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ભદગ-૧ અરજદદરનર તવગતમ 
અરજદદરનન નદમ : 
Annexure I - રદષરય કકતષ વરમદ યમજનદ હમઠળ તધરદણર ખમડડત મદટમનનન દરખદસત પત (દરમક નમટરફદઇડ એરરયદ મદટમ અલગ ફમમર ભરવનન) 
અરજ નનબર : 
અરજદદરનન સરનદમન : 
અમરમલર બદબરદ 
લલગ : મમબદઇલ નનબર: 
બબક મદટમ નનબર: 80940291 
ઇ-મમઇલ : 
જજમ તદરરખ: 
MALE GENERAL 1-Jun-1965 
સનયનકત ખદતમદદર છમ ? 
જતત: 
પદક તધરદણ ધરદવમ છમ. ? 
2014853965 
pravinbhai arjanbhai padshalahai 
Untvad ,365421 
હદ 
નદ 
padshalakalpesh00@gmail.co 
m 
કયદ પકદરનદ ખમડડત છમ.? 
રકમ(ર.): 70000.00 
વષર ૨૦૧૪-૧૫ ખરરફ 
નમટરફદઇડ એરરયદ જલલમ: તદલનકમ : 
9879065540 
નદનદ 
પદક તધરદણનમ પથમ હપતમ ઉપદડમલ છમ.? હદ કનલ ઉપદડમલ રકમ(ર.): 70000.00 ઉપદડનર પહમલર તદરરખ : 
23/06/2014 
અરજ(દરખદસત પતક) ભયદર તદરરખ : 04-Aug-2014 6:12 pm 
ભદગ-૨ ખદતમદદરનર તવગત 
કમ નનબર ગદમ ખદતદ નનબર ખદતમદદરનમ કમ નનબર તથદ નદમ ખદતદનર કનલ જમરન (હમ.આર.મચમમર) 
1 ઉઉટવડ 868 1 પડશદલદ પતવણભદઈ અરજણભદઈ 1.5580 
ગદમ ખદતદ નનબર સરવમ નનબર 
કનલ કમતફળ 
હમ.આરમ.ચમમર 
પદકનન કમતફળ 
પદકનન નદમ હમ.આર.મચમમર 
ભદગ-૩ પદકનર તવગત(ખરરફ - ૨૦૧૪-૧૫ ) 
કમ નનબર 
પરતમયમ સદમદજય 
દર(%) 
State SOF 
(ર/હમ.) 
થમસમલડ વમલયન 
(ર/હમ.) 
પરતમયમ Actuarial 
Rate(%) 
1 ઉઉટવડ 868 46p૧ 1.5580 કપદસ(Hybrid) 1.5508 6.00 6.00 62000.00 13700.00 
Courtesy:National Informatics Centre Gujarat State 04-Aug-2014 18:21:26 PAGE: 1 / 2
અરજ નનબર : 2014853965 
બબક મદટમ નનબર: 80940291 
ભદગ-૪ તવમદનર ગણતરર પદકનન કનલ 
કમ નનબર 
પદકનન નદમ 
(A) 
પરતમયમ(ર.) 
(G=E+F) 
કમલમ (D) નન 
પરતમયમ(ર.) 
(F) 
કમલમ (C) નન 
પરતમયમ(ર.) 
(E) 
આરકરત તવમદનર રકમ(ર.) 
સદમદજય દર પમદણમ 
(C) 
આરકરત તવમદનર રકમ(ર.) 
