+-__:_

Govt. of West BengalOffice of the Sub-Divisional Officer

Kalimpong Sadar

Notification for engagement of ASHAMemo No.- 17 6 /Gen.

Date of Submission of Application form- 24.5. 18 to 11.6.18Time of submission of Application form- 1 1am to 3pm on allVenue of submission of Application form- Respective OfficeASHA post has been sanctioned.

Dated-23.5.18

HFWAIRHM-65211211162invited for the recruitmentunder respective Blocks of

working daysof the Block Development Officer under whose jurisdiction the

ln accordance with the Memo No. HFWA..IRI1M-652112/1168 Dated- 12119.3.18 & Memo No.Dated-12119.3.18 of the Health & Family Welfare Deptt., Govt. of West Bengal, applications areto the post of Accredited Social Health Activist (in short, ASHA) for different villages comprisedKalimpong Sadar Sub-Division, Kalimpong district.

Eligibility:1 The applicant should be a Married/Divorced/Widowed woman.2- The list of vacancies, the villages/area covered by the particular ASHA post, reservation status, etc. has been

mentioned in Annexure-"A" to this notification.3. The permanent residence of the applicant must fall under the jurisdiction of the ASHA post for which she is

applying i.e. she should be a permanent resident of the same service village(s) for which she will be selected.4. The age of the applicant shall not be more than 40 years as on 01.01.18 and not less than 30 years as on 01.01.18.

The lower age limit for SC/ST applicants, on submission of valid SC/ST certificate issued by competent authority,may be relaxed to 22 years as on 01 .01 . 1 8. An SC/ST candidate from states other than West Bengal shall be treatedas a General candidate. The OBC candidates may mention the Category. However they will be treated as Generalcandidate during the process of selection.There is no relaxation of agelreservation of post for OBC candidates.

5. The minimum qualification should be Madhyamik appeared or equivalent recognized by the Govt. of West Bengal.6. Selection is based on marks obtained by the candidates in the Madhyamik/recognized equivalent examination (90%

weightage) and score in interview(l0% weightage). Candidates may be shortlisted for interview based on score inMadhyamik/equivalent examination. In case of candidates possessing higher qualification, only the marks obtainedin the Madhyamik or equivalent examination recognized by Govt. of West Bengal will be considered.

7. The applicant shall not possess adverse criminal record which may render her unsuitable for the post.8. General/QBC candidates are not eligible to apply for the reserved posts. Only suitable applicant from the respective

catego{ is eligible to apply for the reserved posts. The Reservation status has been decided based on 2001Census.9. Applications received after 3pm on 11.6.18 will not be entertained.10. The candidature of a candidate will be rejected if she does not appear in interview (when'talled for) even if she is

otherwise eligible and secures the highest marks. .

Mode of Application:1. The Gram Panchayat shall issue a certificate w.r.t. ASHA Code to which the candidate may apply. Furthermore the

same certificate shall certify the marital status of the applicant if she is married (not for WiAowlabivorced woman).This should be submitted in original. Self attested copy of Death Certificate of Husband for WidowedWoman/Cerlificate of dissolution of marriage from competent authority for Divorced Woman need to be submitted.

2. The applicant must submit the application in the format mentioned as Annexure "8" to this notification.3. Application shall be submitted by hand in sealed envelope only at the Office of the respective Block Development

Officer against proper receipt. Application by speed post,registered post, drop box, whatsapp, e-mail, etc. shall notbe entertained. In case of any difficulty to subrnit the application, the applicant may meet the concerned BlockDevelopment Officer/Block Medical Officer of Health/Jt.'Block Development Officer/Personnel manning the HelpDesk at the Office of the Block Development Officer in person.The envelope covering the application shall be addressed as below-

1. ASHA Code No.2. Name of the Candidate3. Contact No.(s)4. Address of the Applicant with PIN code

Application should be in A'4 size white paper on one side only and should be clearly legible.Defect applications will be rejected. One applicant shall submit only one application. More than one application, ifsubmitted by the same applicant, will not be entertained and remaining application(s) will be cancelled.

4.

5.

6.

M,1T

PIN:

) --',*-Documents to be submitted with the application form:

l. Proof of permanent residence- Self attested copy of the Ration cardlvoter Identity Card(EplC) to be submitted.2. Self attested copy of the original marksheet of Madhyamik/recognized equivilent examination is required to besubmiffed.Self attested copy of the aforesaid mark sheet must be provided even in case of failure in the examination.3. For proof of age, the Self attested copy of Admit card/Registration certificate/Pass certificate, etc. of theMadhyamik/recognized equivalent examination is required to be submitted.

4 . A self attested passport sized colour photograph of the candi date is required to be pasted on the application form andanother selfattested passport sized colour photograph is required to be attached.

5. Two self addressed envelopes with postage stamp of Rs. 5/- affixed on each of them are required to be submitted.6. Self attested copy of SC/ST/OBC certificate, if applicable is required to be submitted in support of claim/relaxation.7 . Self attested copy of higher educational qualification(s) above class 1 0tr' standard may be submitted.8. Original Certificate issued by the Gram Panchayat containing the ASHA Code No. & verification of marital status

(if applicable) is required to be submitted.9. Self attested copy of Death Certificate of Husband for Widowed Woman/Certificate of dissolution of marriage from

competent authority for Divorced Woman is required to be submitted, if applicable.10. Preference will be given to the Grade I & Grade II SHG members/Trained Dais/Link Workers keeping the selection

criterion fixed' For availing this benefit, the original certificate issued by the Block Devetoiment Officer ofKalimpong-I/Kalimpong-Il/Gorubathan (for Grade I & Grade II SHG members) or by Block Medical Officer ofHealth of Kalimpong-I/Kalimpong-Il/Gorubathan (for Trained Dais/Link Workers) issued after publication of thisnotice is required to be submitted. In this case, only certificates issued by the aforesaid officials stratt be accepted.

I 1 . The original documents (except mentioned in Point 8 & l0) need not to be submitted. The self attested copy of thecertificates will be checked/verified during the interview. Hence the qualified/short listed applicants will be asked tobring the original documents during interview or consequently for verification of self attested copies.

General1.

2.

.tJ.

4.

5.

t.t

Memo No. -17 611 ( 1 4)/Gen.

Conditions:Carefully read the instructions mentioned above before applying. Fill up Application Form with due care.Help Desk has been set up at all the Block Offices of Kalimpong-I, Kalimpbng-ll & Gorubathan. Apart from this,the Gram Panchayats/BPHCs/PHCs/Health Sub Centres have been briefed, too. they may be approched.Submission of the application does not guarantee an appointment.In case of any misrepresentation of facts and documents, the applicant shall be disqualified at any time and at anystage during the process of selection. Appropriate legal action may be taken.against the candidate, ioo.The Sub-Divisional Level ASHA Selection Cornmittee reserves:the right to alter the mode of examinations or toconduct re-interview or to cancel part or whole of any process of recruitment at any stage, if required.

