Beruflich Dokumente
Kultur Dokumente
(Niloy Ghosh)
Special Secretary-in-Charge
To
The Director of Information Paste passport size
Information & Cultural Affairs Department self attested
Government of West Bengal photograph
Writers’ Buildings, Kolkata – 700001
PROFORMA
(To be submitted in duplicate)
Sir,
Application for pension for retired journalist
In pursuance of Government of West Bengal notification No.2725-ICA dated 13.10.2010 read
with 3219-ICA dated 09.12.2010, I do hereby apply for the pension for the retired journalist.
1 N a m e :
2 Father’s name :
3 Address :
4 Date of birth (age proof enclosed) :
5 Particulars of experience (certificate from :
employer where last served before
retirement on superannuation enclosed)
a) Name of the organization
(from where retired on
superannuation)
b) Address of the organisation
c) Date of Joining
d) Date of superannuation
6 Press Accreditation Card No. (copy :
enclosed)
7 Whether any pension is drawn, if yes, :
please furnish
a) P.P.O.No
b) Amount of Pension
c) Pension sanctioning authority
d) Other details, if any
8 Bank/Treasury (in case of district) :
Particulars:
a) Bank A/c No.
b) Name of the Bank
c) Branch Address
d) Name of the Treasury
e) One cancelled cheque
I do hereby declare that the aforesaid statement is true to the best of my knowledge.
Note :
1. As age proof
a) Declaration from organization last served - OR
b) Duly attested certificate/admit card of SF/MP/HS/School leaving certificate or equivalent
– OR
c) Duly attested copy of valid passport
2. Copy of first page of Bank Pass Book is to be enclosed
3. Two copies of extra passport size photographs duly signed by the candidate