PENSION PROPOSALS PREPARATION PACKAGE

PERSONAL DETAILS IDENTIFICATION MARKS

Name Smt K. Gangamma 1 A mole on the left side palm
Father Kotaiah
Designation Office Subordinate
Emp. ID 1905542 GPF A/c No. 023-145-01-98
PAN Card no. BRJPG7696F Aadhar no.

DATES NON-QUALIFYING SERVICE

Birth 01 07 1960 S.No. Leave Type Y M
Appointment 04 05 1989 F.N. a E.O.L 00 00
Retirement (If voluntary) b Suspension Period 00 00
Commutation Date c Dies-Non 00 00
Age of Superannuation 60 d Boy Service 00 00
Application Date 27 05 2020 e Any other 00 00

ADDRESS FOR COMMUNICATION

Office Address Present Address Permanent Address
Collectorate
Nalgonda

SALARY PARTICULARS BANK DETAILS

Pay 40,270 Bank Ac. No. 52078856352
D.A. % 33.536 Name of the Bank SBI, Collectorate Complex, Nalgonda
% Commutation 40.00 IFSC Code SBIN20951 MICR code
Pension Disbursing Authority DTO, Nalgonda
NOMINATION DETAILS
Nominee Name Age Relation Share Identification Mark 1 Identification Mark 2
K. Shirisha ### Daughter 100

FAMILY MEMBERS

Name of the Member Relation Date of Birth Marital Status Employment

Status

DDO DETAILS DDO OFFICE

Name Sri Prashanth J. Patil Collectorate,
Designation District Collector Nalgonda
Letter No. & Date A3/ 2020
 PENSION BENEFITS
Service Pension 20,135.00 Gratuity payable 887,288.00
Pension after commutation 12,081.00 Commutation of pension 800,922.00
Family Pension 12,081.00 Date of Restoration of Pension 7/1/2025
POSALS PREPARATION PACKAGE

A mole on the left side palm

023-145-01-98

D
00
00
00
00
00

Permanent Address

52078856352
SBI, Collectorate Complex, Nalgonda

DTO, Nalgonda

Identification Mark 2

Collectorate,
Nalgonda
PENSION BENEFITS
887,288.00
800,922.00
7/1/2025
 CHECK LIST FOR PENSION PROPOSALS
1 Name and Designation : K. GANGAMMA, Office Subordinate

2 Place of working : O/o Collectorate, Nalgonda, ,

3 Date of Birth : 01-07-1960

4 Date of Entry into Service : 04-05-1989

5 Date of Retirement : 30-06-2020

6 Total Service : 31 years 01 months 26 days

7 Break period (if any) : 00 years 00 months 00 days

8 Net qualifying service : 31 years 01 months 26 days

9 Weightage if any : 01 years 10 months 04 days

10 Total qualifying service for calculation of : 33 years 00 months 00 days

pension

11 Last Pay drawn and scale of Pay : Rs 40,270.00

12 Calculation of :

A. Gratuity : Rs.887,288.00

B. Pension : Rs.20,135.00

C. Family Pension :

Enhanced : Rs.20,135.00

Normal : Rs.12,081.00

13 Whether any charges are pending against the : Nil

retired employee

14 Whether any dues are to be recovered from : Nil

the incumbent

15 If so the details of amount to be recovered : Nil

from the incumbent

16 Whether the pension proposalsare furnished in : Yes

4 sets

17 Whether all the Service verification entries are : Yes

made in the service book of the incumbent

18 Whether final L.P.C. is produced : Provisional L.P.C. enclosed

19 Any other information :

 Government of Andhra Pradesh
Forest Department
A3/ O/o the Collectorate,
Date : 30-11-2019 Nalgonda

From To
Sri Prashanth J. Patil The Accountant General ( A&E )
District Collector/ Audit Office , LFA, Hyderabad
Collectorate, Andhra Pradesh
Nalgonda

Sir,

Sub : Forest Department - Pensions - Proposals of Smt K. Gangamma, Office Subordinate O/o
Collectorate, Nalgonda - Pension / Service Pension / Family Pension and other Retiring Benefits -
Submitted.