MflSub-Divisional-Offi cer, Kal impong Sadar

8tMember Secretary, ASHA Selection Committee, Kalimpong Sadar

Dated-23.5.18Copy forwarded for information, necessary action and with a request to cause wide circulation to

1. The CMOH, Kalimpong, .2. The OC, IT Cell, Kalimpong with a request to upload this in district website of Kalimpong immediately,3. The DPHNO, Kalimpong,4. The DPO(ICDS), Kalimpong with a request to brief the CDPOs under his jurisdiction to display same in their office

and all the AWCs under their jurisdiction and to send a certificate to that effect to the undeisigned within two daysof receiving this notice,

5. The Block Development Officer, Kalimpong-I/Kalimpong-Il/Gorubathan with a request to brief the GramPanchayat staff accordingly, to advertise the above Notice in Block & Gram Panchayat Ofhce, to set up a Help Deskfor ASHA at the Block Office, to recieve applications of ASHA with proper reliept, to maintain'a register forapplicants, etc. and to send a ceftificate to that effect to the undersignea wlttrin two days of receiving this nolice,6. The BMOH, Kalimpong-I/Kalimpong-IliGorubathan with a request to brief the BPHC/PHC/Health Sub-Centre staffaccordingly and to display same in all BPHC/PHC/Health Sub-Centre within his jurisdiction and to send a certificateto that effect to the undersigned within two days of receiving this notice,

7: The IT Co-ordinator, IT Cell, Swasthya Bhawan, GN-29, Sector-V, Salt Lake, Kolkata -700091 with a request toupload this notification in the website immediately,

8. The PA to the Hon'ble Chairperson, ASHA Selection Committee, Kalimpong Sadar,9. The CA to the District Magistrate, Kalimpong,10. The CA to the ADM(LR) & District Land & Land Reforms Officer, Kalimpong. ,

lSnS'*S ub-Div i sib'nal Offi cer, Kalimpong Sadar

&Member Secretary, ASHA Selection Committee, Kalimpong Sadar

AuNEXURE*,IASHA: Kalimpong-l

SI.

No.Gram Panchayat Health Sub-Centre Gram Sansad

Asha Code

No.Name of Village lHamlets to be

covered by the AshaSC/ST/Un-Reserved

I

Dungra Upper Dungra Dungra-IV K1 Chisopani-I & II UnreservedDungra Upper Dungra Dungra-IV K2 Chisopani-III UnreservedDungra Upper Dungra Dungra-V K3 Joredhara-I UnreservedDungra Upper Dungra Dungra-V K4 Joredhara-II UnreservedDungra Upper Dungra Dungra-VI K5 Rousay-I UnreservedDungra Upper Dungra Dungra-VII K6 Rousay-II UnreservedDungra Lower Dungra Dungra-I K7 Damaitar I UnreservedDungra Lower Dungra Dungra-I K8 Damaitar II UnreservedDungra Lower Dungra Dungra-II K9 Ramitay-I UnreservedDungra Lower Dungra Dungra-II K10 Ramitay-II l]nreservedDungra Lower Dungra Dungra-III Kll Ambokey-I UnreservedDungra Lower Dungra Dunsra-III KTz Ambokey-II UnreservedDungra Lower Dungra Dunsra-VIII Kl3 Seedfarm I UnreservedDungra Lower Dungra Dungra-VIII K14 Seedfarm II UnreservedDungra Lower Dungra Dungra-IX K15 Kazi Compound Unreserved

2

Bong Upper Bong Bong-III K16 Lower Salimbong UnreservedBong Upper Bong Bong-III Kt7 Upper Salimbong Unreserved

Bong Upper Bong Bong-VII K 18 Kamshi F.V. & Ringkingpong F.V. Unreserved

Bong Lower Bong Bone-VII K19 Upper Gairi Gaon UnreservedBong Lower Bong Bone-VII K2A Lower Gairi Gaon UnreservedBong Lower Bong Bong-I K2r Lower Tari Gaon UnreservedBong Lower Bong Bong-I K22 Upper Tari Gaon UnreservedBong Lower Bong Bone-III K23 Dixit Gaon UnreservedBong Lower Bong Bong-IV K24 Deorali Gaon UnreservedBong Lower Bong Bong-V K25 Barbotey Gaon UnreservedBong Lower Bong Bong-V K26 Barbot Gumba Gaon Unreserved

J

Sindebone S ndebong S ndepone-Il K27 Beach Gaon UnreservedSindebone S ndebong S ndepong-I K28 Upper Gairi Gaon IjnreservedSindebong S ndebong S ndepong-I K29 Lower Gairi Gaon UnreservedSindebone S ndebong S ndepone-III K30 Chalamthung UnreservedSindebong S ndebong S ndepong-Iv K 3l Barbot UnreservedSindeb.ong S ndebong S ndepone-V K32 Maney Gumba I UnreservedSinddbone S ndebong S ndepone-V K33 Maney Gumba II UnreservedSindebone S ndebong S ndepone-VI K34 Tadungchain & Cashier Gaon UnreservedSindebong S ndebong Sindepone-VII K35 Pradhan Gaon UnreservedSindebone S ndebong S ndepone-VIII K36 l2th Mile MLA Gaon UnreservedSindebong S ndebong S ndepone-VIII K37 Karbari Gaon Unreserved

4

Samthar Samthar Samthar-I K38 Upper & Lower Gairi Gaon UnreservedSamthar Samthar Samthar-Il K39 Purba & Pachim Kabi Gaon UnreseruedSamthar Samthar Samthar-Ill K40 Lower Dara Gaon UnreservedSamthar Samthar Samthar-IV K41 Upper Daru Gaon UnreservedSamthar Samthar Samthar-Vl K42 Nazok F.V. & Sepkhola ljnreservedSamthar Samthar Samthar-V K43 Upper Dong UnreservedSamthar Samthar Samthar-VI K44 Lower Dong UnreservedSamthar Samthar Samthar-Vll K45 Chotta Suruk UnreservedSamthar Samthar Samthar-Vlll K46 Upper & Lower Bara Suruk Unreserved

5

Dr Gr Homes Dr. Grahams Homes Dr Gr Homes-I K47 Eden Brough & Purdie UnreservedDrSr Homes Dr. Grahams Homes Dr Gr Homes-I K48 Pokhari Gaon [JnreservedDr Gr Homes Dr. Grahams Homes Dr Gr Homes-II K49 Delo Gaon UnreservedDr Gr Homes Dr. Grahams Homes Dr Gr Homes-III K50 Dispensary Gaon-I UnreservedDr Gr Homes Dr. Grahams Homes Dr Gr Homes-III K 51 Dispensary Gaon-II UnreservedDr Gr Homes Dr. Grahams Homes Dr Gr Homes-IV Ks2 Ground Gaon UnreservedDr Gr Homes Dr. Grahams Homes Dr Gr Homes-IV K53 Dhobieaon UnreservedDr Gr Homes Dr. Grahams Homes Dr Gr Homes-V K54 Fulbagan Gaon UnreservedUpper Ecchey Ecchey Upper Echhay-I K55 Mandal Gaon - I UnreservedUpper Ecchey Ecchey Upper Echhay-I K56 Mandal Gaon -lI Unreserved

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6 Upper Ecchey Ecchey Upper Echhay-Il K57Purba Sherpa Gaon & MandalGaon

