GoYcrntntllt ol Wcsl lltng{l l)cp:u lnrcnl of S{ hool I'il cxlii'rl D:rtr lnput Shcct for C0SA

"

F'or timely preparation of accurate selaD' bills and also with a view to building up a comprclrensive Employee's database, the Govemorhas now been pleased to decide implementation of " Computefization of Salary Accounts (COSA)" software packdge mo dahrily in all State Govelrunent Ofrces and other

Autonomous Bodies (Municipalities / Panchayats / lducational Institutions) which draw and Grant-in-Aid Salary Bills from Govemment Treasuries/ Pay & AccoLlnts Offices "1329F(l')dutcLll'MutLh2t:)12o/Altlit I)tLulcit l'it)dncc DrPu nle t, (ja|et nent of School Dctdls (To be lilled in at DI/ADI Office)

th* pal bills

I
2.

DDO code

WAccount DDO Sl. No.

DISI'l CoJc

,.*\'
(tlalisilt vhich

(Satary Hea.l-af Ac@un, runses

flan

00

Ib

0467)

.1

''ls/ r.,/
Erqtaree I.l. co"4,
Tcachi g/Non-Ted.

ri

r,ld)t,)",rh'hitelt,,!

\..)

-i

lnstitution Ndlr1e
Employee Id.

tt ,li]its. ltti4../i;*chaal Iipe + 1 disitsfor DDOSetidl+ t distl Jot h itg I/dil I 5 ligidfoi.Flnti"8 Sel iul n.ler that DD) SchoolTvPe: Ptindt)
ises 01

S.haal: I, Secondaty School:2.

a/f= I, Non-Tedch i ns

St alf:

2.

Eiiployia Dctails
'Io be

lilled itt

the Ehl i,t Blocl!!e!!!!le!]4!!!L!!! the qprupiate optiott if reqai) 3 Nar Setup SchoaL l Canr'Ittuu! / r\',/ 5S,.1Slro , - .{\r !./'!, /

i..\ba-Ssl
Ernplo Name

8b. Middle

t_
10

Se'ice'I
Servi

E
1.1

Prcserlt PrJ,Scale DA & satue ather allo$ances

ate calculatedon Bdsic ?af i c (Crctle Pay + ?u! bahd po/)

.r'rC-COSA- D,rr Inpur S[c.F

17 | Designation
18

H/t,

Hr ) rk
2

1rr1ttu

,A.cquisition Section

it ---i t,t;.;;
t

19

Residential Status
Next Ilcrement Date

L A ovt. l lt, 6 i ry

t' t i\ tt ( R0

tI

0,u,,

r;;;;;;;;;:;;:::;:
/is .)n/M rrlvvvv
!.....-.

20

2t
12
23

Inclemed Amount (Rs.)

Personal Scale ? (Y/N)

14

Deputation ? (Y/10 PhlsicaltyOraleneed?(yN Village Worker ? {Y,4{) GIS Type (1983/1987)

GIS Group (A,ts/C.D)

t5
26 27
28

29

PFAccount Type PF' Group (A,ts/C/D) BP% as NPA PAN Axdhar UID. ifany Last Pay (Rs.)
Pension (Rs.) Date of Birth Date of Joining

cPF

d4

'!

i{i :ll
:r?

ixxsax,xffit
ii:ll:t$a:..,4r:!i6ili

,.!,* ,
(tn tos. o/ Rc.enployeJ enphyee) (In

i4
35

(DD/MI,r/Ynt
31

1n

Religion
Gender
Caste

i8

. )*.1.- r**^p.i -l---iilJlii 1J:' t. Hid ?.Musi;; s. cn i",i* i-i)il-,]u--

s"*x"
t.

av.f Re enptayed enpioyee) (i DD/MMlwryformat)

i[ale t:Fonule
3ST

1l

I. Seheibt 2 SC

40 | Approval No. ofPresetrt I Post PostApproval Date . 1l

I OBa,,t

5 oRa-R

(in
1.

DD/MM/r"yWfotna,

1l
'+l
45 46

fensron Optr PRAN No.,.iilhii. Madtal SAju;:: SpousgS3riice Status

DCRB

2. NPS

Othets
S tt

Nonp (rn cdsc

afN&

Pensioh scheDra)
6

LMdnied
L AOI

2 Un l.iL
2.

t.id

idav

l.lt:nlt et
1- Nahe

5_Di\r-cee

ScDanl

G.ll'B

3.Uthets

Sfqls!
Rs.

Pay

& Htu{ in

47

PresentAddress

P"h"" St.rlt,

\IC-COSA- Datl Iaput Shei>

48

Permanent Address

49
50
51

Contact Number

Land Line Nahber includibp STD Codl

52
53

Email Id., ifany Father's Name Mother's Name

Spouse's Name Joining Designation Educational

54
55

56

Qualification Acadenic Group

Professional

J.crrJ/,s'r,,,,. LllM : trt;@), r)..rr \ ttott Lt.,.-ttun^ t,^ r'rt Lru.r'tun o Hr)<Dot

57
58 59
6A

Qualification
Pay Related

BT/ BEd/ DEIEd/

PTT'

DEd/

6l 6)
63

b.

Qualification Mother Tongue 1. Reheali 2. Hi.hdV\}l.xebali 4.Santali 5. Utdu 6. Enslish 7.Otheft Height in Inches Blood Group ldentification Mark BankAccount Deqwt vthich Salary is disbursed electronically. (please w ite CTNCELLED dia4onaUy,an iYlleq\e of yot Cheque BooL ahd attach CanceUe.l Cheqe vith this shect) Rank Name Branch Name Bank MICR Code Bank IFSC Code

-\r

e,

Number
61
a,

llanliAccount
r,

i;,

1.:

Salaty Eaminss

Pa

(us pet salaryfot the nonth

afsepte ber2012)

BandPa:i
irade.Pay $pqqlal Pay Demess Allowance House Rent Ailorvance SDecial Allorvaice (Conveyance CiJst For PH. Category) CPf (Govenlneni Slure) , ifan)

c.
d.

t
h.
1

).
k.

sdtary

pa!!.dtio;

pi;G;i;;dr,\,.8; tre nD,trr

Professionai Tax Income 'l'ax, if any

PF'

SubscriEion-liany

CPF Subscription (Covemment Shard,

ifiqv

Pa

(as

per Salaryfor the

nonn

o7 S"pte.tu

:0 t 2.1

Out-of-e""oun oea,aio,

djCtrltt Aot,,,.onn

erc.l P",4as per

the notuh

of Septenbet 20t2)
PolicyNomber, ilany

Loan Recorery

rpes ofcavt. toani

Pa

(as

pet salaryfor the

n",th

o7 Septe^be,

n 14

(Signature

of the Employee)

Signatue with dt & Seat of erik ?ANCELIED + :!1eer ta hunirS dty mBtake rerarng
ofyour Bank Account at which
<NIC-COSA- Dlta Inprr Shr.r>

HI\,|HTIICIAIM)
c.a"
& Accaunt Nunbet

++.:l:asc

yoit

diacokatty aD a Cheque aJ yaur chcque Book and auach the cance ed cheque with this ro,tora enry o:f;a," a,po,r)it po,o,"i"n,a. C"i, iacn
Satarv is iistursed.

tiii