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28407-A/239/PSC/2007 Dated: 04-01-2008)
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Type of Pension (Service Pension /Family Pension) Name of Individual (S/o , W/o, D/o, H/o) Date of Birth & Age P.P.O No. Name of Bank & Branch Bank Account No Old / New Employee particulars (applicant if Re-employed after retirement / appointed on Compassionate Grounds) (a) Name of the Office (b) Date of employment/Re-employment (c) What is the D.A being drawn on employment (d) Date from which D.A is drawn
Re-Marriage Particulars if any (a) Date of Re-Marriage (b) Name of the spouse
Present Residential Address & Phone No PAN No., if any
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Place : Date : Signature of the Gazetted officer/ Bank Manager with name seal Signature of the Treasury officer i.CERTIFICATE – I (To be issue by the Drawing & Disbursing Officer) Certified that Smt/ Sri ____________________________________________________ Wife /Husband/ Late of _________________________________________________________ Was appointed as __________________ on compassionate grounds in this office with effect from _______________________ she /he is being paid the Dearness allowance eligible to her at the rates sanctioned by the Government from time to time. The Non-receipt of the annual Verification Certificate the pension shall be stopped from 1 st April onwards (i. If pensioner does not appear personally before the pension disbursing officer.e. As per the declaration field by the individual. 4. Station : Date : Signature & Office seal CERTIFICATE – II Certified that I have seen the pensioner as on _______________________ and he/she is alive on this date. STo /ATO /APPO with name and seal Note : 1. the certificate shall be signed by Branch Manager.. The pension disbursing officer can sign the certificate if the pensioner appears before the pension disbursing officer..R on the family pension being drawn vide PPO No _______________ from the Sub Treasury /Pension Payment Officer.) March payable on 1 st April. 3. The Annual Verification certificate are obtained 1st November onwards.e. Page 2 of 2 . she/he is not drawing any D. 2.