Unreserved

Upper Ecchey Ecchey Upper Echhay-III K58 Pashim Sherpa Gaon UnreservedUpper Ecchey Ecchey Upper Echhay-IV Ks9 Dara Gaon Unreserved

7

Lower Ecchey Ecchey Lower Echhay-I K60 Uttar Thapa Gaon UnreservedLower Ecchey Ecchey Lower Echhay-I K6l Dakshin Thapa Gaon UnreservedLower Ecchey Ecchey Lower Echhay-Il K62 Kaffley Gaon UnreservedLower Ecchey Ecchey Lower Echhay-III K63 North Walline Gaon UnreservedLower Ecchey Ecchey Lower Echhay-III K64 South Walling Gaon UnreservedLower Ecchey Ecchey Lower Echhay-IV K65 Nepal Gaon Unreserved

8

Pudung Pudung Pudung-I K66 Khadalay-I UnreservedPudung Pudung Pudung-II K67 Khadalay-II UnreservedPudung Pudung Pudung-III K68 Upper Pudung UnreservedPudung Pudung Pudung-IV K69 Pudung (Sundung-I UnreservedPudung Pudung Pudung-IV K70 Pudung (Sundung-Il Unreserved

9

KafferKangkebong

SeokbirkhaniKaffer Kangkebong

I K7t Kaffer F.V., Lolay Gaon &Pemling F.V.

Unreserved

KafferKangkebong

SeokbirkhaniKaffer KangkebongI K72 Siddim Kaffer - I Unreserved

KafferKangkebong

SeokbirkhaniKaffer Kangkebong

I K73 Siddim Kaffer - II (North) Unreserved

KafferKangkebong

SeokbirkhaniKaffer Kangkebong

II K74 Siddim Kaffer - II (South) Unreserved

KafferKangkebong

SeokbirkhaniKaffer Kangkebong

ilI K75 Beach Gaon & Gairi Gaon Unreserved

r0

Seokbir SeokbirkhaniKaffer Kangkebongry K76 Mungthuffi, Khola Tar & Samali Unreserved

Seokbir Seokbirkhani Seokbir-I K77 Primtam UnreservedSeokbir Seokbirkhani Seokbir-II K78 Yok UnreservedSeokbir Seokbirkhani Seokbir-IV K79 Khani UnreservedSeokbir Seokbirkhani Seokbir-III K80 Rangul UnreservedSeokbir Seokbirkhani Seokbir-Ill & V K81 Chuikhim Unreserved

l1

Nimbong Nimbong Nimbong-V K82 School Dara, Gengin g & GedongSCneouleo

Triha

Nimbong Nimbong Nimbong-Vl K83 Kharel GaonScheduled

Tribe

Nimbong Nimbong Nimbong-VIl K84 Suraksh a & ReongScheduled

Tribe

Nimbong Nimbong Nimbong-VII K85 Katahare & SabungScheduled

TribeNimbong Nimbong Nimbong-I K86 Nimbong DIF Bazar UnreservedNimbong Nimbong Nimbong-II K87 Ghanti I)ara UnreservedNimbone Nimbong Nimbong-I & II K88 Central Gaon & Paila Line UnreservedNimbong Nimbong Nimbong-III K89 Gyashok (Upper Karki Gaon) UnreservedNimbong Nimbong Nimbone-III K90 Gyashok ( Lower Karki Gaon) UnreservedNimbong Nimbong Nimbong-V K9l Sungurey & Saldara UnreservedNimbong Nimbong Nimbong-IV K92 Dalapchand, Kamarey & Bieha Unreserved

t2

Bhalukhop Choata Bhalukhop Bhalukhop-II K93 Alichikhop-I UnreservedBhalukhop Choata Bhalukhop Bhalukhop-II K94 Alichikhop-Il UnreservedBhalukhop Choata Bhalukhop Bhalukhop-IV K95 Dhobi Dhara UnreservedBhalukhop Choata Bhalukhop Bhalukhop-IV K96 Chamra Godwan UnreservedBhalukhop Choata Bhalukhop Bhalukhop-III K97 Lamini Gaon-I UnreservedBhalukhop Choata Bhalukhop Bhalukhop-III K98 Lamini Gaon-II UnreservedBhalukhop Choata Bhalukhop Bhalukhop-III K99 I)antey & Dalman UnreservedBhalukhop Bara Bhalukhop Bhalukhop-II K 100 MahakalDara UnreservedBhalukhop Bara Bhalukhop Bhalukhop-II K l0r Rai Gaon UnreservedBhalukhop Bara Bhalukhop Bhalukhop-V K 102 Mandal Gaon UnreservedBhalukhop Bara Bhalukhop Bhalukhop-V K 103 Tripai Gaon UnreservedBhalukhop Bara Bhalukhop Bhalukhop-VI K 104 Newar Gaon Unreserved

1?

Tashiding Tashiding Tashiding-V K 105 Lashiding F.V. UnreservedTashiding Tashiding Tashidins-V K 106 Lepcha Lower Tashidine UnreservedTashidine Tashiding Tashidins-I K 107 Upper Tanek UnreservedTashidine Tashiding Tashidins-I K 108 Gumba Gaon UnreservedM

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Tashidine Tashiding Tashidine-II K 109 Lower Tanek (Part-I Unreserved

Tashidine Tashidine Tashiding-II K 110 Lower Tanek (Part-II IjnreservedTashidine Tashidine Tashid ine-III K 111 Nonsong Unreserved

