1. This is a history sheet for a pensionable officer that tracks their service details including dates of appointment, promotions, salary, leave periods, and other remarks. 2. It collects information such as the officer's full name, date of birth, nationality, educational qualifications, dates and nature of appointments held, annual salary, and periods of leave like half-pay leave. 3. Certificates are also included, one for authentication of date of birth and one if the officer has no previous service to declare.

1. —ÊòåÄ Éæ´êÀà Íú• ¾øȽåÖ¾à Àèο ®ÚÆå ̴;
è 53 (¡) Éæ¾ø ïÀåó ¡å¨îºø ÀºòÆ
General 53 A
*
HISTORY SHEET - PENSIONABLE OFFICERS (A4 S. & E) 08/82
(Internet Version)
1. ¾øȽåÖÆåïªà ¾Ä (ÌŠÀìÚ¸ïƾà) .................................................................................................................................
¾øȽåÖÆå ¡å¸à¶êïŒ ïÍåà ¡å¸à¶êïŒ ¡Ú½ ÀåÈ¾Æ Àè´ .................................................................................................................
Name of Officer (in full) Àɺà¾å ¨øÌèÆŠ ĸà¶Èƨà ïÍåà Æ´ïºà ä´ ¨Èè¾à
2. °åºø¨ºàÉÆ Íå ÉÚªÆ ïÌàÉÆï¨å´ ºøæÆú ïÄÍú Ì¿Í¾à ¨Ç¾à¾ ........................................................................................................................................
...................................................................................................................................
Nationality and Race State whether the officer has had prior service under
Government or under Quasi.Government Body ........................................................................................................................................
(1940.01.23 Éæ¾ø¼åÆú¾à ÀÌêÉ Àºà ¨Ç¾ ȼ Êòé Èåâ¨ø¨Æ¨ë ï¾åɾ ¡Æ¨ë ¾Š ¦Ä Àºà¨ø×Ä ¡¾êĺ ï¨Çæ¸ê
ÈèƨøÆ—Èè ÀèÎè¿ ïºåǺëÇæ Ì´Í¾à ¨Ç¾à¾.) (Ìæ.Æê. _ ä´ ¨Èè¾à ¨Î ïÌàÉÆ ÀèÎè¿ ïºåǺëÇæ Æ»åïÆåàªñ ÀÖ¼ú 234 Éæ¾ø ïÀåó ¡å¨îºø ÀºòïÆÍú ïÍåà 226¡ Éæ¾ø ïÀåó ¡å¨îºø
(If non-Sri Lankan appointed after 23.01.1940, give reference to correspondence authorizing appointment.) ÀºòïÆÍú ïÍåà ̴;à ï¨å´ ä´ ¡æ•¸èÆ ÆêºëÆ.)
3. ¤À¾à ¼ú¾Æ ¦Æ Ìͺø¨ ¨Î ¡¾à¼Ä (Note. – Particulars of previous service should be annexed on Form General 234 or Form General 226A, as the case may be.)
................................................. ........................................................
Date of birth How authenticated ¾øȽåÖÆå ä´ ¨Èè¾à ¦Âß ïÌàÉƨ ïƼû ¾æºà¾Š §Íê Àͺ ̿;à ɾ Ìͺø¨Æ ¡ºàÌ¾à ¨Î ÆêºëÆ :_
If the officer has no previous service, the following certificate should be signed by him :–
4. Éæ.Íå ¡.—.Éæ ¡â¨Æ ........................................ ........................................................................
W. & O.P.No. Äå¸à¶Èè¨ ¾øȽåÖÆåïªà ¡ºà̾.
Signature of Staff Officer.
Ìͺè¨Æ/ CERTIFICATE
Äå ä´ ¨Èè¾à ¡å¸à¶êïŒ ïÍåà ¡å¸à¶êïŒ ¡Ú½ ÀåÈ¾Æ Æ´ïºà Àɺà¾å ¨øÌèÄ Ä¸à¶Èƨ ïÍåà ïÌàÉÆ ï¨å´ ¾æº.
5. ¡½ñåÀ¾Æ ȼ Ìà»å¾Æ .......................................................................................................................................... I have no previous service under Government or under a Quasi. Government Body.
Where Educated
6. ¡½ñåÀ¾è¨ ÌêóÌꨊ Íå .................................................................................................................
ÌĺàÑ ¡æºø ¡å¸à¶êïŒ —Ãåª
Educational Qualifications and
................................................................................................................. ¼ú¾Æ/Date : ..................................... ........................................................................
Government Examinations passed ¡ºà̾/Signature.
