1. ï¾å•ÈïÆà ï¼¾ ¾øÉå¶ê óŠÖÆ ÂÈÀºò ¢ÈàõŠ ¨ø×ÄÆú 21 Éæ¾ø ïÀåó ¡å¨îºø ÀºòÆ
General 21
APPLICATION FOR FREE RAILWAY HOLIDAY WARRANTS *
(A4 S., & E) 11/58
(Internet Version)
........................................................................................................................................................................ ï¼ÀåںàºïŒ ..................................................................................................... ïɺ´ Æú.
ë
¨åÚÆåÈÆ : ................................................................................................................................................................................... ¼ú¾Æ : 20 ................................................................................ Éæ¾ø ¼ú¾
To The ................................................................................................................................................. Department : ............................................................................................................................................
Office : ............................................................................................................................................................................................................................. Date : ................................................................................
1. ¢ÈàõŠ¨Çæ/¨åÖïªà ¾Ä ...................................................................................................................................................................................................................................................
Name of Applicant
*
2. º¾ºëÇ .............................. ....................................................... À¾àºøÆ .............................. ............................... ïÊòà¸èÆ .............................. ...........................
Appointment * Class Grade
3. ¼æ¾à Ⱦ ÉåÚËè¨ Éæ´êÀ : Çæ. .......................... ...................................................................................... 4. ÄêÈè¾àÄ ÀºàÉì ¼ú¾Æ ................................
Present Annual Salary Rs. Date of First Appointment
5. º¾ºëÇ Ìà»üÇ ¼, ¡ºøïÚ¨ ¼, ºåɨåÈè¨ ¼? ..................................................................................................................................................................................
Is the Appointment Fixed, Extra or Temporary ?
6. ¢ÈàõŠ¨Çæ/ ¨åÖ —Éåͨ¼, ¡—Éåͨ¼, Éæ¾à¼Åê ¡ïÆ¨à ¼, ¾ùºñå¾ê¨íÈÉ ïɾà Éì ¡ïÆ¨à ¼?, ¼ú¨à¨Ìå¼ Éì ¡ïÆ¨à ¼? ......................................................
Is the Applicant Married/ Single/ Widower/ Widow/ Legally separated/ Divorced ?
7. ÌàÉå•ÀêÇæËÆå/ ÃåÆñþåÉ Ç°ïÆà ïÌàÉïÆà ¾øÆê¨àº ¼? ................................................................................. ¦ïÌà ¾Š Àͺ ¡Ìå ¡æºø ¨Çæ¸ê ¼¨àɾà¾.
Is the Spouse in the Public Service ? If so, Please state –
ÌàÉå•ÀêÇæËÆå/ ÃåÆñþåÉ ïÌàÉÆ ¨Ç¾ ï¼ÀåںàºëÉ ..............................................................................................................................................................
Department in which spouse is employed
§Íê/ ¡æÆ ¼Ç¾ º¾ºëÇ . ..........................................................................................................................................................................................................................................
Post held by Spouse
§Íê/ ¡æÆ ¼Ç¾ º¾ºëÇ ºåɨåÈè¨ ¼, Ìà»üÇ ¼? ................................................
§Íê ¡æÆ ¼æ¾à Ⱦ ÉåÚËè¨ Éæ´êÀ ..............................................
Is the Post Temporary or Permanent ? Present Annual Salary
§Íêïªà/ ¡æÆïªà º¾ºëÇ´ ¡Æºà Éæ´êÀà ¨òÄÆ ...................................................................................................................................................................................
Salary scale attached to post
8. ¢ÈàõŠ¨Çæ/ ¨åÖ ÃåÆñþåÉ諭à/ ÌàÉå•ÀêÇæËÆåïª¾à ¾éºñå¾ê¨íÈÉ ïɾà Éì ¡ïÆ¨à ¾Š ¾æºïÍåºà,
¼ú¨à¨Ìå¼ Éì ¡ïÆ¨à ¾Š, ¡“¨Ç¸Æ Īú¾à ÎÄÆè¾àïªà ÃåǨåǺàÉÆ ÀÉǾ ȼàï¼à ¨å´ ¼ ƾ ɪ ........................................................................
