(Executive)

ID-CARD FORM
(TO BE FILLED IN BLOCK LETTERS)
Serial No:
..
HR No.:

200903613

Old I/Card No.:

AO

0535
Name:

PRASHANT KANWAT

Designation:

J.T.O
Fathers Name: Mr. BHARAT SINGH KANWAT

Date of Birth:

20-

04-1985
Date of
Superannuation:

30-04-

2045
Office Address: IP TAX-II, O/o DGM D-TAX, EASTERN COURT, JANPATH, NEW

DELHI - 110001
Phone (O): 011-23328791

(Resi.): 011-28035359

(Mobile):

9868111612
Blood Group: O+
Residential Address:

216, INDRAPRASTHA APARTMENTS

SECTOR-12, POCKET-3
DWARKA, NEW DELHI-110078

Two Recent
Passport Size
Photographs
(One paste
here)
35mm x 45
mm

Signature of Applicant:
Purpose of ID Card:
(i) New ID Card*

(ii)
(iii)

Renewal of ID Card*

Loss of ID Card: In case of loss of ID Card a copy of FIR and receipt of

payment of
100/- to A.O. (Cash) is to be attached.
(iv) Modification of Design./Office Address*
Above data and reason for issue of Identity card is duly verified by Controlling
Authority.
Signature of Controlling
Authority
Name of Controlling Authority:
Stamp / Seal with date:

Signature and Seal of Issuing Authority with date:

*Please Note:
1. Please provide copy of relevant orders issued for the purpose.
2. Card issued by AGM (HRD) NTR New Delhi will be accepted for
surrender.
Surrender/declaration certificate may be obtained from the previous
unit in ORIGINAL in case
of cards surrendered/expired, as the case may
be.

(Executive)

ID-CARD FORM
(TO BE FILLED IN BLOCK LETTERS)
Serial
No
HR No.: 198100281
Name:

SHASHI KANT ASTHANA

Fathers Name: Late Mr. P.N. ASTHANA

Old I/Card No.:

AO 0267

Designation:

S.D.E

Date of Birth:

08-07-

1956
Date of
Superannuation: 31-07-2016
Office Address : IP TAX-II, O/o DGM D-TAX, EASTERN COURT, JANPATH NEW

DELHI - 110001
Phone (O) : 23328781

(Resi. ) : 28547290

(Mobile) :

9868185990
Blood Group: B+
Two Recent
JG-II/735C, LIG FLATS, VIKAS PURI,
Passport
Size
NEW DELHI-110018

Residential Address:

Photographs
(One paste
here)
35mm x 45
mm

Signature of Applicant :
Purpose of ID Card :
(i) New ID Card*
(ii) Renewal of ID Card8
(iii) Loss of ID Card : In case of loss of ID Card a copy of FIR and receipt of
payment of

100/- to A.O. (Cash) is to be attached.

(iv) Modification of Design./Office Address*
Above data and reason for issue of Identity card is duly verified by Controlling Authority.

Signature of Controlling
Authority:
Name of Controlling Authority
Stamp / Seal with date :
Signature and Seal of Issuing Authority with date:

*Please Note :
I. Please provide copy of relevant orders issued for the purpose.
2. Card issued by AGM(HRD) NTR New Delhi will be accepted for
surrender.
Surrender/declaration certificate may be obtained from the previous
unit in
ORIGINAL in case Of cards surrendered/expired, as the case may be.

(Non-Executive / Executive)

ID-CARD FORM
(TO BE FILLED IN BLOCK LETTERS)
Serial No
HR No.: 200104443

Old I/Card No.: 3102

Name: SANJAY SINGH BISHT

Designation: T.T.A.

Fathers Name: Late Mr. HIRA SINGH

1974

Date of Birth: 12-04Date of

Superannuation: 30-04-2034

Office Address : IP TAX-II, O/o DGM D-TAX, EASTERN COURT, JANPATH NEW DELHI 110001
Phone (O) : 23328781

(Resi. ) : 27632138

(Mobile) : 9868258458

Blood Group : A+
Residential Address : I 254, JAHANGIR PURI,
DELHI-110033

Two Recent
Passport
Size
Photographs
(One paste
here)
35mm x 45 mm

Signature of Applicant :
Purpose of ID Card :
(i) New ID Card*
(ii) Renewal of ID Card*
(iii) Loss of ID Card : In case of loss of ID Card a copy of FIR and receipt of
payment of

100/- to A.O. (Cash) is to be attached.

(iv) Modification of Design./Office Address*

Above data and reason for issue of Identity card is duly verified by Controlling Authority.

Signature of Controlling
Authority:
Name of Controlling Authority
Stamp / Seal with date :
Signature and Seal of Issuing Authority with date :

*Please Note :
I. Please provide copy of relevant orders issued for the purpose.
2. Card issued by AGM(HRD) NTR New Delhi will be accepted for
surrender.
Surrender/declaration certificate may be obtained from the previous
unit in
ORIGINAL in case Of cards surrendered/expired, as the case may be.