Ref : 1. G.O.Ms.No.262, Fin. & Plg. (FW-PSC ) Dept., dt.23-11-1998

2. G.O.Ms.No.263, Fin. & Plg. (FW-PSC ) Dept., dt.23-11-1998
3. Application of the individual.

I am herewith forwarding the Service / Family Pension Proposals of Smt K. Gangamma D/o Kotaiah who is
working as Office Subordinate in the office of Collectorate, Nalgonda, is due to retire / retired /expired while in
service on the afternoon of 30-06-2020

The following documents are forwarded herewith for authorizing Pensionery Benefits.

1. Part - I : Information furnished by the Govt. Servant / Family Pension

Beneficiary
2. Part - II : Information filled in by the Pension Sanctioning Authority

3. Part - II B : Sanction Order of Pensioner Benefits.

4. Annexure - I : Descriptive Roll
5. Annexure - II : Nomination
6. Annexure - III :
7. Service Register of Govt. Servant. :
8. L.P.C :
9. Death Certificate (in case of Death) :
10. Legal heir Certificate (- do-) :
11
12

The receipt of the advance pension papers along with Service Register may please be acknowledged and
necessary arrangements may please be made for issue of Pension Payment Order, Gratuity Payment Order and
Commutation Authorization.

No. of enclosures ( ) Yours Faithfully

Copy to Smt.K. Gangamma

Office File.
 FORM OF APPLILCATION FOR SERVICE PENSION/FAMILY
PENSION/RETIREMENTGRATUITY/SERVICEGRATUITY /COMMUTATION

(To be furnished in duplicate)

PART-I
Information to be furnished by the Government Servant / Applicant
(The Pension Sanctioning Authority shall forward the application duly processed to the AG (A&E) /
L.F Authority within a period of 30 days)

1 (a)Name of the Government Servant Smt K. Gangamma

(b) Post held Office Subordinate

Name of the Applicant

2 (in case of death of government servant)

3 Permanent Address

4 Employee I.D. Number 1905542

5 GPF Account Number 023-145-01-98

6 PAN Card No BRJPG7696F

7 Aadhaar No 0

IFS code and MICR code of the Bank where IFSC: SBIN20951
8 payment is opted MICR:

9 Address after retirement

10 Commutation of Pension

(a) Whether willing to commute *40% of

monthly pension, subject to A.P. Civil Pensions Yes, 40% of Family Pension
(Commutation) Rules, 1944

(b) If the answer is ‘NO’ specify the fraction

less than *40%

(a) Name of the Pension Disbursing Authority

11 DTO, Nalgonda
i.e., Treasury officer/Pension Payment Officer

(b) Name of the Paying Bank from where

S.B. Account
pension payment is desired by the pensioner Name of the Bank & Branch
no.
/family pensioner gratuitant

SBI, Collectorate Complex, Nalgonda 52078856352

*Note :-Consequent on the issue of orders in G.O.Ms.No.158 Fin &Plg (FW.Pen.I) Dept., dt. 16.9.99 enhancing the
maximum pension that can be commuted upto 40% w.e.f. 1.4.99, this 1/3rd was to be changed as 40% at both the
places.
12. List of family members
(e ) Marital / Employment status of the
(a) (b) (c) (d) Children of the applicant / deceased
Relationship Government servant. whether
S. Name of the family member Date of birth with Married or employed or
No. government unmarried not .Give details
1 servant of employment
2
3
4
5
6

Instructions:
1 The Government servant is instructed to fill up the format carefully as the data furnished is vital for
sanction of family pension. He/She may note that alterations of the data furnished at a later date is not
permissible.
2 The "family for the purpose mean "wife" or "husband" as the case may ne "sons" and "unmarried
daughters" as laid down in Rule 50(12) (for Family Pension) and Rule 46(5) (for gratuity) of AP Revised
Pension Rules,1980.
3 In case of death while service of Government servant, at the answer 'Married' in case of daughter will
be understood that the daughter is already married as on the date of death of the Government servant.

DECLARATION
1 I undertake to refund the amount of Pension. Gratuity and commutation, if it is found subsequently to
be in excess of the amount to which I was entitled under the Rules.
2 I solemnly affirm that the particulars given by me in part – 1 at item 7 are correct and true to the best of
my knowledge. If found false in future, I am liable for suitable action as may be taken by the
Government.
3 The particulars given above are correct and true to the best of my knowledge. If found false in future I
may be liable for any action that may be taken by the Government.