ïÌàÉå ¨åÈÆ ºëÎ ÈÂåªºà ¡Ú½ Éæ´êÀà
¾èÉå¶ê ïÍåà Éæ´êÀà ÇÍúº ¾øÉå¶ê ïÍåà —ïÊàËïƾà
Àºà¨Ç¾ ȼ Éæ´êÀà ïªÉ¾ê ¡æïºåºà ïÄÍú Ì¿Í¾à ¨Î ÆêºëÆ. Ì¿Í¾à ¨Î Æêºë
¼ú¾Æ Íå Àºà¨ø×ïŠ ïÍåà ººàºàÉïÆ¾à ¤ÌÌà Ⱦ ÄåÚªÆ _ (¡Ú½ Éæ´êÀà ¾øÉå¶ê Ì¿Íå, ¡.Éæ.¼, ¨øÌè ¨Ç渨à
À‘ Éæ‘ ï¨Çæ¸ê ïÍåà ¨ø×ïŠ ïÍåà ÌàÉÃåÉÆ (ïÄÄ ºùÇæïÉÍú À¾àºøÆ Àê¼àªÈè¨ Éæ´êÀà ÇÍúº ¾øÉå¶ê Ì¿Íå, Éæ.Ç.¼, ¡æïºåºà ¦Æ Íå
ººàºàÉïÆ¾à ¤ÌÌà ï¼ÀåںàºëÉ ¾øȽåÖÆå ȼ ÌèÆÝÄ Ìà»üÇ Àºà¨ø׊ À‘¾‘
¤À Íå ïÌàÉÆ ¨Ç¾ Æ»å ïÆåàªñ ÀÖ¼ú Ì¿Í¾à ¨Î ÆêºëÆú.) ª¸¾à Àרà˨ïªà
ï¨Çæ¸ê ¼ú¾Æ ÉåÚËè¨ Éæ´êÀ
Department ï¼ÀåںàºëÉ ïÍåà ººàºàÉïÆ¾à ¤ÌÌà ¨ø׊ ïÍåà ïÊòà¸èÆ Ìà»å¾Æ ïɾºà ïªÑŠ Half-pay Leave or Leave without Pay ÍÖ ÉæǼú ÂæÈéŠ
Date of Appointment, Sub-Department
Ì¿Í¾à ¨Î ÆêºëÆ.) Annual Salary
¡å¼Æú during Service Periods (Insert H.P. for ÀèÎè¿ Ìͺø¨Æ
Class Station
Increment of Promotion & Half-pay Leave or N.P. for Leave
Nature of Appointment or Promotion where serving
Grade Source of without Pay, as the case may be) Remarks, if
(in this column insert all the Substantive
Payment – any, and
Appointments held by, or Promotions to,
P.E, other ¡.Éæ. Certificate
the officer.)
ÉÚËÆ ÄåÌÆ ¼ú¾Æ charges, &c. ïÍåà ¨É¼å ¨É¼å of Audit
ÄåÌ ¼ÉÌà
Year Month Date Çæ. Ê. Éæ.Ç. Ìè´ ¼ ïº¨à ¼ Months Days
Verification
Rs. c. H.P. or From To
N.P.
[¡ Àè Â./P. T. O.

2. ïÌàÉå ¨åÈÆ ºëÎ ÈÂåªºà ¡Ú½ Éæ´êÀà
¾èÉå¶ê ïÍåà Éæ´êÀà ÇÍúº ¾øÉå¶ê ïÍåà —ïÊàËïƾà
Àºà ¨Ç¾ ȼ Éæ´êÀà ïªÉ¾ê Ì¿Í¾à ¨Î Æêºë
¼ú¾Æ Íå Àºà ¨ø×ïŠ ïÍåà ººàºàÉïÆ¾à ¤ÌÌà ¡æïºåºà ïÄÍú Ì¿Í¾à ¨Î ÆêºëÆ.
Ⱦ ÄåÚªÆ _ (¡Ú½ Éæ´êÀà ¾øÉå¶ê Ì¿Íå ¡.Éæ.¼, ¨øÌè ¨Ç渨à
À‘ Éæ‘ ï¨Çæ¸ê ïÍåà ¨ø×ïŠ ïÍåà ÌàÉÃåÉÆ (ïÄÄ ºùÇæïÉÍú À¾àºøÆ Àê¼àªÈè¨ ¡æïºåºà ¦Æ Íå
ººàºàÉïÆ¾à ¤ÌÌà ï¼ÀåںàºëÉ ¾øȽåÖÆå ȼ ÌèÆÝÄ Ìà»üÇ Àºà¨ø׊ Éæ´êÀà ÇÍúº ¾øÉå¶ê Ì¿Íå Éæ.Ç.¼,
¤À Íå ïÌàÉÆ ¨Ç¾ À‘ ¾‘ Æ»å ïÆåàªñ ÀÖ¼ú Ì¿Í¾à ¨Î ÆêºëÆú.) ª¸¾à Àרà˨ïªà
ï¨Çæ¸ê ¼ú¾Æ ÉåÚËè¨ Éæ´êÀ
Department ï¼ÀåںàºëÉ ïÍåà ººàºàÉïÆ¾à ¤ÌÌà ¨ø׊ ïÍåà ïÊòà¸èÆ Ìà»å¾Æ ïɾºà ïªÑŠ Half-pay Leave or Leave without Pay ÍÖ ÉæǼú ÂæÈéŠ
Date of Appointment, Sub-Department
Ì¿Í¾à ¨Î ÆêºëÆ.) Annual Salary
¡å¼úÆ ÀèÎè¿ Ìͺø¨Æ
Class Station during Service Periods (Insert H.P. for
Increment of Promotion & Half-pay Leave or N.P. for Leave
Nature of Appointment or Promotion where serving
Grade Source of without Pay, as the case may be) Remarks, if
(in this column insert all the Substantive
Payment – any, and
Appointments held by, or Promotions to,
P.E., other ¡.Éæ. Certificate
ÉÚËÆ ÄåÌÆ ¼ú¾Æ
the officer.)
charges, &c. ïÍåà ¨É¼å ¨É¼å of Audit
ÄåÌ ¼ÉÌà
Year Month Date Çæ. Ê. Éæ.Ç. Ìè´ ¼ ïº¨à ¼ Months Days
Verification
Rs. c. H.P. or From To
N.P.
H - 022222 (2004/10) Êòé Èâ¨å Ç°ïÆà Äê÷¸ ï¼ÀåںàºëÉ