Form no.

1
(To be filled in quadruplicate)
FOOD CORPORATION OF INDIA
MEMBERSHIP & OPTION FORM BY THE EMPLOYEE
(DEFINED CONTRIBUTION PENSION SCHEME)

1. Name of the employee BANKER SHAILESH ARVINDBHAI

2. Father’s / Husband’s Name ARVINDBHAI S PARMAR
3. Designation ASSISTANT GRADE -II
4. Name of the office/ Place of posting REGIONAL OFFICE, AHMEDABAD
5. Gender MALE
6. Staff Code No. SW131162C
7. Employee No. 246672
8. Permanent Account No.(PAN) BDAPB 9670 D
9. Aadhaar Number: 796936400223
10. Date of Birth 22-02-1985
11. Date of joining FCI 25-04-2011
12. Date of Superannuation 28-02-2045
13. Permanent address with Pin Code 20 SATYAM SOCIETY, NEAR CHANSMA
HIGH WAY, PATAN - 384265

114. Address for communication / Present address A-303, SAUNDARYA RESIDENCY, BESIDES
HEMANGI APARTMENT, SNEH PLAZA, IOC
ROAD, CHANDKHEDA AHMEDABAD -
382424
15. Mobile number 9724391929
16. E-mail ID banker.mca@gmail.com
17. Option to deduct the arrears of a) in 15 installments
Employee’s subscription @ 2%
(Basic Pay + DA)

(Signature of the employee)

Date:-
__________________________________________________________________________________

(To be filled by the Controlling Office)

Details of lump sum payment of arrears, if opted. Amount of payment:

Date of payment:
IOG No. & Date:

Above documents verified and countersigned by the controlling office.

Name:
Designation:
Date: (with Seal)
_____________________________________________________________________________________

Controlling Office to forward the Form to:-

1. The Manager / Assistant General Manager (Bills), FCI, Local.

2. The Secretary, FCI-DCP Trust, FCI, Headquarters.
3. The Assistant General Manager (Bills),FCI, Zonal Office
4. Personal File of the Employee.
 Form no.8
(To be filled in quadruplicate)
FOOD CORPORATION OF INDIA
(DEFINED CONTRIBUTION PENSION SCHEME)
NOMINATION FORM (Under Rule-24.11)

1. Name of the employee BANKER SHAILESH ARVINDBHAI

2. Father’s / Husband’s Name ARVINDBHAI S PARMAR
3. Designation ASSISTANT GRADE -II
4. Name of the office/ Place of posting REGIONAL OFFICE, AHMEDABAD
5. Gender MALE
6. Staff Code No. 131162
7. Employee No. 246672
8. Permanent Account No.(PAN) BDAPB 9670 D
9. Aadhaar Number: 796936400223
10. Date of Birth 22-02-1985
11. Date of joining FCI 25-04-2011
12. Date of Superannuation 28-02-2045
13. Permanent address with Pin Code 20 SATYAM SOCIETY, NEAR CHANSMA HIGH WAY,
PATAN - 384265
14. Address for communication / Present address A-303, SAUNDARYA RESIDENCY, BESIDES HEMANGI
APARTMENT, SNEH PLAZA, IOC ROAD, CHANDKHEDA
AHMEDABAD - 382424
15. Mobile number 9724391929
16. E-mail ID Banker.mca@gmail.com
17. Details of Nominee(s)
Sl. Name Age Relationship %age If Minor, name of the
No. with Employee of Guardian
share
1 BANKER BEENABEN 26 WIFE 100%

(Signature of the employee)

Date:-__________________

_____________________________________________________________________________________

DECLARATION BY WITNESS

Sr. No. Name and Address of the Witness Signature of the Witness
Signature of the Witness
1 Shri Bhargav Shah,
B-3, Jethabhai Park, Nr. Shantivan,
N.N. Road, Paldi,
Ahmedabad- 380007
2 Smt Barkha Mehta
L-7/73, Balkrishnanagar, Opp. Krishnanagar BRTS
Bus stand, Krishnanagar, Ahmedabad - 382345

__________________________________________________________________________________

(To be filled by the controlling unit office)

Verified and countersigned by the controlling office.

Name:
Designation:
Date:
_____________________________________________________________________________________
Controlling Office to forward the nomination to:

1. The Secretary, FCI-DCP Trust, FCI, Headquarters. (2 Copies).

2. The Assistant General Manager (Bills),FCI, Zonal Office
3. Personal File of the Employee.