FORM 1
[See Rule 53(1)]

Nomination for Retirement Gratuity/Death Gratuity

   When the Government servant has a family and wishes to nominate one member, or more than one member, thereof.

    I,......................., hereby nominate the person/persons mentioned below who is/are member(s) of my family, and confer on him/them the right to receive, to the extent specified below, any gratuity the payment of which may be authorised by the Central  Government in the event of my death while in service and the right to receive on my death, to the extent specified below, any gratuity which having become admissible to me on retirement may remain unpaid at my death -

Original nominee(s) Alternate nominee(s)


Names
and
addresses
of
nominee/ nominees

Relationship
with the Government servant



Age

Amount
or share
of gratuity
payable
to each*		 Name, address relationship and age of the person or persons, if any, to whom the right conferred on the nominee shall pass in the event of the nominee pre-deceasing the Government servant or the nominee dying after the death of the Government servant but before receiving payment of gratuity

Amount
or share
of gratuity
payable
to each**
(1) (2) (3) (4) (5) (6)
 

 

          

This nomination supersedes the nomination made by me earlier on ....................................... which stands cancelled.

NOTE. - (i) The Government servant shall draw lines across the blank space below the last entry to prevent the insertion of any name after he has signed.
(ii) Strike out which is not applicable.

Dated this...................................day
of..................................................2000
at...........................................

Witnesses to signature :

1.
..........................................
2. .......................................... Signature of Government servant

*This column should be filled in so as to cover the whole amount of the gratuity.
**The amount/share of the gratuity shown in this column should cover the whole amount/share payable to the original nominee(s).

(To be filled by the Head of Office)

Nomination by..................................... Signature of Head of Office
Designation.......................................... Date................................................
Office.................................................. Designation.....................................

 

 

 

 

 

 

 

 

 

 

 

Pro forma for acknowledging the receipt of the
nomination form by the Head of Office

To

    ...................................................
    ...................................................
    ...................................................

Sir,

    In acknowledging the receipt of your nomination, dated the ................/cancellation, dated the ...............................of the nomination made earlier in respect of gratuity in Form ................................... I am to state that it has been duly placed on record.

Signature of Head of Office
Place ...........................................
Dated the .................................... Designation.............................................

    NOTE. - The Government servant is advised that it would be in the interest of his nominees if copies of the nominations and the related notices and acknowledgements are kept in safe custody so that they may come into the possession of the beneficiaries in the event of his death.

 

 

 

 

 

 

 

 

 

 

 

FORM 2
[See Rule 53(1)]

Nomination for Retirement Gratuity/Death Gratuity

   When the Government servant has no family and wishes to nominate one person or more than one person

    I,...................., having no family, hereby nominate the person/persons mentioned below and confer on him/them the right to receive, to the extent specified below, any gratuity the payment of which may be authorised by the Central Government in the event of my death while in service and the right to receive on my death, to the extent specified below, any gratuity, which having become admissible to me on retirement may remain unpaid at my death :

Original nominee(s) Alternate nominee(s)


Names
and
addresses
of
nominee/ nominees

Relationship
with the Government servant



Age

Amount
or share
of gratuity
payable
to each*		 Name, address relationship and age of the person or persons, if any, to whom the right conferred on the nominee shall pass in the event of the nominee pre-deceasing the Government servant or the nominee dying after the death of the Government servant but before receiving payment of gratuity

Amount
or share
of gratuity
payable
to each**
(1) (2) (3) (4) (5) (6)
 

 

          

    This nomination supersedes the nomination made by me earlier on .......................................which stands concelled.

NOTE. - (i) The Government servant shall draw lines across the blank space below the last entry to prevent the insertion of any name after he has signed.
(ii) Strike out which is not applicable.

Dated this...................................day
of..................................................200....
at...........................................

Witnesses to signature :

1.
..........................................
2. .......................................... Signature of Government servant

(To be filled by the Head of Office)

Nomination by..................................... Signature of Head of Office
Designation.......................................... Date................................................
Office.................................................. Designation.....................................