Actuarial Rate પમદણમ 
(D) 
કનલ તધરદણનર 
રકમ(ર.)(B) 
1 કપદસ(Hybrid) 70000.00 21245.96 31946.48 1,274.76 1,916.79 3,191.55 
કનલ આરકરત તવમદનર રકમ (C+D) (ર.) 53,192.44 કનલ પરતમયમ(ર.) 3,191.55 
બદનહમધરર (Declaration) 
આથર હનન જહમર કરન છનન કમ પસતદવપત ભરતદન પહમલદ આ યમજનદનર જમગવદઇઓ મબ તવગતવદર વદનચર અનમ સમજ છમ/મનમ તવગતવદર સમજવવદમદન આવમલ છમ. તવશમષમદન હનન જહમર કરન છનન કમ ઉપર જણદવમલ તવગતમ 
ખરર અનમ સદચર છમ અનમ પદક વરમદ મદટમ આ દરખદસત હમઠળ પસતદતવક પદકનદ વદવમતરનમ આ દરખદસતપતનર તદરરખમ એક મતહનદ કરતદન વધન સમય થયમલ નથર. વધદરદમદન વરમદ મદટમ આ દરખદસતપત હમઠળ 
પસતદતવક પદકમનર પરરતસથતત આ તદરરખમ સદમદજય છમ. વધનમદ અમમ પથમ હપતદ બદદ લરધમલ તધરદણનન પણ યમજનદનર જમગવદઈઓ મનજબ પરતમયમ આપવદ સહમતર આપરએ છરએ.મબ ઉપર જણદવમલ પદક 
મદટમ ચદલન ઋતન દરમયદન આ યમજનદ હમઠળ વરમદ આવરણ મદટમ આ બબકનર શદખદ/પદથતમક ખમતર તવષયક સહકદરર મનડળર મદરફત અથવદ અજય કમઇ બબક શદખદ મદરફતમ અથવદ પદથતમક ખમતર તવષયક સહકદરર 
તદરરખ: સથળ: 
નનધ : ખમડડતમ ભદગ ૧,૨,૩ નર મદતહતર અવશય આપવદનર રહમ છમ. 
અરજદદરનન નદમ : pravinbhai arjanbhai padshalahai સહર અથવદ અનગનઠદનનન તનશદન(નનધ: અનગડઠદનન તનશદન હમય તમ યમગય રરતમ ઓળખદવવ)ન 
કનલ 
પરતમયમ(ર. 
પરતમયમ 
સબસરડર 
નમટ 
પરતમયમ(ર.) 
બબકનમ તસકકમ તરરખ અનમ સહર 
બબક દદરદ ભરનદર વવગતત બબકનન નદમ 
STATE BANK OF INDIA 
Untvad 
બબક બચત ખદતદ નનબર 03144369186 
અરજ નનબર 2014853965 
તદરરખ 
પથમ હપતમ કટ ઓફ તદરરખનર મયદરદદમદ લરધમલ છમ. જમનર ચકદસણર બબક રમકડર સદથમ કરમલ છમ. 
મનડળરનદ સભય તરરકમ લમન મમળવમલ છમ.? 
મનડળરનન નદમ 
મનડળરનમ બબક અકદઉજટ નનબર 
ખમડડતનમ મનડળરમદ લમન અકદઉજટ નનબર 
નદ 
બદનજચ નન નદમ 
Courtesy:National Informatics Centre Gujarat State 04-Aug-2014 18:21:26 PAGE: 2 / 2

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Abc

  • 1. ભદગ-૧ અરજદદરનર તવગતમ અરજદદરનન નદમ : Annexure I - રદષરય કકતષ વરમદ યમજનદ હમઠળ તધરદણર ખમડડત મદટમનનન દરખદસત પત (દરમક નમટરફદઇડ એરરયદ મદટમ અલગ ફમમર ભરવનન) અરજ નનબર : અરજદદરનન સરનદમન : અમરમલર બદબરદ લલગ : મમબદઇલ નનબર: બબક મદટમ નનબર: 80940291 ઇ-મમઇલ : જજમ તદરરખ: MALE GENERAL 1-Jun-1965 સનયનકત ખદતમદદર છમ ? જતત: પદક તધરદણ ધરદવમ છમ. ? 2014853965 pravinbhai arjanbhai padshalahai Untvad ,365421 હદ નદ padshalakalpesh00@gmail.co m કયદ પકદરનદ ખમડડત છમ.? રકમ(ર.): 70000.00 વષર ૨૦૧૪-૧૫ ખરરફ નમટરફદઇડ એરરયદ જલલમ: તદલનકમ : 9879065540 નદનદ પદક તધરદણનમ પથમ હપતમ ઉપદડમલ છમ.? હદ કનલ ઉપદડમલ રકમ(ર.): 70000.00 ઉપદડનર પહમલર તદરરખ : 23/06/2014 અરજ(દરખદસત પતક) ભયદર તદરરખ : 04-Aug-2014 6:12 pm ભદગ-૨ ખદતમદદરનર તવગત કમ નનબર ગદમ ખદતદ નનબર ખદતમદદરનમ કમ નનબર તથદ નદમ ખદતદનર કનલ જમરન (હમ.