Tashidine Tashidine Tashidine-IV K 112 Upper & Lower Dara Gaon Unreserved

t4

Kalimpong Chiboo Kalimpong-ll K 113 Nashay Unreserved

Kalimpong Chiboo Kalimpong-I K 114 Poshyore Unreserved

Ka mpong Chiboo Kalimpong-III K 115 Upper Chiboo Unreserved

Ka mpong Chiboo Kalimpong-IV K ll6 Lower Chiboo Unreserved

Ka mpong Chiboo Kalimpong-V K 117 Mungbol - I [Jnreserved

Ka mpong Chiboo Kalimpong-V K ll8 Mungbol - II Unreserved

Ka mpong Chiboo Kalimpone-VIII K 119 l6th Mile Purbons Unreserved

Kalimpong Chiboo Kalimpong-VI K 120 8th Mile, School Gaon Unreserved

Kalimpong Chiboo Kalimpong-VI K r2t Nursery Gaon Unreserved

Kalimpong Chiboo Kalimpong-Vll K 122 7th Mile - I Unreserved

Kalimpong Chiboo Kalimpong-VII K 123 7th Mile - II Unreserved

15

Samalbong Sin ee Samalbong-I K T24 Tamyang Samalbong Unreserved

Samalbong Sin ee Samalbong-l K 125 Tamyang Ratey Samalbong Unreserved

Samalbong Sin ee Samalbong-Ill K t26 Yokbong Unreserved

Samalbong Sin ee Samal bone-III K 127 Khadal Gaon & Malbong Unreserved

Samalbong Sin ee Samal bone-V & I K 128 Purba & Pachim Samalbong Unreserved

Samalbong Sin ee Samal bong-VI K 129 Purba & Pachim Pabong Unreserved

Samalbong Sin ee Samal bone-VII K 130 Charkholay & Lolay Gaon Unreserved

Samalbong Sin ee Samal bone-IV K t3l Sinii Gairi Gaon Ijnreserved

Samalbong Sin ee Samal bong-IV K T32 Chaarkhol & Sunar Gaon Unreserved

Samalbong Sin ee Samalbong-lI K 133 Tanyang Dang Unreserved

Samalbong Sin ee Samalbong-II K 134 Saprung Unreserved

r6

Teesta Teesta Teesta-IV K 135 Teesta Bazar Upper [Jnreserved

Teesta Teesta Teesta-IV K 136 Teesta Bazar Lower Unreserved

Teesta Teesta Teesta-VI K 137 Deogram [Jnreserved

Teesta Teesta Teesta-V K 138 Teesta DIF Bazar (North) Unreserved

Teesta Teesta Teesta-V K 139 Teesta DIF Bazar (South) Unreserved

Teesta Teesta Teesta-VII K 140 Teesta Bridge Unreserved

Teesta Malli Teesta-X K 141 Bhalukhop & Kirney F.V. Unreserved

Teesta Malli Teesta-IX K 142 Damsang F.V.& Malli F.V. Unreserved

Teesta Malli Teesta-IX K 143 Maneber F.V. & Chitrey F.V. Unreserved

Teesta Rambi Teesta-II K t44 Tangey F.V. Unreserved

Teesta Rambi Teesta-II K 145 Rambi DIF Upper Ijnreserved

. ,,I eesta Rambi Teesta-III K 146 Tarzem F.V.

Scheduled

TribeTeesta Ramb 1 Teesta-Il K t47 Birik F.V., Suntaley & Lohapool Unreserved

Teesta Ramb I Teesta-I K 148 Reang Railway Station Unreserved

Teesta Rambi Teesta-VIII K 14929th Mile Baluwa Kahani &Mangwa F.V.

Unreserved

Teesta Rambi Teesta-VIII K 150 Geil Khola & 3rd Block Unreserved

t7

Pabringtar Chunabhatti Pabringtar-VII K 151 Mangpong F.V. & 6th Aikar Unreserved

Pabringtar Chunabhatti Pabringtar-VII K 152 Checkpost Unreserved

Pabringtar Chunabhatti Pabringtar-Vl K 153 Lish Forest Unreserved

Pabringtar Chunabhatti Pabringtar-VI K 154 Chunabhatti DIF Unreserved

Pabringtar Chunabhatti Pabrinetar-II K 155 Serwani Benu Dara Unreserved

Pabringtar Chunabhatti Pabrinetar-IlI K 156 Upper Chuikhim Unreserved

Pabringtar Chunabhatti Pabrinstar-III K 157 Lower Chuikhim Unreserved

Pabringtar Chunabhatti Pabringtar-IV K 158 Yelbone & Lungrep Unreserved

Pabringtar Chunabhatti Pabringtar-I K 159 Ratey Unreserved

Pabringtar Chunabhatti Pabringtar-I K 160 Tamyang & Deorali Unreserved

Pabringtar Chunabhatti Pabringtar-V K 161 Tuni Botey Unreserved

Pabringtar Chunabhatti Pabringtar-V K 162 Barbot Unreserved

Pabringtar Chunabhatti Pabringtar-V K 163 Devithan Unreserved

18

Yang-Makum Fengtar Yang-Makum-I K 164 l6th Mile Unreserved

Yane-Makum Fengtar Yang-Makum-I K 165 Solak & Yangreek Unreserved

Yang-Makum Fengtar Yang-Makum-III K 166 Jarayotar &Barbotey Unreserved

Yang-Makum Fengtar Yang-Makum-IV K t67 Panbu & Panbu F.V. IjnreservedYang-Makum Fengtar Yang-Makum-V K 168 Makum & Kali Khola Unreserved

Yang-Makum Fengtar Yang-Makum-Vl K 169 Fengtar & Kambal Unreserved

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ASHA: Kalimpong-llName of GramPanchayat

Name of Gram Sansad Name of the Sub

Health CentreASHA

Llnit No.

Name of villages/hamlets to be covered by theASHA

SC/ ST/Llnreserved

(UR)

Lingsay Lingsey/I Lingsey SC AI Lingsey (Lepcha Gaon, Upper Subba Gaon,Upper Mudung Gaon)

ST

Lingsay Lingsey/I Lingsey SC A2 Lingsey (Lower Mudung Gaon, Kali Khola,Lingsey) UR

L ngsay L ngsey/II L ngsey SC A3 Dabai Pani, Daragaon, Jumtang URL ngsay L ngsey/II L ngsey SC A4 Lower Dabaipani, Lower Jumtang URLingsay L ngsey/III L ngsey SC A5 Pithamchin-I ST

L ngsay L ngsey/III L ngsey SC A6 Pithamchin-Il STL ngsay L ngsey/IV L ngsey SC A7 Tagathang STL ngsaykha L ngsaykha/I L ngsey SC A8 Chagey URL ngsaykha L ngsaykha/I L ngsey SC A9 Changsing ST

L ngsaykha L ngsaykha/II L ngsey SC A10 Upper Chuba URL ngsaykha L ngsaykha/I\ Lingsey SC Alr Lower Chuba URLingsaykha L ngsaykha/III L ngsey SC At2 Dagyong, Lungchu URLingsaykha L ngsaykhallll L ngsey SC A13 Kolbong, Libong URKagay Kagayll Kagay SC At4 Maria URKagay Kagaylll Kagay SC Als North Pabak URKagay Kagay/II Kagay SC A16 South Pabak URKagay Kagay/III Kagay SC At7 Thulo Benda URKagay Kagay/III Kagay SC A18 Sano Benda uRKagay KagaylIY Kagay SC A19 Kagay Gerok, Gangab URKagay KagaylIY Kagay SC /.20 Beech Kagay URKagay KagaylY Kagay SC A2t Upper Gyendong URKagay KagaylY Kagay SC /'22 Lower Gyendong uRKagay KagayNI Tandrabong SC 423 Duka URKagay Kagay/VII Ladam SC /.24 Upper Rabeek URKagay KagayA/II Ladam SC 425 Ladam Busty uRKagay Kagay/VII Ladam SC 426 Lower Rabeek URPedong Pedong/I Dalep SC /.27 Lowpr Newang URPedong Pedong/I Dalep SC /.28 Lower Merong URPedong PedongilI Pedong SC /.29 Upper Neong-Merong (North) URPedong Pedong/Il Pedong SC A30 Upper Neong-Merong (South) URPedong Pedong/II Pedong SC A 3l Prashanti Nagar area URPedong Pedong/III Pedong SC /^32 Upper DIF IJRPedong Pedong/IV Pedong SC A33 Lower DIF uRPedong Pedong/V Pedong SC 434 Upper Pedong (North) URPedong Pedong/V Pedong SC A35 Upper Pedong (South) URPedong Pedong/VI Pedong SC A36 Upper Dalep (North) URPedong Pedong/VI Dalep SC /-37 Upper Dalep (South) URPedong Pedong/VII Dalep SC A38 Lower Dalep (North) IJRPedong Pedong/VII Dalep SC A39 Lower Dalep (South) TJR

