| 1. Name of the officer ** |
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| 2. HRMS number ** |
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| 3. PAN Number ** |
Please enter your PAN for 80-G purpose ---> |
| 4. Name as in your PAN ** |
Please enter NAME as in your PAN ---> |
| 5. Date of Birth ** |
Directly type date OR use Calendar ---> |
| 6. Date of appointment as JAO ** |
Directly type date OR use Calendar ---> |
| 7. Present Designation/Unit eg. RETD DGM TN ** |
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| 8. Email ID ** |
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| 9. Telephone Number |
STD |
Phone Number |
| Office |
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| Residence |
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| Mobile ** |
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| 10. Residential Address |
| Door/Flat No. |
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| Plot No. ** |
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| Street ** |
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| Area/Locality ** |
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| City/Town ** |
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| PIN Code ** |
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| 11. Permanent Address |
| Door/Flat No. |
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| Plot No. |
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| Street |
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| Area/Locality |
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| City/Town |
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| PIN Code |
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12. Amount remitted
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One time for Life period (Rs.3,000/-)
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| Amount may be remitted in the form of Cash/Cheque/Bank Transfer to the Bank account |
Punjab National Bank IFSC PUNB0034400, SAVINGS A/c No.0344000100933153 in the name of: TAMIL NADU TELECOM ACCOUNTS AND FINANCE OFFICERS WELFARE TRUST
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| 13. Station ** |
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| 14. Upload your Photo (JPG, JPEG OR PNG only) **
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