Panchayat:Repo18/Law Manual Page0530
| 15 | Remarks | . ....... .......... . |
| 14 | If out of station due to transfer, pension etc.,permanent address | |
| 13 | If relieved, that date | |
| 12 | Date of entry in service | |
| 11 | Total Income | |
| 10 | Other payment | |
| 9 | Bonus | |
| 8 | Other fixed Allowances | |
| 7 | Dearness Allowance | |
| 6 | Salary (including special pay & personal pay) | |
| 5 | Code num | |
| 4 | Official address (including Division Number, | |
| 3 | Designation | |
| 2 | Name | |
| 1 | Serial No. |