Professional Documents
Culture Documents
N TRIPLICATE
ICNo : Tele No:
Name : Mobile No :
Address:
Appendix-I
Passport size
phot,ographs of
the pensioner
To and his spouse
duly attested
Addl Dte Gen of Manpower
(Policy & Planning)/tutP 5(B)
Adjutant General's Branch
Integrated HQ of MoD (Army)
Wing No 3, Ground Floor, Room No 21,
West Block-III, R K Puram t
New Delhi- 1 10066
Name of Pensioner
(a) Station
(b) Treasury IDPDO/IAO/
Bank/Post Office
(c) Bank branch with full address
and SB A/C No
...2/
2
(Attestation can be done by any Gazetted Officer, pension Disbursing Officer, Head of office
of retired official, village Sarpanch, Block Development Officer, MLA/MLC etc).
(xii) Signature of or thumb impression of
spouse.
1.
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4
2.
II
The pafticulars furnished above have been verified from th records available
could be verfied at our end.
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ONLY ONEE COPY REQUTREp
Telephone lr ame
Mobile F ddress
C ity
Date :
To
Dear Sir,
1. ln order to record Date of Birth in PPO for additional pension in terms of para 12 of GOl,
MoD Revised Pension letter 17(4)12008/(1)/D(Pen/Policy) dated 11 Nov 2008. Data Sheet
designed by PCDA(P) for issue of corrigendum PPO is provided below :-
(b) Spouse
(i) Name
(ii) Date of Birth (DD/MMiYY)
Necessary Documents duly attested by Gazetted Officers are attached(Copy of any one of
PAN Card/Matriculation certificate/Passport/ECHS Card, Driving License as proof of birth of
Spouse/family pensioner alongwith copies of Original and Corrigendum PPOs)
.l Yours sincerely,
I
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Enclosufeg l-
Proof of birth.
Copies of Original and Corr PPOs.