FORM E
Service Register
[See rule 37 (ii)]

(1) Name of working journalist……………….
(2) Native place……………………………….
(3) Father’s name and residence………………
(4) Date of Birth………………………………
(5) Educational and other Qualifications……..
(6) Date of first appointment and nature of job……
(7) Date of termination of employment resignation, retirement or death……………..
(8) Reasons for termination…………………..
(9) Personal marks of identification………………………..
(10) Signature of the working journalist…………………….
(11) Signature with date and designation of the employer………………..

Name of post	Scale of pay of the post		Whether (i) appretice; (ii) part-time; (iii) Permanent; (iv) Probationer; (v) temporary	Emolument drawn Period
				Pay	Other emoluments	Form	To
1	2	3		4	5	6	7

Signature of working journalist	Signature of the employer or any other officer of the establishment	Reference to any recorded increment, reward or appreciation of the working journalist
8	9	10