appointment: District
Mandal
Village



1.13 Initial Department
1.14 Details of Local Status District
as per presidential order: Mandal
Village




1.15 Current Designation / Post
1.15.1 Employee Status Gazetted Non Gazetted LGS Others________________________________
1.16 Local Carder of the Post District Zonal Multi Zonal State
1.17 Office in Which Employee is Working
1.18 Head of Account of Salary
1.19 Is spouse working?
(If yes is ticked then Please provide the
details from 1.19.1 to 1.19.5)
Yes No

1.19.1 Name of the Office
1.19.2 Office Location
1.19.3Name of the Spouse
1.19.4Aadhar No of the Spouse
Finance Department, Government of Andhra Pradesh
Regular 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)


Page 2 of 4
1.19.5Aadhar Enrolment
Number of the Spouse


1.20 Mobile No of the employee
1.21 Personal E-mail of the employee
1.22 Personal ID provided by Department
(employee)

1.23 Community SC ST BC A BC-B BC-C BC-D BC-E

Minority Others

2. Salary Details
2.1 Scales Applicable
2.2 Pay Scale
2.3 Current Basic
2.4 Next Date of Increment / / (DD/MM/YYYY)
2.5 Special Pay
2.6 Personal Pay
2.7 Staying in Government quarter Yes No
2.8 Standard Rent Paid (If Staying in Govt Quarters)
3. Bank and Other key Details
3.1 GPF No
3.2 PRAN / CPS No
3.3 APGLI Number
3.4 Aadhar No
3.5 Aadhar Enrolment No

3.6 PAN
3.7 Ration Card No
3.8 Bank Name
3.9 District of the Bank Branch
3.10 Bank Branch
3.11 IFS Code
3.12 Bank A/C Number for Entry of Salary
3.13 Contribution to EHS by Self Spouse Exemption
4.Employee Residential Address
4.1 Street/Road/Lane
4.2 Landmark
4.3 Area/Locality/Sector
4.4 District
4.5 Mandal
4.6 Village/Town/City
4.7 PIN code
Finance Department, Government of Andhra Pradesh
Regular 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)

Page 3 of 4
Dependent Family Member Details

No Relationship Name

Gender Date of
Birth
Aadhar Number Disability Daughters
Marital
Status
1 Father Mother

Wife Husband

Daughter Son

Male

Female

/ /
DD/MM/YYYYY
Aadhar No

Enrolment No


Ortho
Blind
Hearing
Mental
Percent(%)
a) Single
b) Married
c) Divorced
d) Widow
2 Father Mother

Wife Husband

Daughter Son

Male

Female

/ /
DD/MM/YYYYY
Aadhar No

Enrolment No


Ortho
Blind
Hearing
Mental
Percent(%)
a) Single
b) Married
c) Divorced
d) Widow
3 Father Mother

Wife Husband

Daughter Son

Male

Female

/ /
DD/MM/YYYYY
Aadhar No

Enrolment No


Ortho
Blind
Hearing
Mental
Percent(%)
a) Single
b) Married
c) Divorced
d) Widow
4 Father Mother

Wife Husband

Daughter Son

Male

Female

/ /
DD/MM/YYYYY
Aadhar No

Enrolment No


Ortho
Blind
Hearing
Mental
Percent(%)
a) Single
b) Married
c) Divorced
d) Widow



Finance Department, Government of Andhra Pradesh
Regular 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)
Page 4 of 4
Deductions
NO Deduction
Description
Sanction
Date
Dd/mm/yyyy
Sanction
Ref. No
Sanctioned
Amount
Loan No First Month
Adjustment
Amount
Total no of
Instalments
Interest
Instalments
Interest
Rate
Instalment
Amount
Recovery
Start
MM/YYYY
Remarks
1
2
3
EHS Contribution LIC Details
EHS Start Date: Amount Policy No Sum
Assured
Monthly
Premium
Date of Last
Instalment.
Recover Start
Month/Year
1
2
Allowances
No Allowances Amount Percentage of
Basic(%)
Periodicity
(Monthly/Quarterly
Half Yearly/Yearly)
1
2
3
4
*Please take additional printouts if required and attach the same to the application.

____________________________
Date : (DDOs Signature)
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
____________________________
Date : (Employee Signature)