*    This column should be filled in so as to cover the whole amount of the gratuity.
**  The amount/share of the gratuity shown in this column should cover the whole amount/share payable to the original nominee(s).

 

 

 

 

 

 

 

 

 

 

Pro forma for acknowledging the receipt of the
nomination form by the Head of Office

To

    ...................................................
    ...................................................
    ...................................................

Sir,

    In acknowledging the receipt of your nomination, dated the ................/cancellation, dated the ...............................of the nomination made earlier in respect of gratuity in Form ................................... ,I am to state that it has been duly placed on record.

Signature of Head of Office
Place ...........................................
Dated the .................................... Designation.............................................

    NOTE. - The Government servant is advised that it would be in the interest of his nominees if copies of the nominations and the related notices and acknowledgements are kept in safe custody so that they may come into the possession of the beneficiaries in the event of his death.

 

 

 

 

 

 

 

 

 

 

 

 

FORM 3
Details of Family
[See Rule 54(12)]

Name of the Government servant ... ...............................................................
Designation ... ... ... ..............................................................
Date of birth ... ... ... ..............................................................
Date of appointment ... ... ... .............................................................
Details of the members of my family
*as on ... ... ... .............................................................

Serial
No.
Name of the members of family*
Date of
Birth
Relationship
with the
officer
Initials of
the Head
of Office
Remarks
(1) (2) (3) (4) (5) (6)
1.
2.
3.
4.
5.
6.
7.
8.
9.		          

    I hereby undertake to keep the above particulars up-to-date by notifying to the Head of Office any addition or alteration.

Place............................................. Signature of Government servant
Dated the.......................................  

    *Family for this purpose means family as defined in Clause (b) of sub-rule (14) of Rule 54 of the CCS (Pension) Rules, 1972.

    NOTE. - Wife and husband shall include respectively judicially separated wife and husband.

 

 

 

 

 

FORM 4
[Omitted]

 

 

 

 

 

 

 

FORM 5
[See Rule 59(1)(c) & 61(1)]

Particulars to be obtained by the Head of Office from the retiring Government servant eight months before the date of his retirement
1. Name.
2. (a) Date of birth.
(b) Date of retirement.

3.    1Two specimen signatures (to be furnished in an separate sheet) duly attested by a Gazetted Government servant.

4.    2Three copies of passport size joint 3photograph with wife or husband (To be attested by the Head of Office).

5.    Two slips showing the particulars of height and 4personal identification marks duly attested by a Gazetted Government servant.

6.    Present address.

7.    5Address after retirement.

8.    Name of the Treasury or the Branch of Public Sector Bank or the Pay and Accounts Office through which the pension is to be drawn.

9.    6Details of the family in Form 3.

10.    Indicate whether family pension is admissible from any other source - Military or State Government and/or a Public Sector Undertaking/Autonomous body/Local Fund under the Central or a State Government.

Place................................................ Signature
Dated the......................................... Designation
  Ministry/Deptt./Office

Footnote : 1. Two slips each bearing the left hand thumb and finger impressions duly attested may be furnished by a person who is not literate to sign his name.If such a Government servant on account of physical disability is unable to give left hand thumb and finger impressions he may give thumb and finger impressions of the right hand.Where a Government servant has lost both the hands, he may give his toe impressions. Impressions should be duly attested by a Gazetted Government servant.

                2. Two copies of passport size photograph of self only need be furnished if the Government servant is governed by Rule 54 of the Central Civil Services (Pension) Rules, 1972 and is unmarried of a widower or widow.

                3. Where it is not possible for a Government servant to submit a photograph with his wife or her husband, he or she may submit separate photographs. The photographs shall be attested by the Head of Office.