Kashyong Kashyong/I Dalep SC A40 Samdong-I ST

Kashyong Kashyonell Kashyong SC A4t Samdong-II ST

Kashyong Kashyong/II Kashyong SC 442 Kamjer, Dumtam ST

Kashyong Kashyong/III Kashyong SC 443 Phurun- I ST

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Kashyong Kashyong/III Kashyong SC 444 Phurun- II ST

Kashyong Kashyong/IV Kashyong SC 1.45 Namcheylekha-I URKashyong Kashyong/IV Kashyong SC /.46 Namcheylekha-II ST

Kashyong KashyongN Kashyong SC 447 Silleri & Dhobi Toli ST

Kashyong KashyongA/l Kashyong SC A48 Upper Kashyem, ST

Kashyong Kashyong/VI Kashyong SC /.49 Middle Kashyem ST

Kashyong Kashyong/VII Kashyong SC As0 12 No. GCP (Upper) ST

Kashyong Kashyong/VII Kashyong SC A 51 12 No. GCP (Lower) STKashyong Kashyong/VIII Kashyone SC /.52 Lower Kashyem GCP UR

Sakyong Sakyong/INorth Sakyong

SCA53 Dokyong- I (North) UR

Sakyong Sakyong/INorth Sakyong

SC454 Dokyong- I (South) UR

Sakyong Sakyon glU:North Sakyong

SCA55 Dokyong- II (21st Mile) I.]R

Sakyong Sakyong/IllNorlh Sakyong

SCA56 Lower Menchu (Subba Gaon) UR

Sakyong Sakyon gllll North SakyongSC

457 Lower Menchu (Lepcha Gaon) uR

Sakyong Sakyon elIYNorth Sakyong

SCAs8 Mul Sakyong-I UR

Sakyong Sakyon glYNorth Sakyong

SCA59 Mul Sakyong-Il (Merong Gaon) ST

Sakyong Sakyong/YNorth SakyongSC

A60 Mul Sakyong-U (Dibu Gaon) uR

Sakyong SakyongA/I Tandrabong SC A6l North Tandrabong URSakyong SakyongNI Tandrabong SC 462 South Tandrabong URSakyong Sakyong/VII Tandrabong SC A63 Mairung F.V URSakyong SakyongA/Ill Tandrabons SC /.64 Chumerchin UR

Sakyong Sakyong/VlllNorth Sakyong

SCA6s 20th Mile uR

Sakyong Sakyon glIX Tandrabong SC 466 Upper Menchu (Gairi Gaon) URSakyong Sakyon glIX Tandrabong SC A67 Upper Menchu (Karbari Gaon) URSantook Santook/I Algarah SC A68 Mul-Santook URSantook Santook/I Algarah SC 469 Lumboong tJR

Santook Santook/II Algarah SC /.70 Lou*er Santook URSantook Santook/III Algarah SC A7t Menjong, Samerchen UR

SantookSantook/III,Santookllv(P)

Algarah SC /.72 Mirik, Paiyong F.V UR

SantookSantook/V,

Santook/Iv(P)Algarah SC 473 Pakthang East, Rissium UR

SantookSantook/V,

Santook/IV(P)Algarah SC /'74 Pakthang West UR

Santook Santook/VI Algarah SC 475 Block Colony, Raniban URSantook SantooWI Algarah SC 1.76 Police Line, Chowk Line URSantook Santook/VII Algarah SC 1^77 Lama Ward URSantook Santook/VII Algarah SC A78 Gosh Khan Line URSantook Santook/VIII Algarah SC /.79 Algarah DIF-III (Jhilkey Dhara) URPaiyong Paiyong/I Paiyong SC A80 Upper Gairi Gaon URPaiyong Paiyong/I Paiyong SC A8l Ojha Gaon ST

Paiyong Paiyong/tI Paiyong SC A82 Upper Gairi Gaon Middle URPaiyong Pa yong/II Paiyong SC A83 Upper Gairi Gaon Middle (Beech Gaon) URPaiyong Pa yong/III Paiyong SC A84 Upper Gairi Gaon West

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Paiyong Paiyong/IV Paiyong SC A85 Lower Gairi Gaon UR