(Non-Executive)

ID-CARD FORM
(TO BE FILLED IN BLOCK LETTERS)
Serial No:

..

HR No.:

200011761

Old I/Card No.:

1578

Name:
SUMER CHAND RAMOLA
TELECOM MECHANIC

Designation:

Fathers Name: LATE Sh. BHAGWAN CHAND RAMOLA

15-07-1970

Date of Birth:

Date of
Superannuation:

31-07-

2030
Office Address: IP TAX-II, O/o DGM D-TAX, EASTERN COURT, JANPATH, NEW
DELHI - 110001
Phone (O): 011-23328785
(Mobile): 9868242683

(Resi.): 011-28520809

Blood Group: B+
Residential Address:
RZ-368/394, GALI NO.-9
SHIVPURI, WEST SAGARPUR
NEW DELHI-110046

Two Recent
Passport Size
Photographs
(One paste
here)

Signature of Applicant:

35mm x 45

mm
Purpose of ID Card:
(i) New ID Card*

(ii)
(iii)

Renewal of ID Card*

Loss of ID Card: In case of loss of ID Card a copy of FIR and receipt of

payment of
100/- to A.O. (Cash) is to be attached.
(iv) Modification of Design./Office Address*
Above data and reason for issue of Identity card is duly verified by Controlling
Authority.
Signature of Controlling
Authority
Name of Controlling Authority:
Stamp / Seal with date:
Signature and Seal of Issuing Authority with date:

*Please Note:
1. Please provide copy of relevant orders issued for the purpose.
2. Card issued by AGM (HRD) NTR New Delhi will be accepted for
surrender.
Surrender/declaration certificate may be obtained from the previous
unit in
ORIGINAL in case Of cards surrendered/expired, as the case may be.

(Executive)

ID-CARD FORM
(TO BE FILLED IN BLOCK LETTERS)
Serial No:
..
HR No.:

200700191

Old I/Card No.:

AO

0286
Name:

RAJIV KUMAR YADAV

Designation:

J.T.O
Fathers Name:

Mr. R.M.S. YADAV

Date of Birth:

04-03-1982
Date of
Superannuation:

31-03-

2042
Office Address: IP TAX-II, O/o DGM D-TAX, EASTERN COURT, JANPATH, NEW

DELHI - 110001

Phone (O): 011-23328781

(Resi.): 011-22564656

(Mobile):

9868156757
Blood Group: O+
Residential Address:

Two Recent
Passport Size
Photographs
(One paste
here)
35mm x 45
mm

A-12/277B, BRIJPURI
DELHI-110094

Signature of Applicant:
Purpose of ID Card:
(i) New ID Card*

(ii)
(iii)

Renewal of ID Card*

Loss of ID Card: In case of loss of ID Card a copy of FIR and receipt of

payment of
100/- to A.O. (Cash) is to be attached.
(iv) Modification of Design./Office Address*
Above data and reason for issue of Identity card is duly verified by Controlling
Authority.
Signature of Controlling
Authority
Name of Controlling Authority:
Stamp / Seal with date:
Signature and Seal of Issuing Authority with date:

*Please Note:
1. Please provide copy of relevant orders issued for the purpose.
2. Card issued by AGM (HRD) NTR New Delhi will be accepted for
surrender.
Surrender/declaration certificate may be obtained from the previous
unit in ORIGINAL in case
of cards surrendered/expired, as the case may
be.

(Non-Executive)

ID-CARD FORM
(TO BE FILLED IN BLOCK LETTERS)
Serial No:
..
HR No.:
Name:

T.T.A

200904933
ABHISHEK KANDURI

Old I/Card No.:

1591

Designation:

Fathers Name: Mr. K.S.R.MOORTHI

Date of Birth:

13-08-1984
Date of
Superannuation:

31-08-

2044
Office Address: IP TAX-I, O/o DGM D-TAX, EASTERN COURT, JANPATH, NEW

DELHI - 110001
Phone (O): 011-23328782

(Resi.): ---

(Mobile):

9013495185
Blood Group: O+
Two Recent
Passport Size
Photographs
(One paste
here)
35mm x 45
mm

Residential Address:

Signature of Applicant:
Purpose of ID Card:
(i) New ID Card*

(ii)
(iii)

Renewal of ID Card*

Loss of ID Card: In case of loss of ID Card a copy of FIR and receipt of

payment of
100/- to A.O. (Cash) is to be attached.
(iv) Modification of Design./Office Address*
Above data and reason for issue of Identity card is duly verified by Controlling
Authority.
Signature of Controlling
Authority
Name of Controlling Authority:
Stamp / Seal with date:
Signature and Seal of Issuing Authority with date:

*Please Note:
1. Please provide copy of relevant orders issued for the purpose.
2. Card issued by AGM (HRD) NTR New Delhi will be accepted for
surrender.
Surrender/declaration certificate may be obtained from the previous
unit in ORIGINAL in case
of cards surrendered/expired, as the case may
be.