                4. Specify a few conspicuous marks, not less than two, if possible.

                5. Any subsequent change of address should be notified to the Head of Office.

                6. Applicable only where Rule 54 of the Central Civil Services (Pension) Rules, 1972, applies to the Government servant.

 

 

 

 

 

FORM 6
[Omitted]

 

 

 

 

 

 

 

2FORM 7
(Superscript 2 means Substituted by G.I., Dept. of Pen. & P.W., Notification No. 38/84/89-P. & P.W. (F), dated the 3rd September, 1993.)
See Rule 58,60,61(1) & (3) and 65(1)]

Form for assessing Pension/Family Pension and Gratuity
[To be sent in duplicate if payment is desired in
a different circle of accounting unit]

PART - I

1. Name of the retiring Government employee ... ... ...
2. Father's/Husband's name ... ... ...
3. Height ... ... ...
4. Marks of Identification ... ... ...
5. Date of Birth ... ... ...
6. Service to which belongs (indicate name of organized service, if any, otherwise say, General Central Service)
...
...
...
7. Particulars of post held at the time of retirement -
(a) Name of the Office ... ... ...
(b) Post held ... ... ...
(c) Whether the appointment mentioned above was under Government or outside the Government on foreign service terms

...

...

...
8. Whether declared substantive in any post under the Central Government
...
...
...
9. Date of beginning of service ... ... ...
10. Date of ending of service ... ... ...
11. Cause of ending of service -
(a) Voluntary retirement on being declared surplus (Rule 29)
...
...
...
(b) Permanent absorption in public sector undertaking/autonomous body (Rule 37-A)
...
...
...
(c) Due to abolition of post (Rule 59) ... ... ...
(d) Superannuation (Rule 35) ... ... ...
(e) Invalidment on medical ground (Rule 38) ... ... ...
(f) Voluntary/premature retirement at the initiative of the Government servant [ under Rules 48, 48-A and FR 56 (k) ]

...

...

...
(g) Premature retirement at the initiative of the Government [ Rule 48 or FR 56 (j) ]
...
...
...
(h) Compulsory retirement (Rule 40) ... ... ...
(i) Removal/dismissal from service (Rules 24 and 41) ... ... ...
(j) Death ... ... ...
12. In the case of compulsory retirement, the orders of the competent authority whether pension may be allowed at full rates or at reduced rates and in case of reduced rates, the percentage at which it is to be allowed


...


...


...
13. In case of removal/dismissal from service whether orders of competent authority have been obtained for grant of compassionate allowance and if so, at what rate

...

...

...
14. Particulars relating to military service, if any -
(a) Period of military service ... ... ...
(b) Terminal benefits drawn/being drawn for military service
...
...
...
(c) Whether opted for counting of military service towards civil pension
...
...
...
(d) If answer to (c) above is in the affirmative, whether the terminal benefits have been refunded
...
...
...
(e) In case of ex-servicemen who are eligible for family pension under the Armed Forces Rules, whether opted to retain family pension under the Armed Forces Rules or to draw family pension under the Civil Rules



...



...



...
15. Particulars relating to service in autonomous body, if any -
(a) Particulars of Service :

Name of Organization

Post held

Period

From

To
 

 

      

(b) Whether the above service is to be counted for pension
...
...
...
(c) Whether the autonomous organization has discharged its pensionary liability to the Central Government

...

...

...
16. Whether any departmental or judicial proceedings are pending against the retiring employees
...
...
...
17. Qualifying service -
(a) Detail of omission, imperfection or deficiencies in the Service Book which have been ignored [under Rule 59 (1) (b) (ii) ]

...

...

...
(b) Period not counting as qualifying service -
(i) Boy service (2nd proviso to Rule 13) ... ... ...
(ii) Extraordinary leave not counting as qualifying service (Rule 21)
...
...
...
(iii) Periods of suspension not treated as qualifying service (Rule 23)
...
...
...
(iv) Interruptions in service [Rule 27 (1) (b) and Rule 28 (c)]
...
...
...
(v) Periods of foreign service with United Nations bodies for which United Nations pension has been availed

...

...

