Indian Systems of Medicine

Application for General Transfer

Application No: 256509

1. Permanent Employee Number (PEN) 534614
2. Name SHABANA S M
3. Department Indian Systems of Medicine
4. Designation Medical Officer
5. Contact Number 9249985310
6. E-mail [email protected]
7. Name of present institution GOVT AYURVEDA HOSPITAL, CHALAVARA(SRR)
8. Date of Entry in Service 28/10/2009
9. Date of retirement 30/06/2037
10. Order no. & date of promotion in the e01,01/06/2018
present post
11. Date Of Joining in the Present Designation in the 28/10/2009
Present Department
12. Date of joining in the present district 28/10/2009
13. Date of joining in the present station/Office 01/07/2014
14. (a)Whether recruited in the present post NIL
through DRB?
(b) If yes, District in which recruited
15. Home station /District declared at the time of Palakkad
joining service
16. Change of home station if any New Home Station : Date of change :
17. Details of Service History
Sl No. Name of institution Designation From Date To Date
1 GOVERNMENT AYURVEDA Medical Officer 28/10/2009 31/05/2010
DISPENSARY, PERUVEMBA
2 GOVERNMENT AYURVEDA Medical Officer 01/06/2010 31/05/2011
DISPENSARY, KUTTANASSERY
3 GOVERNMENT AYURVEDA Medical Officer 01/06/2011 31/05/2012
DISPENSARY, KUTTANASSERY
4 GOVERNMENT AYURVEDA Medical Officer 01/06/2012 31/05/2013
DISPENSARY, KUTTANASSERY
5 GOVERNMENT AYURVEDA Medical Officer 01/06/2013 31/05/2014
DISPENSARY, KUTTANASSERY
6 GOVERNMENT AYURVEDA Medical Officer 01/06/2014 30/06/2014
DISPENSARY, KUTTANASSERY
7 GOVT AYURVEDA DISPENSARY, Medical Officer 01/07/2014 31/05/2015
CHERPULASSERY
8 GOVT AYURVEDA DISPENSARY, Medical Officer 01/06/2015 31/05/2016
CHERPULASSERY
9 GOVT AYURVEDA DISPENSARY, Medical Officer 01/06/2016 31/05/2017
CHERPULASSERY
10 GOVT AYURVEDA DISPENSARY, Medical Officer 01/06/2017 31/05/2018
CHERPULASSERY
11 GOVT AYURVEDA DISPENSARY, Medical Officer (I HG) 01/06/2018 31/05/2019
CHERPULASSERY
12 GOVT AYURVEDA DISPENSARY, Medical Officer (I HG) 01/06/2019 31/05/2020
CHERPULASSERY
13 GOVT AYURVEDA DISPENSARY, Medical Officer (I HG) 01/06/2020 22/03/2021
CHERPULASSERY
14 TRANSIT Medical Officer (I HG) 22/03/2021 22/03/2021
15 GOVT AYURVEDA HOSPITAL, Medical Officer 23/03/2021 28/02/2023
CHALAVARA(SRR)
18. Details of service in Notified Difficult Areas NIL
19. Station to which Transfer is Requested for as per Sl District Name of institution Reason for
order of Preference(Name of Institution/District) No. Preference
1 Palakkad GOVT. AYUR DISP,
VALLAPUZHA(SRR)
2 Palakkad GOVT. AYURVEDA
DISPENSARY, KULUKKALLUR
3 Palakkad GOVERNMENT AYURVEDA
DISPENSARY, MURIYANKANNI
4 Palakkad GOVT AYURVEDA DISPENSARY
SREEKRISHNAPURAM
5 Palakkad GOVT. AYURVEDA
DISPENSARY, ANANGANADI
20. Whether Transfer is Requested on the basis of any protection given below? Tick as applicable. Supporting documents to be attached along
with signed hard copy
I. Less than two years to retirement NIL
21. Details of LWA availed if any NIL
22. Details of Deputation availed NIL
23. Details of Working arrangement availed on request NIL
by the employee
24. Declaration I declare that all the above details are correct. I also declare that I will submit the certificates required
for Protection (item 20) along with the signed copy of this application.
 Application for General Transfer

Date : 05/04/2023

Place : Palakkad Signature of applicant

SHABANA S M