BY RPAD

MEDICAL EDUCATION DEPARTMENT

From To
Dr.T.Rajakumar MD., The Dean
Superintendent , Mahatma Gandhi Memorial Govt
Govt. Rajaji TB Hospital Hospital , Trichy
Tiruchirappalli-1

Ref. No.311/ OS/2018 dt .03.19

Sub: Establishment-Govt. Rajaji TB Hospital, Trichy-

Thiru.K. Thangavel Hospital worker – Due to Retire on
Superannuation on 31.03.2019 AN Permission to relieve
him from Government Service-Requested- Regarding.
-------
I submit herewith the Proposals for Superannuation
Retirement (Due on 31.03.2019 A.N) in respect of Thiru.K.Thangavel
Hospital worker of this Hospital for your kind perusal and necessary
action.

I request you to kindly grant permission to relieve

him from Government Service on the After Noon of 31.03.2019.

RETIREMENT PROPOSALS ARE

1. Complete Service Particulars
2. Proforma form to be filled by Forwarding Authority
3. No Dues/No Disciplinary Proceedings Pending Certificate
4. Declaration of the individual in Green Bond Paper (4 copies

SUPERINTENDENT
GOVT. RAJAJI TB HOSPITAL
TRICHY
 SERVICE PARTICULARS OF THIRU.K.THANGAVEL,HOSPITAL
WORKER GOVT. RAJAJI TB HOSPITAL, TRICHY-1

1 Name and Designation Thiru.K.Thangavel Hospital worker

2 Institution to which attached Govt. Rajaji TB Hospital, Trichy
3 Date of Birth 07.03.1959
4 Date of Joining in Govt.Service 16.07.1980 FN
5 Date of Regularization 16.07.1980 FN
6 Date of Completion of Probation 19.07.1981 AN
7 Date of Superannuation 31.03.2019AN

Post held and stations which worked

Sl. Post Name of the Institution From To

N
o
1 Sanitary worker Govt .Leprosy control 16.07.1980 F.N 16.06.1986 AN
unit jayankondam
Trichy Dt
2 Transit Period 17.06.1986 22.06.1986 A.N
3 Sanitary Worker Govt.Hd.Qrs Hospital 23.06.1986 06.07.2012 AN
Trichy

4 Hospital worker Govt Rajaji TB Hospital 07.07.2012 FN Till Date

SUPERINTENDENT
GOVT. RAJAJI TB HOSPITAL
TRICHY
 ANNEXURE

PROFORMA FORM TO BE FILLED UP BY THE FORWARDING

AUTHORITY WHILE SENDING PROPOSALS FOR
SUPERANNUATION RETIREMENT

1 Name,Designation and Present Thiru.K.Thangavel Hospital worker

Station of the retiring personnel
2 Date of Birth 07.03.1959
3 Date of First Appointment 16.07.1980 FN
4 Present Scale of Pay 18000-56900 Level 04 cell -23
5 Date of Retirement 31.03.2019AN
6 Whether any disciplinary action Nil
is pending against the individual
as on Date? If so the pendency
at whose level may be
mentioned with Ref.No. and
date
7 Whether any disciplinary action Nil (No Due certificate enclosed)
is contemplated, If so, the
present Stage may be furnished
8 Whether any disciplinary action Nil (No Due certificate enclosed)
is disposed off and in such a
case the nature of punishment
imposed with Ref.No.and
Date.Please mention whether the
punishment period is over
9 Whether any Government dues Nil (No Due certificate enclosed)
are pending recoverable against
the Government Servant? If so,
the Details may be furnished.
10 Whether any audit recoveries are Nil (No Due certificate enclosed)
pending, If so, the details may
be Furnished
11 Whether advance intimation was Yes
sent to the individual regarding
her Retirement on attaining the
age of Superannuation

SUPERINTENDENT
GOVT. RAJAJI TB HOSPITAL
TRICHY
 NO DUE CERTIFICATE(1)

Certified that no amount is pending towards

Bank/Society Loan to be recovered from Thiru.K.Thangavel

hospital worker due to retire on Superannuation on 31.03.2019

AN and no House Building Advance Recovery/Interest Recovery

is pending to be recovered.