...
(vi) Any other period not treated as qualifying service (give details)
...
...
...
(c) Additions to qualifying service -
(i) Military service (Rule 19) ... ... ...
(ii) War service (Rule 20) ... ... ...
(iii) Weightage on voluntary retirement on being declared surplus (Rule 29)
...
...
...
(iv) Weightage under Rule 30 ... ... ...
(v) Benefit of service in an autonomous body (Rule 37) ... ... ...
(vi) Weightage under Rule 48-B ... ... ...
(d) Net qualifying service ... ... ...
(e) Qualifying service expressed in terms of completed six monthly periods (Period of three months & over is to be treated as completed six monthly period.)
...
...
...
18. Emoluments -
(a) Emoluments drawn during 10 months preceding retirement -

From

 To Rate of Pay Amount
 

 

      
(b) If the officer was on foreign service immediately preceding retirement, the notional emoluments which he would have drawn under Government but for being on foreign service


...


...


...
(c) Average emoluments reckoned for pension ... ... ...
(d) Emoluments reckoned for retirement gratuity/death gratuity
...
...
...
(e) Emoluments reckoned for family pension ... ... ...
19. Date on which the retiring employee submitted his application for pension in Form 5
...
...
...
20. Complete and up-to-date details of the family as given in Form 3 -
...
...
...

Sl. No.

1		 Name of the
Member of the
family
2
Date of Birth

3		 Relation with
the Government
servant
4
 

 

      
21. Whether nomination made for death gratuity/retirement gratuity
...
...
...
22. The date on which action initiated to -
(a) obtain the `No demand certificate' from the Directorate of Estates as provided in Rule 57
...
...
...
(b) assess the service and emoluments qualifying for pension as provided in Rule 59 and
...
...
...
(c) assess the Government dues other than the dues relating to the allotment of Government accommodation as provided in Rule 73 (1)

...

...

...
23. Details of Government dues recoverable out of gratuity -
(a) Licence fee for Government accommodation [see sub-rules (2), (3) and (4) of Rule 72]
...
...
...
(b) Dues referred to in Rule 73 ... ... ...
24. (a) Proposed pension/service gratuity ... ... ...
(b) Proposed dearness relief on pension (as on the date of retirement)
...
...
...
(c) Date from which pension is to commence ... ... ...
25. Rate of Family Pension -
(a) Enhanced rate ... ... ...
(b) Period for which family pension will be payable at enhanced rate
...
...
...
(c) Ordinary rate ... ... ...
(d) Date from which ordinary rate of family pension will be payable
...
...
...
26. Amount of retirement gratuity/death gratuity ... ... ...
27. Commutation of pension -
(a) Whether simultaneously applied for commutation of pension with the pension application (applicable only in the case of those who retire on superannuation pension)


...


...


...
(b) The portion of pension commuted ... ... ...
(c) Commuted value of pension ... ... ...
(d) Amount of residuary pension after deducting  Commuted portion
...
...
...
(e) Date from which reduced pension is payable ... ... ...
28. Name and address of Bank/Pension Accounting Office from where pension is to be drawn
...
...
...
29. Head of Account to which pension and gratuity are debitable
...
...
...
30. Post-retirement address of the retiree ... ... ...


Signature of the
Head of Office

PART II

1. Date of receipt of pension papers by the Accounts Officer from Head of Office ... ... ...
2. Entitlements admitted -
A. Length of qualifying service ... ... ...
B. Pension -
(i) Class of pension ... ... ...
(ii) Amount of monthly pension ... ... ...
(iii) Date of commencement ... ... ...
C. Commutation of Pension -
(i) Commuted value of portion of pension commuted, if any
...
...
...
(ii) Residuary pension after commutation ... ... ...
(iii) Date from which reduced pension is payable ... ... ...
(iv) Date of restoration of commuted portion of pension subject to the pensioner continuing to live
...
...
...
D. Retirement/Death Gratuity -
(i) Total amount payable ... ... ...
(ii) Amount to be adjusted towards Government dues ... ... ...
(iii) Amount to be withheld for adjustment of unassessed dues
...
...
...
(iv) Net amount to be released immediately ... ... ...
E. Family Pension -
(i) At enhanced rate ... ... ...
(ii) Period for which Family Pension at enhanced rate is payable
...
...
...
(iii) At normal rate ... ... ...
3. Head of Account to which the amount of pension, retirement/death gratuity and family pension are to be debited
...
...
...


