Professional Documents
Culture Documents
MODIFICATION
DELETION
RECOVERY
BANK OF INDIA
Branch ____________________
Date: _____/____/______
1. Type of Pension *
: __________________________________________
3. PPO Number *
4. TS No /PS No
:__________________
5. Retiring Office/Dept
:______________________________
7. SB ACCOUNT NO *
:_______________________________
8. Date of Birth *
:______/______/_______
9. Date of Retirement
:_____/______/_______
: _____/______/_______
: _____/______/_______
DA :
Medical Allowance:
Rs:_______________
Rs:_______________
Rs:_______________
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
Rs.
: _____/______/_______
16. Commutation Restoration Date : _____/______/_______ (15 years from the date of Commutation)
17. MEDICAL ALLOWANCE*
18. Date of Death
Rs: ____________________
Rs:_____________________ ( on Retirement)
Rs:_____________________ ( on Retirement)
22. Please pay Pension from month _________to _________ total Rs. ____________________
23. Remarks___________________________________________________________________________________________
________________________________________________________________
Note*: Medical Allowance of Rs. 300/- admissible for all state Govt. Pensioner/ Family Pensioner as per 6th
Pay commission w.e.f. 01.09.2008 . For Defence, Railway & Central Civil M.A. admissible only when it is
mentioned in PPO or in declaration basis that pensioner is not availing any Health/Medical Scheme .