Self-Declaration Form to be Filled by Employee
GPF/PRAN No *:
(I) Employee Personal & Official Details
1. Employee Name *:
2. Marital Status (Please Tick) *: Married / Unmarried
Photograph
3. Spouse Name (Wife or Husband) *:
4. Mother’s Name:
5. Blood Group:
6. Personal Mobile No (For OTP) * :
7. Official Mobile No (if any):
8. Personal Email Id:
9. Official Email Id:
10. Type of Disability: (Visually Impaired / Deaf & Dumb / Locomotive/ Mental Disorder) Please tick
11. Percentage of Disability:
12. If Govt. Quarter allocated (Yes or No):
13. Govt Quarter Allocated to Self / Allocated to Spouse (Please Tick if applicable)
14. Residential Address (If not same as entered in Service Book):
Address Line 1-
Address Line 2-
State -
District - Postal Code /PIN-
Date: Date:
Place: Place:
Officer’s Signature Employee’s Signature
* marked fields are mandatory 1
Self-Declaration Form to be Filled by Employee
GPF/PRAN No *:
(II) Educational Qualification Details:
Last Educational Qualification Details *:
1. Degree:
2. Course Type (Please Tick): Correspondence / Distance Learning / Regular
3. Board/ University/ Institute:
4. Course Duration (Years):
5. Marks Obtained (%age):
6. GPA:
7. Grade:
8. Passing Year:
9. Description:
10. Acquiring Status (Please Tick): Education at joining / After joining
Date: Date:
Place: Place:
Officer’s Signature Employee’s Signature
* marked fields are mandatory 2
Self-Declaration Form to be Filled by Employee
GPF/PRAN No *:
(III) Training Details:
Sl. No. 1 2 3
Training Type
Training Name
Place (e.g. India / Abroad)
Institute
Sponsored By
From Date
To Date
Description
Certificate Issuing Authority
Certificate No.
Certificate Date
Date: Date:
Place: Place:
Officer’s Signature Employee’s Signature
* marked fields are mandatory 3