Accounts Officer

1PENSION CALCULATION SHEET
(Superscript 1 means  substituted by G.I., Dept. of P. & P.W., O.M. No. 38/24/91-P. & P.W. (F), dated the 22nd November, 1991.)

Revised Format

1. Name ... ... ...
2. Designation ... ... ...
3. Date of birth ... ... ...
4. Date of entry in the Government service ... ... ...
5. Date of retirement ... ... ...
6. Length of qualifying service reckoned for pension/gratuity (as indicated in PPO)
...
...
...
7. Emoluments drawn during the last 10 months ... ... ...
8. (1) Average emoluments for pension (as indicated in PPO)
...
...
...
(2) Pension admissible
Calculations to be shown as follows :-
Average Emoluments/2 x 2Qualifying Service/66

(Superscript 2 means In completed 6 monthly period, not exceeding 66.)

 ... ... ...
9. (1) Emoluments for gratuity (as indicated in PPO) ... ... ...
(2) Retirement gratuity admissible
Calculation to be shown as follows :-
Emoluments/4 x 2Qualifying Service 		... ... ...
10. (1) Emoluments for Family Pension (as indicated in PPO) ... ... ...
(2) Family Pension admissible
Calculations to be shown as follows :-		 ... ... ...
(a) Ordinary Family Pension :
Pay last drawn x Prescribed % subject to prescribed minimum and maximum
(b) Enhanced Family Pension :
Family Pension at ordinary rate as at (a) above x 2, subject to prescribed minimum and maximum as per Rule 54.

Countersigned

Head of Office
PAO

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM 8
[Form of letter to the Accounts Officer forwarding the
pension papers of a Government servant

No....................................................
Government of India
Ministry of........................................
Department/Office.............................
Dated the..........................................
To
The Pay and Accounts Officer/
Accountant-General
...............................................
...............................................
...............................................
Subject :- Pension papers of Shri/Shrimati/Kumari............................for authorization of pension.

Sir,

    I am directed to forward herewith the pension papers of Shri/Shrimati/Kumari.........................................of this Ministry/ Department/Office for further necessary action.

    2.    The details of Government dues which will remain outstanding on the date of retirement of the Government servant and which need to be recovered out of the amount of retirement gratuity are indicated below -

(a) Balance of the house-building or conveyance advance...........................................................
...
...
...
Rs.
(b) Overpayment of pay and allowances including leave salary
...
...
...
Rs.
(c) Income Tax deductible at source under the Income Tax Act, 1961 (43 of 1961)
...
...
...
Rs.
(d) Arrears of licence fee for occupation of Government accommodation
...
...
...
Rs.
(e) The amount of licence fee for the retention of Government accommodation for the permissible period of two months beyond the date of retirement


...


...


...


Rs.
(f) Any other assesed dues and the nature thereof ... ... ... Rs.
(g) The amount of gratuity to be withheld for adjustment of unassessed dues, if any
...
...
...
Rs.

Total		 ----------

----------

3.    Your attention is invited to the list of enclosures which is forwarded herewith.

4.    The receipt of this letter may be acknowledged and this Ministry/Department/Office informed that necessary instructions for the disbursement of pension have been issued to disbursing authority concerned.

5.    The retirement gratuity will be drawn and disbursed by this Ministry/Department/Office on receipt of authority from you. The outstanding Government dues as mentioned in para. 2 above will also be recovered out of the retirement gratuity before making payment.

Yours faithfully,    
Head of Office.    

                                                List of enclosures

     1. Form 5*  and Form 7 duly completed.
     2. Medical certificate of incapacity (if the claim is for invalid pension).

      3.    Statement of the savings effected and the reasons why employment could not be found elsewhere (if claim is for compensation pension or gratuity).