આર.મચમમર) 1 ઉઉટવડ 868 1 પડશદલદ પતવણભદઈ અરજણભદઈ 1.5580 ગદમ ખદતદ નનબર સરવમ નનબર કનલ કમતફળ હમ.આરમ.ચમમર પદકનન કમતફળ પદકનન નદમ હમ.આર.મચમમર ભદગ-૩ પદકનર તવગત(ખરરફ - ૨૦૧૪-૧૫ ) કમ નનબર પરતમયમ સદમદજય દર(%) State SOF (ર/હમ.) થમસમલડ વમલયન (ર/હમ.) પરતમયમ Actuarial Rate(%) 1 ઉઉટવડ 868 46p૧ 1.5580 કપદસ(Hybrid) 1.5508 6.00 6.00 62000.00 13700.00 Courtesy:National Informatics Centre Gujarat State 04-Aug-2014 18:21:26 PAGE: 1 / 2
  • 2. અરજ નનબર : 2014853965 બબક મદટમ નનબર: 80940291 ભદગ-૪ તવમદનર ગણતરર પદકનન કનલ કમ નનબર પદકનન નદમ (A) પરતમયમ(ર.) (G=E+F) કમલમ (D) નન પરતમયમ(ર.) (F) કમલમ (C) નન પરતમયમ(ર.) (E) આરકરત તવમદનર રકમ(ર.) સદમદજય દર પમદણમ (C) આરકરત તવમદનર રકમ(ર.) Actuarial Rate પમદણમ (D) કનલ તધરદણનર રકમ(ર.)(B) 1 કપદસ(Hybrid) 70000.00 21245.96 31946.48 1,274.76 1,916.79 3,191.55 કનલ આરકરત તવમદનર રકમ (C+D) (ર.) 53,192.44 કનલ પરતમયમ(ર.) 3,191.55 બદનહમધરર (Declaration) આથર હનન જહમર કરન છનન કમ પસતદવપત ભરતદન પહમલદ આ યમજનદનર જમગવદઇઓ મબ તવગતવદર વદનચર અનમ સમજ છમ/મનમ તવગતવદર સમજવવદમદન આવમલ છમ. તવશમષમદન હનન જહમર કરન છનન કમ ઉપર જણદવમલ તવગતમ ખરર અનમ સદચર છમ અનમ પદક વરમદ મદટમ આ દરખદસત હમઠળ પસતદતવક પદકનદ વદવમતરનમ આ દરખદસતપતનર તદરરખમ એક મતહનદ કરતદન વધન સમય થયમલ નથર. વધદરદમદન વરમદ મદટમ આ દરખદસતપત હમઠળ પસતદતવક પદકમનર પરરતસથતત આ તદરરખમ સદમદજય છમ. વધનમદ અમમ પથમ હપતદ બદદ લરધમલ તધરદણનન પણ યમજનદનર જમગવદઈઓ મનજબ પરતમયમ આપવદ સહમતર આપરએ છરએ.મબ ઉપર જણદવમલ પદક મદટમ ચદલન ઋતન દરમયદન આ યમજનદ હમઠળ વરમદ આવરણ મદટમ આ બબકનર શદખદ/પદથતમક ખમતર તવષયક સહકદરર મનડળર મદરફત અથવદ અજય કમઇ બબક શદખદ મદરફતમ અથવદ પદથતમક ખમતર તવષયક સહકદરર તદરરખ: સથળ: નનધ : ખમડડતમ ભદગ ૧,૨,૩ નર મદતહતર અવશય આપવદનર રહમ છમ. અરજદદરનન નદમ : pravinbhai arjanbhai padshalahai સહર અથવદ અનગનઠદનનન તનશદન(નનધ: અનગડઠદનન તનશદન હમય તમ યમગય રરતમ ઓળખદવવ)ન કનલ પરતમયમ(ર. પરતમયમ સબસરડર નમટ પરતમયમ(ર.) બબકનમ તસકકમ તરરખ અનમ સહર બબક દદરદ ભરનદર વવગતત બબકનન નદમ STATE BANK OF INDIA Untvad બબક બચત ખદતદ નનબર 03144369186 અરજ નનબર 2014853965 તદરરખ પથમ હપતમ કટ ઓફ તદરરખનર મયદરદદમદ લરધમલ છમ. જમનર ચકદસણર બબક રમકડર સદથમ કરમલ છમ. મનડળરનદ સભય તરરકમ લમન મમળવમલ છમ.? મનડળરનન નદમ મનડળરનમ બબક અકદઉજટ નનબર ખમડડતનમ મનડળરમદ લમન અકદઉજટ નનબર નદ બદનજચ નન નદમ Courtesy:National Informatics Centre Gujarat State 04-Aug-2014 18:21:26 PAGE: 2 / 2