SPARK FORM NO.3 NOMINATION/ CHANGE OF NOMINATION OF DDOs/ Establishment Officers (To be furnished by the Head of Office to the respective Department Management User) 1

Name of Department

2

Name & PEN of the existing DDO/ Establishment Officer (Write NIL if requesting for ID for the first time)

3

Contact Number Of existing Clerk/DDO

4

Reason for change Details of newly nominated DDOs/ Establishment Officials

5

Name

6

PEN of DDO

7

Designation

8

Name of office

9

Place of office

10

Post Office

11

District

12

PIN Code

13

Office Phone Number

14

Residence Phone Number

15

Mobile Phone Number

16

eMail ID

Place: Signature, Name & Designation of the Head of Office

Date To The Chief Project Manager (SPARK) PMU Office,Uppalam Road Statue,Trivandrum-695001

Note : Please fill up the form,take print out and counter sign with seal & send the scanned copy of this form to [email protected]

nomination/ change of nomination of - KHSMSA

12 PIN Code. 13 Office Phone Number. 14 Residence Phone Number. 15 Mobile Phone Number. 16 eMail ID. Place: To. The Chief Project Manager (SPARK).

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