If legally separated or divorced, the spouse to whom the custody of the children has been granted by Court
9. ÉêÉľå ÂÈÀºòÆ ÀèÎè¿ —ÌàºÇ _
Particulars of Warrant required –
ÆåÄ´ ïÍåà £Ä´ ïÍåà Àĸ¨à ÌŠÀìÚ¸
ï¼¾ ÌåÄå¾ñ ÂÈÀºòÆ¨à ¼, ïÍåà
ÆåÄ £Ä Ｈ Ä Ì¿Íå ï¼¾ ÂÈÀºòƨà¼, ̺ø ¡¾àº ¡Ú½
À¾àºÆ
ø
ÂÈ ÀºòÆ¨à ¼, ¾æºïÍåºà —ï¾å༠ªÄ¾à Ì¿Íå ï¼¾ Full
Class ÂÈÀºòÆ¨à ¼ ƾ ÂÉ § or
Ord. Single, Ord. Return, Half
Week End, or Excursion §
¢ÈàõŠ¨Çæ/ ¨åÖ ..................................................................................................................................................................................................................................................................
Applicant
—Éåͨ ¾Š, ÃåÆñþåÉ/ ÌàÉå•ÀêÇæËÆå .............................................................................................................................................................................................................
If married, Wife/ Husband
¡—Éåͨ/ Éæ¾à¼Åê, ¡ïÆ¨à ¾Š _
If Single/ Widow/ Widower –
ÄÉïªà ¾Ä† ..................................................................................................................................................................................................................................................................
Mother’s Name†
ïÌåïÍåÆêÖÆïªà ¾Ä† ............................................................................................................................................................................................................................................
Sister’s Name†
ÎÄÆú‡
Children‡
Ìàºòé ÀêÇæË
¾Ä ÃåÉÆ ÉÆÌ
Name Age
Sex
(1) ........................................................................................................................................................................................................
(2) ........................................................................................................................................................................................................
(3) ........................................................................................................................................................................................................
(4) ........................................................................................................................................................................................................
(5) ........................................................................................................................................................................................................
(6) ........................................................................................................................................................................................................
* ¡½ñåÀ¾ ï¼ÀåںàºëïŒ ªëÇæÉÇæ¾à/ ÉÖƾà ÌèÆ ¾øÈ ¾åÄÆ ¼, ºÄ¾à ïÌàÉÆ ¨Ç¾ ÀåÌæïÈà ¾Ä¼ ¼æ¨à—Æ ÆêºëÆ.
† ÄÉ ïÍåà/ ïÌåïÍåÆêÖÆ ïÍåà Ì¿Íå ÂÈÀºò ¢Èà—Æ Æêºàïºà / §ÉêÍê ¢ÈàõŠ¨Çæ/ ¨åÖÆ —Ìè¾à ¾¶ºàºë ¨Ç¾ê Ⱦà¾øƨà/ ¾øÌå ¾Š Àĸ¨ø.
‡ —Éåͨ ÎÄÆú¾à ¼ ÉÆÌ ¡ÉêÇæó 18 ¨à ïÍåà £´ Éæ‘ ÀèÖ• ÎÄÆú¾à ¼ ¡ÉêÇæó 3 ´ ¡¶ê ÉÆÌà ¡æºø ÎÄÆú¾à ¼ ¡æºëκà ï¾å¨Î ÆêºëÆ.
§ ̺ø ¡¾àº ÀòïŒÊ Àºò ïÍåà —ï¾å༠ªÄ¾à Ì¿Íå ï¼¾ ÀòïŒÊ Àºò ïÍåà ¨åǸƨ´ ÌêóÌê ïŒ ¾Š ÆåÄ´ ïÍåà £Ä´ ïÍåà Àĸ¨à ï¼¾ ÌåÄå¾ñ ÀòïŒÊ Àºò ¾æºïÍåºà, ÆåŠ, £Š ï¼¨Ä Ì¿Íå
ï¼¾ ÀòïŒÊ Àºò ¢ÈàõŠ ï¾å¨Î ÆêºëÆ.
* Teachers in the Education Department should give both their officials designation and the name of their school.
† Warrants in favour of mother and/or Sister to be applied only If dependent on applicant.
‡ Married children, male children of 18 years and upwards, and children under 3 years should not be included.
[¡ Àè Â./P. T. O.
§ Ordinary Single or Ordinary Return tickets must not be applied for when Week End or Excursion tickets serve the purpose.

