SL No 00086495

BHARAT SANCHAR NIGAM LIMITED

(Form for seeking voluntary retirement under BSNL Voluntary
Retirement Scheme, 2019)
[To be submitted duly signed in blue ink, in triplicate, to
concerned controlling officer (Not below the rank of SDE or
DM or equivalent level executive)]
PART-A (For Employees)
.......................
I, Shri/Smt RAVJIBHAI PARMAR, PERNER. 98116285, Son/Daughter/Wife of Shri
/Smt. RANCHHODBHAI hereby opt for and seek voluntary retirement from service on
31st January 2020 under BSNL Voluntary Retirement Scheme, 2019.
2. I declare that I have read and fully understood the terms and conditions of
the BSNL Voluntary Retirement Scheme 2019, including the methodology and
schedule of payments of admissible benefits and hereby accept them
unconditionally.
3. I also agree that the acceptance of the option shall be subject to approval
of the competent authority and decision of the competent authority in this
respect shall be final and binding on me.

Place: Signature
Date:30.11.2019 Name RAVJIBHAI PARMAR
Designation Telecom Technician
Unit of Posting
Contact No.

Date: Signature & Official seal of

controlling officer

Part B (For Office Use)

Service Particulars of the employee as per records (for verification from
service book) -
1 Name of the Applicant RAVJIBHAI PARMAR
2 PERNER 98116285
3 Designation Telecom Technician
4 Unit of Posting
5 Pay Scale 13600-0-25420
6 Basic Pay 26,190.00
7 Date of joining in DoT /BSNL 03.10.1981
8 Present Circle Gujarat Telecom Circle
9 Present SSA Nadiad-Kheda TD
Verified from Service Book and found correct.

Date: Signature
Name and official seal of the
Verifying officer

ACKNOWLEDGEMENT
Received VRS application SL No. 00086495 of Shri/Smt. RAVJIBHAI PARMAR,
PERNER.98116285, Son/Daughter/Wife of Shri /Smt. RANCHHODBHAI

Date: Signature & Official seal of

controlling officer