Paiyong Paiyong/IV Paiyong SC A86 Dungmali Gaon UR

Paiyong Paiyong/V Paiyong SC A87 Upper Pagang UR

Paiyong PaiyongA/I Paiyong SC A88 East Lower Pagang UR

Paiyong Paiyong/VII Paiyong SC A89 West Lower Pagang UR

Paiyong PaiyongA/III Paiyong SC A90 Bidyang UR

Dalapchand Dalapchand/I Dalapchand SC A91 Upper Dalapchand-East ST

Dalapchand Dalapchand/I Dalapchand SC /'92 Upper Dalapchand-West ST

Dalapchand Dalapchand/II Dalapchand SC A93 Upper Bidyang UR

Dalapchand Dalapchand/Il Dalapchand SC /.94 Lower Bidyang UR

Dalapchand Dalapchand/Ill Dalapchand SC A95 Lower Dalapchand-A&B UR

Sangsay Sangsay/I Sangsay SC A96 Bhangay UR

Sangsay Sangsay/Il Sangsay SC A97 Bimbong UR

Sangsay Sangsay/Ill Sangsay SC A98 Yogda ST

Sangsay Sangsay/Ill Sangsay SC 1^99 Tumlabong ST

Sangsay Sangsay/IV Sangsay SC A 100 Kharka UR

Sangsay SangsayA/ Sangsay SC A 101 Khamdong UR

Sangsay Sangsay/V Sangsay SC A t02 Pethong UR

Sangsay SangsayA/I Sangsay SC A 103 Narag ST

Sangsay SangsayA/Il Sangsay SC A 104 Biruk, Harisay, Rubasta ST

Sangsay Sangsay/Vlll Sangsay SC A 105 Lower Munshidhura & Karbutar ST

Sangsay Sangsay/IX Sangsay SC A 106 Dara Gaon TJR

Sangsay Sangsay/IX Sangsay SC A 107 Kothi Dhura UR

Sangsay SangsayD( Sangsay SC A 108 Echhey F.V. ST

Sangsay Sangsay/Xl Sangsay SC A 109 Ram Dhura UR

Sangsay SangsayXI Sangsay SC A 110 Upper School Dhura UR

Sangsay Sangsay/Xl Sangsay SC A 111 Lower School Dhura, Sirisey UR

Sangsay Sangsay/Xll Sangsay SC A ttz Upper Munsong, Jalsa UR

Sangsay Sangsay/Xlll Sangsay SC A 113 Middle Munson 9,35 No. Dhura ST

Sangsay SangsayDilV Sangsay SC All4 Lower Munsong ST

Sangsay SangsayDry Sangsay SC A 115 Mangarjung UR

Sangsay SangsayDWl Sangsay SC A 116 Nalsha ST

Sangsay Sangsay/XVI Sangsay SC A 117 Barrack Village UR

Sangsay SangsayD(Vll Rangpo SC A ll8 Upper Rangpo F.V UR

Sangsay SangsayD(Vll Rangpo SC A ll9 Lower Rangpo F.V UR

Sangsay SangsayDWIII Rangpo SC A 120 Tarkhola, Mamkhola, UR

Sangsay SangsayD(VIII Rangpo SC A t2t Mangchu FV, l0th Mile FV UR

Sangsay Sangsay/XVm Rangpo SC A t22 I lth Mile FV, Izth Mile FV UR

Lolay Lolayll Lolay SC A 123 Doon Busty ST

Lolay Lolay/II Lolay SC A t24 Upper Lolay UR

Lolay Lolay/III Lolay SC A 125 Lower Lolay-I UR

Lolay Lolay/III Lolay SC A t26 Lower Lolay-II, Mission Taar UR

Lolay Lolay/IV Lolay SC A 127 Dhajay UR

Lolay LolaylY Mool-Pala SC A 128 Mool-Pala, UR

Lolay Lolay/V Mool-Pala SC A 129 Siddim, Khapp arey, Takna ST

Lolay Lolay/V Mool-Pala SC A 130 Kamjer ST

Gitdabling Gitdablingll G'itdabling SC A l3l DIF GitdablingBazar TJR

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Gitdab ing Gitdabling/II G tdabl ng SC A t32 Upper Beong & Sericulture area UR

Gitdab mg Gitdablingill G tdabl ng SC A 133 Chumang FV & Gumba Gaon ST

Gitdab ing Gitdabling/Il G tdabl ng SC A 134 Lower Beong ST

Gitdab ing Gitdabling/III G tdabl ng SC A l3s Tugung ST

Gitdab ing Gitdabling/III G tdabl ng SC A 136 Chyangdong ST

Gitdab ing Gitdabling/IV G tdabl ng SC A 137 Upper Pochok UR

Gitdab ing Gitdabling/IV G tdabling SC A 138 Lower Pochok, Mahaj andara ST

Gitdab mg GitdablingA/ Gitdabling SC A 139 Upper Dabling ST

Gitdab ing Gitdabling/V Gitdabling SC A 140 Lower Dabling ST

Gitdab ing GitdablingA/I Gitdabling SC A t4t Pakang- 1 ST

Gitdab ing GitdablingA/I Gitdabling SC A t42 Pakang-2 Bakhim F.V ST

Lava -Gitbeong Lava-Gitbeong/I Lava SC A 143 Lava DIF-I, Kolbong FV UR

Lava -Gitbeong Lava-Gitbeong/Il Lava SC A 144 Lav a DIF-II (Haat Bazar) UR

Lava -Gitbeong Lava-Gitbeong/Il Lava SC A 145 Lav aDIF-II (Dolay Gaon, Bhanjyang) UR

Lava -Gitbeong Lava-Gitbeong/III Lava SC A 146 LavaF.V (Maneydara) ST

Lava -Gitbeong Lava-GitbeongiIV Lava SC A 147 Upper Nokdara UR

Lava -Gitbeong Lava-Gitbeong/IV Lava SC A 148 Lower Nokdara, Shankhay UR

Lava -Gitbeong Lava-Gitbeong/V Lava SC A 149 Upper Git Kolbung UR

Lava -Gitbeong Lava-Gitbeong/V Lava SC A 150 Lower Git Kolbung UR

Lava -Gitbeong Lava-GitbeongA/I Lava SC A 151 Passabong n ST

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PanchayatHealth Sub-

CentreGram Sansad

AshaCode no.

Name of Village I Hamlets to be covered bythe Asha

SC/ST/Unreserved

W

Todey Tangta Tode SC Todey Taneta/I GI Lower Suruk UnreservedTodey Tangta

&,

Paten GodakJaldhaka SC

Todey Tangta/IPaten Godak/VII

G2 Joredhun5&, Bindu &Bindu Bazar

Unreserved

Todey Tangta Todey SC &dey Tangta/ll G3 Upper Suruk UnreservedTodey Tangta Todey SC Iqdey Tangta/III G4 Qpper Godak UnreservedTodey Tangta Todey SC Todey Tangta/III G5 Lower Godak UnreservedTodey Tangta Todey SC Todey Tangta/IV G6 Todey-Pala UnreservedTodey Tangta Todey SC Todey Tangta/IV G7 Todey-Chargharey UnreservedTodey Tangta Todey SC Todey Tangta/Y G8 Chisang UnreservedTodey Tangta Todey SC Todey Tangta/Vl G9 Keram UnreservedTodey Tangta Todey SC todey Tangta/VII Gl0 Tangta UnreservedPaten Godak Jaldhaka SC Patengodak/I Glt Parentar UnreservedPaten Godak Jhalung SC Patengodakll Gt2 Batgy Pani ljnreservedPaten Godak Jhalung SC Patengo daWI G13 Jholung Bazar & Magazine Line UnreservedPaten Godak Jaldhaka SC

Patengo daWI,Patengodak/III

Gr4 Arawaltar &, Lower Gairi Gaon Unreserved

Paten Godak Jhalung SC

Patengodak/I,

Patengodak/Vlll,

!atengodak/VIIIG15

. Sims&ty,Dewkota Toll &

Ground LineUnreserved

Paten Godak Jaldhaka SCPatengodak/II

Patengodak/VIG16 Upper Gairigaon & New Paren Colony Unreserved

Paten Godak Jaldhaka SC Patengodak/IV G17 Dhaulay FY & Compound FV UnreservedPaten Godak Jaldhaka SC Patengodak/V G r8 I&pqr Tungsung UnreservedPaten Godak Jaldhaka SC Patengodak/V Gl9 Lower Tungsung UnreservedPaten Godak Jaldhaka SC Patengodak/Vl G20 2 No. Colony-F-6 [Jnreserved

Rongo Gairibas SC Rongo/XVI G2t CFC UnreservedRongo Gairibas SC Rongo/I G22 Upper Maidan Gaon Rongo UnreservedRongo Gairibas SC Rongo/I G23 Lower Maidan Gaon Rongo UnreservedRongo Ga ribas SC Rongo/lI G24 Sangam Gaon & Line Gaon UnreservedRongo Ga ribas SC Rongo/III G2s Ground Gaon UnreservedRongo Gairibas SC Rongo/III G26 Bar Golai [JnreservedRongo Gairibas SC Rongo/IV G27 Dokan Dara, Dara Gaon & Pakhrin Golai UnreservedRongo Gairibas SC Rongo/V G28 upperDhap Gaon @aon UnreservedRongo Gairibas SC Rongo/VI G29 Line Dara & Bhasmay UnreservedRongo Gairibas SC Rongo/VI G30 Lower Dhap Gaon UnreservedRongo Gairibas SC Rongo/VII G 3l @ Upper Village & Maidan Gaon UnreservedRongo Gairibas SC Rongo/VIII G32 46 Block Unreserved

Rongo Gairibas SC Rongo/IX G33 Bikhbari & RangbariUnreserved

Rongo Gairibas SC Rongo/IX G34 lqllqgaon & Tallogaon [Jnreserved

Rongo Gairibas SCRongo/X

Rongo/XII G3s 52 Block & Kaliser [Jnreserved

Rongo Gairibas SC Rongo/XI G36 Naxal & Bhasmay Gaon UnreservedRongo Jhalung SC Rongo/XIIl G37 Mini Gaon & Sundar Gaon Unreserved

