LpC-,CUM-DATA SHEET FOR REVISION OF PENSION EN RESPECT .

OF PRE-2016 PBORs AS PER CIRCULAR NO, 585

LPGUMATA SHEET FO REV|SIN OENS|ON IN RESPEGF PRE-2016 PBORs AS PEIRCULAR NO 585

1 R 0 Code ] [ I 2 LPC Serial No 3 O

4 Latest COrr PPO No |

5 PPO for Disability Element (if separately granted)

6 Latest Corr PPO No Of Disablity Pens| on, if any ],-

7 Penson Type Being Drawn presently [ [ [ ] 8 DSC/TA Category ]____j

9-Name

10 Regimental No 11 Rank Last 1-fold 12 Fank Pensloned for3 p 13a DEP'o-na (AiCTE)

14 Trade 15 Net Qua ervjce 1l 6.Date of Birtflj[ [ [ ][ [ ]17"ACP/MACP Rank if a

18 Date of Discharge 9 Date of Enrollment [ | I I|I |O TyPe oens'on j j I ]

, 21 Date of Death 22-Aadhaar No

2 PAN No 24 E malt ID

-- _____- ,
27 Pay scale (In which the personnel discharged Pre 86 cases)

28 Notional Pay / Actual Pay 29 ,Notional Pay J Actual pay Code ] - ] 30 Notional Pay I Actual Pay as per 5th CPC ] ] ] ] ]
As per 4th CPC As per 4tfl CPC

31 Notiona4 Pay i Actual Pay Code ] ] ] 32 pay Band Corresponding to Notional Pay ] ] 33 Notional Pay / Actual Pay as per 6th CPC I I I I I I
As per 5th CPC I 1 J As per 6th CPC I ' ,

34.Grade Pay as per 6th CPC 35.MSP (As per 6th CPC) 358 peGrP 56" hPayC el

37.Notional Pay in Pay Level | | | | j | | 38 Class Pay [ | [ | [ 39,Gal, Award 1| | I 40 ,Gal. Award 2 | | |41.Gal, Award 3[ I |i
(As per ?th CpC) I L- J 1 i I (As per7th ] J L L J L I J

42 Spouse/Family PenSEoner s Name

43 Date of Birth of Family Pensloner 44-Refaton 45.PAN No

46 Aadhaar No Of F.P. 4 bile No Of F. P [ + j I ]

48 E-mall ID j j j ! j j | j I j | j I j j j | | ] j | | j j j j j j_..I_._1 j j j
of F. P

49 Pensioner
Address

498 Penslo net Address] j ] j j j I ] | J j I J ] I J I I I j ] 49b-Penstoner Address] j ]

Dfstrict ate

49c" Pensoner ] ] ] ] ] ] ]50.War Injury Element %j ] ] 151War Injury Rounded to| I ] j 52. Dsability Element % j I j ]
Address Pin L 1 1 1 L >> J L 1 1 J

53 Dlsabili Rounded to (OtherthIE) I I I 54 , C omposite Disability ol I I I 55 Disability From

56Dsabdity to j I ] ] ] ] ] I ] 57.Seice Element ] ] ] [ ] j ] 58,LFP/SFP/OFP ] j j j | ] j

As on 31 12 20 15 As on 31 12 20 1 5 --

~ . .~ ~. ~ ~~~~

68 PDA Code {____] 69 DO Code [ ] ] 70- PDA State Code1 Bank Code [ |

72 BSR Code of ] I ] ] | ] ] | 73,CPPCiLink

CPPC or link Bank Ad

74 Bank Account

76, Bank Branch | | | | | 1 I | 1 | | I I 1 I _ I_ I

75 IFSC Code ] ] | ] ] ] ] I ] ] j j Address
of Paying

CUR No. 1 I I I 1 I I I I I I I 1 Date of Receipt | | | | | | | ] |

 Record Office

No.

Date signature & Seal of R,O,

PA\c-"ACUNTS OFFff..F
' C'E
1 Certified that Col. Nos. 1 to 78 of LPG-Cum-Data Sheet in respect of Regt. No, , , , . - . . . . . . . .. , . . , . . , , , . Ran k. . . , . . . . . . , , . . -

Name . , . . . . . , . .. . . , , . , . _ . , . . . . , . . .. . . . . . . . . . . . . .. . .. have been properly checked with reference to the entries in the
Form, Discharge Roll (Original) etc. and found correct.
2_ Certified that qualifying service has been checked with reference to the Sheet Roll (Original).

Name & Signature of Name & Signature of Name & Signature of p.A.0. SEAL
ClktAud/SA SO/AAO AD/SAD
__________________________________________________________________________________________
PAC.DAIP) AllAffASAD

P_AC.DA1f>) AllAffASAD

Claim Notified Vide PPO No.

Adr/Sr .Adr. S 0(A)/ AAO , AO/SAO ( P)__