SUPERINTENDENT
GOVT. RAJAJI TB HOSPITAL
TRICHY
 NO DUE CERTIFICATE(2)

Certified that Thiru.K.Thangavel, Hospital worker

working at Govt. Rajaji TB Hospital, Trichirappalli has not,

come across any adverse remarks/No Disciplinary action is

pending/contemplated against her and also no Government money

is pending to be recovered from the individual and no Audit Para

Pending in respect of the above individual.

SUPERINTENDENT
GOVT. RAJAJI TB HOSPITAL
TRICHY

NO DUE CERTIFICATE(3)
1. Certified that she has not come across any adverse remarks/No
Disciplinary action is pending / contemplated against him at
this institution.

2. Certified that no Government money is due to be recovered

from her no long term loan is pending to be recovered from him
at this institution.

3. Certified that no leave period is pending to be regularized

against her at this institution.

4. Certified that no Audit para is pending to be settled against her

at this institution.

SUPERINTENDENT
GOVT. RAJAJI TB HOSPITAL
TRICHY
 DECLARATION
RECOVERY CERTIFICATE AS PER G.O.MS.NO.845/FINANCE
DATED:12.3.1978

I, K.Thangavel Hospital worker working at Govt.

Rajaji TB Hospital, Trichy declare that the Government

Money, if any due from me or the loss caused to the

Government by any overdrawn of pay and allowances etc., by

me and any other obvious dues as a result of negligence or

fraud noticed on my part while in service may be recovered

from the Death-cum-Retirement Gratuity or Pension or

Commutation of Pension or any other amount due to me or by

way of Revenue Recovery Act if necessary in one lumpsum.

SIGNATURE OF THE INDIVIDUAL

/COUNTERSIGNED/
 DECLARATION

I, K.Thangavel Hospital worker do hereby declare

that No dues are pending to be recovered towards the House

Building Advance, House Building Advance Interest, Society

loan, Bank Loan, Motor Car/Motor Cycle Advance etc., and if

any found later may be recovered from my Death-Cum

Retirement Gratuity/ Pension in one lumpsum.

SIGNATURE OF THE INDIVIDUAL

/COUNTERSIGNED/
 NO DUE CERTIFICATE(2)

Certified that Thiru.K.Thangavel, Hospital worker

working at Govt. Rajaji TB Hospital, Trichirappalli has not,

come across any adverse remarks/No Disciplinary action is

pending/contemplated against her and also no Government money

is pending to be recovered from the individual and no Audit Para

Pending in respect of the above individual.

SUPERINTENDENT
GOVT. RAJAJI TB HOSPITAL
TRICHY
 NO DUE CERTIFICATE(3)

1. Certified that she has not come across any adverse remarks/No
Disciplinary action is pending / contemplated against him at
this institution.

2. Certified that no Government money is due to be recovered

from her no long term loan is pending to be recovered from him
at this institution.

3. Certified that no leave period is pending to be regularized

against her at this institution.

4. Certified that no Audit para is pending to be settled against her

at this institution.

SUPERINTENDENT
GOVT. RAJAJI TB HOSPITAL
TRICHY
 DECLARATION
RECOVERY CERTIFICATE AS PER G.O.MS.NO.845/FINANCE
DATED:12.3.1978

I, K.Thangavel Hospital worker working at Govt.

Rajaji TB Hospital, Trichy declare that the Government

Money, if any due from me or the loss caused to the

Government by any overdrawn of pay and allowances etc., by

me and any other obvious dues as a result of negligence or

fraud noticed on my part while in service may be recovered

from the Death-cum-Retirement Gratuity or Pension or

Commutation of Pension or any other amount due to me or by

way of Revenue Recovery Act if necessary in one lumpsum.

SIGNATURE OF THE INDIVIDUAL

/COUNTERSIGNED/
 DECLARATION

I, K.Thangavel Hospital worker do hereby declare

that No dues are pending to be recovered towards the House

Building Advance, House Building Advance Interest, Society

loan, Bank Loan, Motor Car/Motor Cycle Advance etc., and if

any found later may be recovered from my Death-Cum

Retirement Gratuity/ Pension in one lumpsum.

SIGNATURE OF THE INDIVIDUAL

/COUNTERSIGNED/