Resignation Form

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அரசுப் பணியிலிருந்து விலக படிவம்
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  f. ///\' PROFORMAOF PARTICULARSTO BESUBMITTED WHILE FORWARDINGLETTERSOF RESIGNATION 1. Name ofapplicant(withqualification)2. Designation,nstitutionStationand District3. Dateof birthandage4.a) Date of frrst appointmentb)IfTemporaryappointmentheNo.anddateof theG.O.nwhichthe Temporaryappointmentwasordered5. NatureofappointmentTemporaryor Regular,f regular,probationer,approvedrobationerorpermanentG.O.No. anddate n whichserviceswereegularisedmaybe furnished)6. Particularsf service o furnishnthe appendedorm-I1.Dateofresignationetter8. Reasonsor resignation9.Addresso whichcommunication-haso besent10.Whetherheresignationsa sequeltoordersoftransfers onewstationor a sequelo refusalofrequestortransferfsothenatureofrequestandother elevantdetailsmaybe furnished.11.Whetherpplicantasurnishedhedeclarationnderule41of theGeneralulesortheMadrasStateandsubordinateervicesntheappendedormI.  t2. lat1 14.6. 15.16.Whetherwheres anydisciplinaq''proceedings;endingo be urnishedRelevantorrespondencerproceedingshouldequoted.Whetherheres anyecoveryfGovernmentoneydue romhecandidatef so,hedetailsobefurnisheduotingRelevantcorrespondencerproceedingsfanyWhetherhe applicantasdesignedwhile oneaveof stoppedwayromdutyfso,romwhenandunderwhatcircumstances,etailsofleaveappliedorgranted tc. mayalsobefurnished.a)The dateuptowhich he officerwaspaidi.e.dutypayand eavesalary tc.)b) Whetherhere s any claimdueotheofficer, f so urnishhedetails.Whetherhe applicants on n-authorisedbsencend fso fromwhatdateandwhetherisciplinaryproccedingsasbeennstitutedagainst im/her.The elevantcorrespondencerproceedingsshouldequoted.Whether eshehasundergoneny post-graduateegreerdiplomacourser othercoursesr training.I7 Whetheror theaboveurposeehasgrantedtudy eavelor otherkindsof leave,f so,whethernyrecovery as obe madedetailso befurnished.Note:TheG.O.NoandDaten whichstudyeavewasgrantedlongwiththis officeeferencen whichhesamewascommunicatedavbefurnished.  18. t9.20. 2T, a)Whether/he/shewaspaideavesalaryduringheperiod of study.b)Whetherhe/shewasgivenpriorpostingduringstudyperiod.Whetherhe hasexecutedbendmakinghimselfiableo serviceheGovernmentor a specifiederiodofyearsafterhe completionofcourseandf so,whetherheprovisionsofthe bondhavebeen ulfilled.If notwhetheranyrecoveryofpenaltysdue,f so,how much?Details o befurnished.The exactdatespecifyinghereasonsi.e.)orenoonr aftemoonfromwhich the resignationhouldbeacceptedith reasonsherefor.The specificecommendationf theforwardingofficewhethero accepttheirresignationr notwithsufficienteasons. SIGNATUREOFFORWARDINGUTHOzuTY.MEDICAL OFFICERN CHARGE D.H.O./DFWOF CIIO/AS THE CASEMAY BE. Particularsurnishedrom item i to 17areverifiedand ound correct. The resignationentered ytheMedical Officermaybe accepteditheffect romFN/AN.Note:1. Theparticularsequired n column l to 17 maybe collected romthe MedicalOfficer concerned.These particularsmaybeverifiedwith thestatementofservice/servicebooks of the MedicalOfficers and also withthe other relevantrecordsavailable n the officeof the forwardingauthority.2. TheStatementof serviceservicebook of theMedicalOfficer may alsobeforwardedo thisoffice dulycompletingall entriesbillthe dateofrelief.p.t.o.  3.ThedetailsoftheamountduefromtheMedicaiOfficermayalsobeurnished'APPENDIXPARTICULARSOFSERVICESOF(NAIVTE)DESIGNATION: MedicalOfficerandalsoduetothe FROM-IDistrict ll{l-o! InstitutionDesiBnation ---v---- FromToRemarksSIGNATUREFORM_IIDeclarationnderRule41oftheGeneralRulesfortheMadrasStateandSubordinateervices.I herebydeclarehatIamawareoftheconsequenceo myresignationfmyappointmentiAssistanturgeonntheTamilNaduMedicalServicesreferredoinnut.+toftheGeneralRulesortheTamilNaduStatendSubordinateervicesndespeciallyfthefactthatI shallorfeitnotonlythe serviceenderedyme inthepresentostheldbymebutalsomypreviouservicesnderhestateGovernment.STATION:DATE:I herebylater.SIGNATURE,:NAMEINBLOCK LETTERS:DESIGNATION:declarehatnorequestor reappointmentrreposting hallbe madevrm/SiGNATURE
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