2. From Station ......................................................................................................................................................................................................... óŠÖÆïÀåïÎà Ìè´
To Station ............................................................................................................................................................................................................. óŠÖÆïÀåÎ ¼¨àÉå
ƾ ¼ú¾Æ ¡åÀÌê ¦¾ ¼ú¾Æ
.......................................... ...........................................
Date of Outward Journey Date of return Journey
10. ¼æ¾´ ÉÎâªë Äê¼Èà ïǪëÈåÌè ¡¾êÉ ïÄÄ ¢ÈàõŠ ÀïºÍú ̿;à ɾ ¡Æ ÂÈ ÀºòÆ´ Íú•¨Š ¡æºø ¡Æ Âɺà, Äïªà ÄÉ/ ïÌåïÍåÆêÖÆ/ ƾ ï¼ï¼¾åÄ/
Ä—Ìè¾à ¾¶ºàºë ¨Ç¾ê Ⱦ ÂÉºà ¡Éâ¨É Àò¨åÊ ¨Ç•.
I declare on honour that the persons named in this application are entitled to the warrant in accordance with the Financial Regulations in force and that my Mother and/ or Sister/
is/ are dependent on me.
ÈèÀ¾Æ
è .......................................................................................................... ....................................................................
¢ÈàõŠ¨Çæïªà ¡ºà̾/Signature of Applicant
Address ..........................................................................................................
¼ú ¾ Æ/Date : ..................................................
ïÄÄ ï¨å´Ì ¢ÈàõŠ¨Çæ/ ¨åÖÆ —Ìè¾à ÀèÇÑÄ Àè¸Ì ï¾åïŒ
è
NOT TO BE FILLED IN BY THE APPLICANT
11. Àרà˨ ÈèÀè¨Çæ —Ìè¾à Ì¿Í¾à ¨Î Æêºë ¨Çæ¸ê (1488 - 1500 ɾ Äê¼Èà ïǪëÈåÌè ÂȾྠ) _
Remarks of Checking Clerk (vide Financial Regulations 1488 – 1500) –
¾øȽåÖÆå/ ÃåÆñþåÉ ÄÉ ïÌåïÍåÆêÖÆ ÎÄÆú
¾øȽåÖ¾ø Wife Mother Sister Children
Officer 1 2 3 4 5 6
¼æ¾´Äºà ÈÂå諭 ¡æºø ÂÈÀºò Ì­Èà ª¸¾ *
................................................................................................................................................................................
No. of Warrant sets already taken *
¢ºøÖÉ ¡æºø ÂÈÀºò Ì­Èà ª¸¾ *
.......................................................................................................................................................................................
No. of Warrant sets available *
¾øÉå¶ê ¼ûïŠ ÈèÀè ÀèÎè¿ ¨Çæ¸ê _
Reference to Leave Papers –
Àרà˨ ÈèÀè¨Çæïªà ¡ºà̾
Signature of Checking Clerk ..........................................................................
¼ú¾Æ
Date ..........................................................................
*ÆåÄ´ ÌÍ £Ä´ ƾ Ｈ´ Ä ï¼¾ ÂÈÀºòÆ Ì­È¨ø; ÆåÄ´ ïÍåà £Ä´ ïÍåà Àĸ¨à ï¼¾ ÂÈÀºòÆ ¡¶ ̭Ȩà ïÈÌ ªú¸èÆ ÆêºëÆ.
*A Warrant for a double journey is a set and that for a single journey should be counted as half a set
12. ï¼ÀåںàºëïŒ Àò½å¾èÆåïªà ïÍåà §Íêïªà ÌͨåÇ ¾øȽåÖÆåïªà ïÍåà ¾øïÆåàªÆ .................................................................................................................
Order of the Head of the Department or Assistant
¡ºà̾
Signature ...................................................................
¼ú¾Æ
Date ..........................................................................
13. ¾ø¨ëºà ¨Î ÂÈÀºò ¡â¨Æ .........................................................................
Number of Warrants issued
14. ¾ø¨ëºà ¨Î ¼ú¾Æ .........................................................................
Date of Issue
H - 022255 (2004/10) Êòé Èâ¨å Ç°ïÆà Äê÷¸ ï¼ÀåںàºëÉ