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     REVISED OPTION IN THE MONTH OF APRIL 2012

  THE PROFORMA OF DECLARATION  IS POSTED BELOW 
  LAST DATE 30TH APRIL 2012.


                                                                    Annexure-II

Name of the Office

                                            LETTER OF AUTHORISATION


To..........................................................
...........................................................
Designation of Divisional Head
I.................................................................... (Name & Designation) being a member of................................................................... (Name of Service Association) hereby authorise deduction of monthly subscription of Rs..............per month from my salary starting from the month of July 2012 payable on 31.07.2012 and authorise its payment to the above mentioned Service Association.


I hereby certify that I have not submitted authorisation in favour of any other service Association. If the above information is found incorrect, I fully understand that my authorisation for the Association becomes invalid.
                                                                                                 Signature
Station:-                                                                                    Name
Date:-                                                                                        Designation
..........................................................................................................................................................
To be filled by the Association
It is certified that Shri/Smt ........................................................................is
a member of..................................................................................... (Name of the Service Association)
It is further certified that the above authorisation has been signed by Shri/Smt.................................................................................................................in my presence


Signature..............................................................
Name (in Capital)............................................ Of authorised office bearer...................................

Signature
Name (in capital)Of the member


Divisional Head’s Attestation

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