Rongo Gairibas SCRongo/XIVRongo/XV G38 44 Block & 45 Block (Dalgaon) Unreserved

Rongo Gairibas SCRongoD(IV &

Rongo XV G39 Saimilan & Nimdhura Unreserved

Rongo Gairrbas SC Rongo/XIV G40 53 Block Unreserved

Rongo Gairibas SCRongo/)(IV,Rongo/XV G41 Upper Dalgaon &

Tanki Dara Unreserved

Rongo Gairibas SC Rongo/XV G42 Wholesale Unreserved

Samsing Samsing SC Samsing/l G43 Lower TinkateryUnreserved

Samsing Samsing SC Samsin elII G44 Upper Tinkateray & Chiplay Dara t,inreservedSamsing Samsing SC Samsin elIU G45 Bhalukhop Unreserved

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Samsing Samsing SCSamsing/IV

Samsin g,lYG46

Lower Ghumti Gaon &Upper Chumti Gaon

Unreserved

Samsing Samsing SC SamsinelYl G47 Chilouni F.V. [JnreservedSamsing Samsine SC Samsin elYl G48 Compound F.V. UnreservedSamsing Samsine SC SamsinsNII G49 Mandal Gaon & Bhuiel Gaon UnreservedSamsing Samsing SC Samsine/Vl[ Gs0 Khola Gaon & Sherpa Gaon UnreservedSamsing Samsins SC Samsins/Ix G51 Samsine F.V UnreservedKumai Kumai SC Kumai/I G52 Guduray Gaon UnreservedKumai Kumai SC Kumai/II G53 Tamang Gaon UnreservedKumai Kumai SC Kumai/III G54 Munshi Line UnreservedKumai Kumai SC Kumai/III, Kumai[Y Gs5 Dharap ari & Top Line UnreservedKumai Kumai SC Kumai/lV Gs6 Guard Line [JnreservedKumai Kumai SC Kumai/V G57 I & 2 No. Villaee UnreservedKumai Kumai SC Kumai/V Gs8 Middle Busty Unreserved

Kumai Kumai SC Kumai/IX G59Naya Busty

Unreserved

Kumai Kumai SC Kumai/VI G60 Kopish F.V UnreservedKumai Kumai SC Kumai/VI G6l Mouray F.V UnreservedKumai Kumai SC KumaiiVII G62 Adibasi Line [JnreservedKumai Kumai SC Kumai/VIII G63 Kothi Line Unreserved

Kumai Kumai SC Kumai/VUI G647 No. Village, 8 No. Village & 12 No.

VillaeeUnreserved

Kumai Kumai SC Kumai/VIII G6s Factory Line UnreservedKumai Kumai SC Kumai/IX G66 Kumani PWD UnreservedKumai Kumai SC Kumai/X G67 Yakha Line UnreservedKumai Kumai SC Kumai/X G68 Mayalu Golai & l0 no village Unreserved

Gorubathan-II Sherpagaon SC Gorubathan-II/I G69 Kuwapani Unreserved

Gorubathan-II Sherpagaon SCGorubathan-Il/I

Gorubathan-II/IVG7A Maipatey & Serpatar Unreserved

Gorubathan-II Dhipdara SC Gorubathan-II/II G7l Phaperkheti UnreservedGorubathan-II Dhipdara SC Gorubathan-II/III G72 Kalikhola UnreservedGorubathan-II Sherpagaon SC Gorubathan-II/IV G73 Syalphokhori UnreservedGorubathan-lI Sherpagaon SC Gorubathan-II/IV G74 Sherpa Gaon [JnreservedGorubathan-II Dhipdara SC Gorubathan-II/V G7s Lower Ambiok IjnreservedGorubathan-II Dhipdara SC Gorubathan-II/V G76 Upper Ambiok UnreservedGorubathan-II Dhipdara SC Gorubathan-Il/V G77 Sitadhungay & Chardgungay UnreservedGorubathan.II Dhipdara SC Gorubathan-Il/VI G78 Badey, Kela & Pankhasari Unreserved

Nim Sherpagaon SC Nim/I G79 Kalikhola UnreservedNim Sherpasaon SC Nim/l G80 Ghantidara lJnreservedNim Sherpagaon SC Nim/II G81 Kolbong UnreservedNim Sherpagaon SC Nim/II G82 r Godamdhura IjnreservedNim Upper Fagu SC Nim/lII G83 Godamtar-Munshiline Unreserved

Nim upper Fagu SCNim/III &Nim/IV

G84 Kothiline, Schoolline & Kausay Line Unreserved

Nim Upper Fagu SC Niim/IV G8s New Line,Gosay Dhura & Godam Line UnreservedNim Upper Fagu SC Nim/V G86 Tunglabong & Gairigaon ljnreservedNim Upper Fagu SC NimlV G87 Lepcha Gaon & Rai Gaon Unreserved

Nim Upper Fagu SC Nim/VI G88Gumb agaon- Jhakri gaon - Khal ingaon,

Moktan Gaon &Lama Gaon-Chhota

Suntalay

Unreserved

Nim Sherpagaon SC Nim/VII G89 Suntalay UnreservedNim Sherpagaon SC Nim/VIII G90 Pasiting & Doorkhola Unreserved

Pokhreybong Mangzing SC Pokhreybongil G91 Chhota Mangzing, & Noam Forest Villaee UnreservedPokhreybong Mangzing SC Pokhreybone/I G92 l2ll5 Gharey (Ghish F.V) UnreservedPokhreybong Mangzine SC Pokhreybone/I G93 Pogu Forest Village UnreservedPokhreybong Mangzing SC Pokhreybone/Il G94 Upper Mangzine' Unreserved

Pokhreybong Mangzing SC Pokhreybong/Ill G9sMangar Gaon, Pokhreybong, Rambhy &

Apathay ( Lower Mangzine )Unreserved

Pokhreybong Mangzing SC Pokhreybong/IV G96 Jhandi & Ijpper Lungsel Unreserved

Pokhreybong Mangzing SC Pokhreybong/IV G97Doring, Malitar, Ghorawal Gaon &

Jhyangaybari (Lower Lungsel)Unreserved

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Pokhreybon Mangzine SC Pokhreybong/V G98 Upper Pubung UnreservedPokhreybong l|/:anszine SC PokhreybongA/ G99 Garucharan & Lower Pubung [JnreservedGorubathan-I Bhuttabari SC Gorubathan-I/I G 100 Mayalu Busty & Dhukurey Busty [Jnreserved

Gorubathan-I Bhuttabari SC Gorubathan-I/I G l0r Mal Busty-I Unreserved

Gorubathan-I Bhuttabari SC Gorubathan-I/II G 102 Mal Busty-II UnreservedGorubathan-I Bhuttabari SC Gorubathan-I/III G r03 Bhuttabari F.V & Special F.V ljnreservedGorubathan-I Bhuttabari SC Gorubathan-I/IV G 104 Nepal Line (Sombaray-North ) Unreserved

Gorubathan-I Bhuttabari SC Gorubathan-I/IV G 105 Goshkhan Line (Sombaray-North) Unreserved