      4.    Service Book (date of retirement to be indicated in the service book).

5.   (a) Two specimen signatures, duly attested by a Gazetted Government servant or in the case of pensioner not literate enough to sign his name, two slips bearing the left hand thumb and finger impressions, duly attested by a Gazetted Government servant.
**(b) Three copies of passport size photograph with wife or husband (either jointly or separately) duly attested by the Head of Office.
  (c) Two slips showing the particulars of height and identification marks, duly attested by a Gazetted Government servant.

     6.    A statement indicating the reasons for delay in case the pension papers are not forwarded before six months of the retirement of Government servant.

     7.    Written statement, if any, of the Government servant as required under Rule 59 (1) (a).

     8.    Brief statement leading to reinstatement of the Government servant in case the Government servant has been reinstated after having been suspended, compulsorily retired, removed or dismissed from service.

        NOTE. - When initials or name of the Government servant are or is incorrectly given in the various records consulted, this fact should be mentioned in the letter.

Footnote : * If a Government servant is compulsorily retired from service and delay is anticipated in obtaining Form 5 from the Government servant, the Head of Office may forward the pension papers to the Accounts Officer without Form 5. The Form may be sent as soon as it is obtained from the Government servant.

               ** Only two copies of passport size photograph need be furnished if the Government servant is governed by Rule 54 of the Central Civil Services (Penion) Rules, 1972 and is unmarried or a widower or a widow.

 

 

 

FORM 9
[Omitted]

 

 

 

 

 

 

FORM 10
[Rule 77(2)]
Form of letter to the member or members of the family of a
deceased Government servant where valid nomination
for the grant of the death gratuity exists

 

No....................................................
Government of India
Ministry of........................................
Department/Office.............................
Dated the..........................................
To
...............................................
...............................................
...............................................
Subject :- Payment of death gratuity in respect of the late Shri/Shrimati........................................

Sir/Madam,

    I am directed to state that in terms of the nomination made by the late Shri/Shrimati....................................(Designation) in the Office/Department/Ministry of..............................a death gratuity is payable to his/her nominee(s). A copy of the said nomination is enclosed herewith.

    2.    I am to request that a claim for the grant of the gratuity may be submitted by you in the enclosed Form 12.

    3.    Should any contingency have happened since the date of making the nomination, so as to render the nomination invalid, in whole or in part, precise details of the contingency may kindly be stated.

Yours faithfully,              
Head of Office.              

 

 

 

 

 

 

 

 

 

 

 

FORM 11
[See Rule 77(2)]
Form of letter to the member or members of the family of a
deceased Government servant where valid nomination for the
grant of the death gratuity does not exist

No....................................................
Government of India
Ministry of........................................
Department/Office.............................
Dated the..........................................
To
...............................................
...............................................
...............................................
Subject :- Payment of death gratuity in respect of the late Shri/Shrimati........................................

Sir/Madam,

    I am directed to say that in terms of Rule 50 of the Central Civil Services (Pension) Rules, 1972, a death gratuity is payable to the following members of the family of late Shri/Shrimati........................................(Designation), in the Office/Department/ Ministry of ..................................................in equal shares :-

(i) Wife/husband including judicially separated wife/husband.
(ii) Sons including step children and adopted children.
(iii) Unmarried daughters including step children and adopted children.

    2.    In the event of there being no surviving member of the family as indicated above, the gratuity will be payable to the following members of the family in equal shares :-   

(i) widowed daughters including step daughters and adopted daughters;
(ii) father including adoptive parents in case of individuals whose personal law permits adoption ;
(iii) mother including adoptive parents in case of individuals whose personal law permits adoption ;
(iv) brothers below the age of eighteen years and unmarried and widowed sisters including step brothers and step sisters ;
(v) married daughters ; and
(vi) children of a pre-deceased son.

    3.    It is requested that a claim for the payment of gratuity may be submitted in the enclosed Form 12 as soon as possible.

Yours faithfully,           
Head of Office.          

