1 [FORM V
(See Standing Order 1, Sch. I-B)
Service Card

                          Name of Estt./Factory/
                          Ticket/Token No.
1. Register Serial No.
2. Name
3. Specimen Signature/Thumb-impression.
4. Father’s or Husband’s name.
5. Sex.
6. Religion.]
7. Date of Birth
8. Place of Birth.
9. Date of Joining.
10. Details of Medical Certificate at the time of joining.
11. Educational and other qualifications.
12. Can Read.
13. Can Write.
14. Can Speak.
15. Height.
16. Identification Marks.
17. Category of Workman
18. Department.
19. Details of family members.
20. Permanent Address.
21. Local Address.
22. Quarter No.
23. Life Insurance Policy No.
24. Provident Fund Account No.
25. Nominee for Gratuity.
26. Nominee for pension, if any
27. Employees State Insurance No.
28. Training courses attended (details)
29. Eligibility for higher jobs.
30. Proficiency Tests passed
31. Employment History

Department	Token No.	Designation	Scale of Pay	Joined	Left Reason
1	2	3	4	5	6

32. Absence Periods
From To Reason Medical reports regarding suitability for continued employment.
(i) Sick Leave.
(ii) Earned Leave.
(iii) Any other leave.
33. Maternity Benefit.
34. Workmen’s Compensation Details of accident:
35. Details of Disciplinary Action.
36. Promotions, -
(i) Details
(ii) Awards
(iii) Issue of Certificate of commendation
37. Date of superannuation.
38. Any other matter.]
1. Added by G.S.R. 30 (E), dated 17th January, 1983.