Gorubathan-I Bhuttabari SCGorubathan-I/IVGorubathan-IA/t

G 106Barpipal Line (Sombaray-South) &

Upper SombarayUnreserved

Gorubathan-I Bhuttabari SC Gorubathan-I/V G r07 Babari Line (Sombaray-South) ljnreservedDalim Dhipdara SC Dalim/I G 108 Dalim Tar unreserved

Dalim Gorubathan SC Dalim/I G 109 Dalim Khola Unreserved

Dalim Dhipdara SC Dalim/II G 110 Upper Ambiok T.E Unreserved

Dalim Dhipdara SC Dalim/III G 111Chhetri Gaon ( Lower Ambiok T.E) &

Rai Gaon ( Lower Ambiok T.E)Unreserved

Dalim Gorubathan SC Dalim/IV G TI2 Dalim Forest Village Unreserved

Dalim Gorubathan SC Dalim/IV G 113 Lepcha Gaon & Gairitar Unreserved

Dalim Gorubathan SC Dalim/V G 114 Tamang Gaon Unreserved

Dalim Gorubathan SC Dalim/VI G 115 Gairigaon Unreserved

Dalim Gorubathan SC DalimA/II G l l6 Rai Gaon Unreserved

Dalim Gorubathan SC DalimA/III G 117Limboo Gaon, School Dara, Bich Gaon &

RC MissionUnreserved

Dalim Gorubathan SC Dalim/IX G 118 North Zone Unreserved

Dalim Gorubathan SC Dalim/IX G 1r9 Shermali [Jnreserved

Dalim Gorubathan SC Dalim/X G 120 Simsarey Unreserved

Ahalay M ssion Hill SC Ahalavll G 121 Upper Ahalay-I Unreserved

Ahalay M ssion Hill SC AhalavA G 122 Lower Ahalay-I Unreserved

Ahalay M ssion Hill SC Ahalay/II G t23 Ijpper Ahalay-Il Unreserved

Ahalay M ssion Hill SC Ahalay/II G 124 Lower Ahalay-Il Unreserved

Ahalay Mission Hill SC Ahalay/III G 125 Mal-4 Unreserved

Ahalay Mission Hill SC Ahalay/III G T26 Burikhola Unreserved

Ahalay Mission Hill SCAhalay/IV

Ahalay/Iv & VG t27

Lower Fagu T.E. - Church Line &School Line

Scheduled

Tribe

Ahalay Mission Hill SC AhalayllY &,Y G r28 Lower Fagu T.E. - Kawar LineScheduled

Triber.l

Ahalay Mission Hill SC Ahalay/V G r29Lower Fagu T.E . - Munda Line &

Lower Fagu T.E. - Top LineScheduled

Tribe

Ahalay Mission Hill SC Ahalay/VI G 130 Lower Fagu T.E .- Mangar GasnScheduled

TribeAhalay M ssion Hill SC AhalayivII G 131 * Mission Hill T.E.- Kharbandi Unreserved

Ahalay M ssion Hill SC Ahalay/VII & VIII G 132 Mission Hill T.E.- Somraline Unreserved

Ahalay M ssion Hill SC Ahalay/VlI.I G 133 Mission Hill T.E.- Shantinagar Unreserved

Ahalay Mission Hill SC Ahalay/VIII G 134Mission Hill T.E. - School Line & Kanu

LineUnreserved

Ahalay Mission Hill SC Ahalay/IX G 13sSaureni, Milan Tar, Kharkhola (Sakham

F.V)Unreserved

Ahalay Mission Hill SC Ahalay/IX G 136 Sakham & Bhotetar (Sakham F.V) Unreserved

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ToThe Sub-Divisional Officer,Kalimpong Sadar,District-Kalimpon (Paste here self attested recent passpo rt siz,e colour

photograph)(Space for office use)Roll No.-

Application form for the Post of Accredited Social Health Activist (ASHA)(Applicationw.r.t. Memo No. 176 /Gen. Dated-23.5.18 of the Sub-Divisional Officer, kalim

Annexure-BSadar, Kalimpon

I.

2.

J.

4.

5.

6.

7.

8.

9.

10.

1t.

Name of the Applicant (in capital letter)-

Name of Father (in capital letter)-

Name of Husband (in capital letter)-

Date of Birth-

Age as on 01.01 .201 8- Years MonthsPermanent Address (Voter Identity Card i.e. EPIC or Ration Card is mandatory in support of claim)-

Village-

Post Office-

Days

I.

II.

IV. Gram Panchayat-

VI. Block-

vm. voter Identity card (EPIC) No. /Ration card No.-

Marital status (1. Tick in qppropriate Box. 2. Attach Certificate)-

Contact No.- I't No.Widowed( ) Divorced( )

III. Health Sub-Centre-

V. Police Station-

VII. PIN Code-

Married( )

2nd No.

CategoryQ.TickinappropriateBox2.Norelaxation/reservqtionapplicable toOBe-SC( ) ST( ) OBC( ) General( )ASHA Code for which applied (attach certificate from Gram Panchayat in support of claim)-Educational qualification (mention highest educational qualification and attach documents .in support of claim)-Description of marks obtained in the Madlryamik/Recognized Equivalent Examination and above. Uirk obtained inoptional papers shall not be counted. Only ylarks oQtained in comoulsory papers shall be taken into consideration.

Following items/self attested copies have been attached (strike out when not applicable)-l. Two selfattested passport sized colour photograph; one to be pasted in application form and the other to be affached.2. Two self addressed envelopes with postage stamp of Rs. 5/- affixed on eiitr of them to be submitted.3. Admit/Registration/Pass certificate of Madhyamik/Recognized Equivalent Examination for proof of age.4. Marksheet(s) of Madhyamik/Recognized Equivalent Examination and above, if applicable.5. voter ldentity card(EPlc)/Ration card for proof of permanent address6. SC/ST/OBC Certificate issued by competent authority of West Bengal, if applicable.7. Death Certificate of Husband for Widowed Woman/Certificate of dissolution of marriage from competent authority for

Divorced Woman.Following documents in original have been attached (strike out when not applicable)-

1. Certificate issued by the Gram Panchayat containing the ASHA Code No. & verification of marital status.2. Certificate issued by the Block Development Officer of Kalimpong-IA(alimpong-Il/Gorubathan for Grade I & Grade IISHG members (issued after publication of ASHA notice) or by Block Medical Officer of Health of Kalimpong-IA(alimpong-Il/Gorubathan for Trained Dais/Link Workers (issued after publication of ASHA notice), if applicable.

I do hereby certi$ that'above information given by me are true to the best of my knowledge and belief. I do not have any adversecriminal record anywhere which may render me unsuitable for the post. I shall bL solely rei=ponsible if any aforesaid information isproved incorrect. My candidature shall be liable to be cancelled if I am found to influenie thl p.oc.r, of selection in future.

Date-Place-

Name of theExamination

Name of theBoard/Council/Un ive

rsity

Year ofappearing/passingin the concerned

examination

Total marksobtained (excludingadditional marks)

o/o of marksobtained

(excludingadditional marks)

(Signature of the applicant in full)