 

 

 

 

 

 

 

 

 

 

 

FORM 12
[See Rule 77(2)]
Form of application for the grant of death gratuity
on the death of a Government servant

(To be filled in separately by each claimant and in case the claimant is minor, the Form should be filled in by the guardian on his/her behalf. Where there are more than one minor, the guardian should claim gratuity in one Form on their behalf}

1. (i)

Name of the claimant in case he is not minor

 ... ... ...
(ii) Date of birth of the claimant ... ... ...
2. (i) Name of the guardian in case the claimants are minors
...
...
...
(ii) Date of birth of the guardian ... ... ...
3. (i) Name of the deceased Government servant in respect of whom gratuity is being claimed
...
...
...
(ii) Date of death of Government servant ... ... ...
(iii) Office/Department/Ministry in which the deceased served last
...
...
...
4. Relationship of the claimant/guardian with the deceased Government servant
...
...
...
5. Full Postal Address of the claimant/guardian ... ... ...
6. (i) Where gratuity is claimed by the guardian on behalf of minors, the names of the minors, their ages, relationship with the deceased Government servant, etc. -


...


...


...
Serial
No.		 Name Age Relationship with the
deceased Government
servant		 Postal Address
1.
2.
3.
4.		        

(ii)

 Relationship of the guardian with minor ... ... ...


7.


Place of payment of Pension and Gratuity (Treasury, Sub-Treasury, Public Sector Bank branch, or the Pay and Accounts Office)


...


...


...


Signature/Thumb-
impression of the claimant/guardian

8.
Two specimen signatures 1or left hand thumb and finger impressions of the claimant/guardian duly attested
(To be furnished in a separate sheet)

...

...

...

9.
2Attested by -

Name

Full Address

Signature
(i) .......................................... ............................................... ................................................
(ii) .......................................... ............................................... ................................................

10.
Witnesses:
(i) .......................................... ............................................... ................................................
(ii) .......................................... ............................................... ................................................

Footnote : 1. To be furnished in case the applicant is not literate enough to sign his name.
                2. Attestation should be done by two Gazetted Government servants or two or more persons or respectability in the town, village or Pargana in which the applicant resides.

 

 

 

 

 

 

 

 

 

 

FORM 13
[See Rule 77(3)]
Form of letter to the widow/widower of a deceased Government
servant for grant of Family Pension, 1964

No....................................................
Government of India
Ministry of........................................
Department/Office.............................
Dated the..........................................
To
...............................................
...............................................
...............................................
Subject :- Payment of Family Pension, 1964, in respect of the late Shri/Shrimati........................................

Sir/Madam,

    I am directed to state that in terms of Rule 54 of the Central Civil Services (Pension) Rules, 1972, a family pension, 1964, is payable to you as widow/widower of the late Shri/Shrimati...........................................(Designation) in the Office/Department/ Ministry of ..........................................

    2.    You are advised that a claim for the grant of Family Pension, 1964, may be submitted in the enclosed Form 14.

    3.    The Family Pension, 1964, will be payable till your death or remarriage, whichever event occurs earlier. In the event of your death or remarriage, the Family Pension, 1964, shall be granted to the child or children, if any, through the guardian.

Yours faithfully,        
Head of Office.        

 

 

 

 

 

 

 

 

 

 

 

FORM 14
[See Rule 77(3) and 81(2)]

Form of application for the grant of Family Pension, 1964,
on the death of a Government servant/pensioner

1. Name of the applicant ... ... ...
(i) Widow/Widower ... ... ...
(ii) Guardian if the deceased person is survived by child or children
...
...
...
2. Name and age of surviving widow/widower and children of the deceased Government servant/pensioner served last

...

...

...
Serial
No.		 Name Relationship with
the deceased person		 Date of birth
by Christian era
1.
2.
3.
4.
5.
6.		      

3.
Name and No. of the PPO of the deceased pensioner

...

...

