Annexure - I HIMACHAL Institute of Public Administration, Fairlawns, Shimla-171012 Nomination Form 1. Programme Title : 2. Name of the Institute : H. P. Institute of Public Administration, Fairlawns, Shimla - 171 012. 3. Venue : 4. Programme Dates : 5. SC/ ST/ OBC/ OTHETS : 6. Date of birth : 7. Designation : 8. Pay Scale : 9. Basic Pay : 10. Academic Qualification : 11. Professional Qualification : 12. Address for Communication with PIN code : ___________________________________ ___________________________________ ___________________________________ Phone (Office) ___________ ___________ (Res.) ___________ ___________ FAX No. ___________ ___________ 14. Brief Description of Duties of the Officer : ( Signature of the Candidate ) TO BE FILLED IN BY THE SPONSORING AUTHORITY : Certified that: a) the particulars given above are correct. b) due care has been taken of the training needs of the officer nominated with reference to his present/ future duties viz-a-viz the contents of this course. c) The officers, if selected, will be relieved on full-time basis for attending the programme. ADDRESS OF COMMUNICATION TO SPONSORING ORGANISATION PIN __________ PHONE __________ FAX ____________ GRAMS _______________ (Signature of the Sponsoring Authority with Seal) Reference No. of Sponsoring Authority Place : Date : Downloaded from http://himachal.nic.in/hipa Page 1 of 1