...
4. Date of death of the Government servant/pensioner ... ... ...
5. Office/Department/Ministry in which the deceased Government servant/ pensioner served last
...
...
...
6. If the applicant is guardian, his date of birth and relationship with the deceased Government servant/pensioner

...

...

...
6-A If the applicant is a widow/widower the amount of service pension which she/he may be in receipt on the date of death of the husband/wife

...

...

...
7. Full address of the applicant ... ... ...
8. Place of payment of Pension and Gratuity (Treasury, Sub-treasury or Public Sector Bank Branch and Pay and Accounts Office)

...

...

...
9. Enclosures :
(i) Two specimen signatures of the applicant, duly attested (To be furnished in two separate sheets).
(ii) Two copies of passport size photograph of the applicant, duly attested.
(iii) Two slips each bearing left hand thumb and finger impressions* of the applicant, duly attested.
(iv) Descriptive Roll of the applicant, duly attested, indicating (a) height and (b) personal marks, if any, on the hand, face, etc. (Specify a few conspicuous marks, not less than two, if possible.)
(To be furnished in duplicate.)
(v) Certificate(s) of age (in original with two attested copies) showing the dates of birth of the children. The certificate should be from the Municipal Authorities or from the local panchayat or from the head of a recognised school if the child is studying in such school. (This information should be furnished in respect of such child or children, the particulars of whose date of birth are not available with the Head of Office).
10. Indicate whether family pension is admissible from any other source - Ministry or State Government and/or a public sector undertaking/autonomous body/local fund under the Central or a State Government


...


...


...
11. Signature or left hand thumb-impression* of the applicant
...
...
...
12. Attested by :
   

Name

Full Address

Signature
  (i) ............................................ ............................................. ..........................................
  (ii) ............................................ ............................................. ..........................................
13. Witnesses :
    Name Full Address Signature
  (i) ............................................ ............................................. ..........................................
  (ii) ............................................ ............................................. ..........................................

    NOTE. - Attestation should be done by two Gazetted Government servants or two or more persons of respectability in the town, village or Pargana in which the applicant resides.

*To be furnished in case the applicant is not literate enough to sign his name.

 

 

 

 

FORM 15
[Omitted]


FORM 16
[Omitted]

FORM 17
[Omitted]

 

 

 

 

 

 

 

FORM 18
[See Rules 78(1),80(1), 80(3) and 880(5) and 80-B (1) & 80-B (5)]
Form for assessing and authorising the payment of family pension
and death gratuity when a Government servant dies while in service
(To be sent in duplicate if payment is desired in a
different Circle of accounting unit)

PART I

Section I

1. Name of the deceased Government servant ... ... ...
2. Father's name (and also husband's name in the case of female Government servant)
...
...
...
3. Date of birth (by Christian era) ... ... ...
4. Date of death (by Christian era) ... ... ...
5. Religion ... ... ...
6. Office/Department/Ministry in which last employed ... ... ...
7. Appointment held last ... ... ...
(i) substantive ... ... ...
(ii) officiating ... ... ...
8. Date of beginning of service ... ... ...
9. Date of ending of service ... ... ...
10. (i) Total period of military service for which pension, gratuity was sanctioned ; and
...
...
...
(ii) Amount and nature of any pension, gratuity received for the military service
...
...
...
11. Amount and nature of any pension received for previous civil service, if any
...
...
...
12. Government under which service has been rendered in order of employment
...
...
...
13. The date on which intimation regarding the death of Government servant was received by the Head of Office
...
...
...
14. The date on which action initiated to -
(i) obtain claim or claims from the claimants in the appropriate form for death gratuity and family pension as provided in Rule 77 ;
(ii) obtain the `No demand certificate' from the Directorate of Estates as provided in Rule 80-C (1) ;
(iii) assess the Government dues other than the dues pertaining to occupation of Government accommodation as provided in Rule 80-C (2) ; and
(iv) assess the service and emoluments qualifying for death gratuity and family pension as provided in Rules 78 and 79.
15. Whether nomination made for death gratuity
16. Length of service qualifying for death gratuity/pension ... ... ...