Place:
Date: 27-05-2020 ( K. GANGAMMA )
Signature of the Government Servant /
Applicant
To be filled in by the Head of the Office
1. Applicant for pension / gratuity etc. in Part-I is received on __________ (Date to be recorded).

2. Certified that the person/persons mentioned by the Government servant/Applicant in item 7 of Part I are
legally entitled to receive the pension/share in gratuity.

3. Guardianship certificate : (to be filled in wherever necessary)

This is to certify that the following minors of the deceased Government Servant Late
Sri/Smt.___________________________________ is/are under the guardianship of Sri/Smt.
_________________

Sl.N Name Date of Birth Relationship

o
1
2
3
4

Place:
Date: 27-05-2020
 Signature of the Head of Office
Office Seal :
 Part II (A) Information to be filled up the Pension Sanctioning Authority

1 Name of the Government Servant and Post held Smt K. Gangamma, Office Subordinate

2 Father's Name/Husband's Name Kotaiah

3 Name of the Applicant

( in case of death of government servant)

4 Date of Birth of Government servant 01-07-1960

5 Date of entering in to service 04-05-1989 F.N.

6 Date of retirement/death 30-06-2020

Designation and officer from which the Government

7 servant retires / retired / died Office Subordinate, O/o Collectorate, Nalgonda, ,

8 TAN of the DDO

9 Signature of the DDO

10 The rule applicable

a)
The relevant Rule under the A.P Revised Pension Rule 33 Superannuation Pension (Rule 42)
Rules. 1980 applicable (tick the rule number(s) Rule 34 retiring Pension (Rule 43/44)
Applicable and strike out the rest) Rule 35 Pension on absorption under a corporation

Rule 38 Compensation Pension Rule 37 Invalid Pension

Rule 40 Compassionate Allowance
Rule 44 Retirement on completion of 33 years of
qualifying service
Rule 39 Compulsory Retirement Pension
Rule 43 Retirement on completion of 20 years of
qualifying service
Rule 46 Retirement Gratuity
Rule 50 Family Pension

b) Whether ANTICIPATORY PENSION is being

sanctioned in terms of Rule - 51.
c) Whether PROVISIONAL PENSION is being
Sanctioned in terms of Rule 9(4) read with Rule 52

d) Any other rule applicable

Years Months Days

11 Total service (6-5) 31 1 26
12 Period of non-qualifying service
a) E.O.L 0 0 0
b) Suspension period 0 0 0
c) Dies-non 0 0 0
d) Boy service 0 0 0
e) Any other service not qualifying for pension 0 0 0
Total non-qualifying service (a to e) 0 0 0
13 Net qualifying service (9-10) 31 1 26
14 Weightage, if any 1 10 4
15 Total qualifying service for calculation of pension 33 0 0
(11+12)
 Last pay drawn ( Rule 31,46(4),50 (12)( C ) of APRPRs,
16 1980) Para 4 of G.O Ms. No 87, Rs 40,270.00
Fin & Plg (FW-Pen.I ) Dept., dt.25.05.1998

Calculation of service pension/service Gratuity (Rule

17 45 of APRPRs, 1980) Rs.40,270.00 X 66/66 X 1/2 = Rs.20,135.00

Calculation of Retirement gratuity Basic Pay Rs.40,270.00, DA@33.536%=

18 ( Rule 46 APRPRs, 1980) Rs.13,505.00(40,270.00 + 13,505.00) X 66 X 1/4 =
Rs.887,288.00
19 Calculation of Family Pension

a) Enhanced family Pension Rs 20,135.00 (Rs.40,270.00 X 50/100 = Rs.20,135.00)

b) Normal Family Pension Rs 12,081.00( Rs.40,270.00 X 30/100 = Rs.12,081.00)

20 Period of Payment of Pension

a) Service Pension From 01-07-2020 to till death

b) Enhanced Family Pension From 01-07-2020 to 30-06-2025

c) Normal Family Pension From 01-07-2025 to till death

21 Government dues to be recovered in respect Principal Interest Total

a) House Building Advance
b) Motor Car/Cycle Advance
c) Marriage Advance
d) Advance Leave Salary
e) Advance salary on Transfer
f) Dues on Account of Government Qrtrs
g) Telephone/Trunk call Charges
h) Festival Advance
i) Education Advance
j) Computer Advance
k) Other Government Dues
Total
Note: Information with conditions will not be accepted by Pension Authority. Amounts for recovery should be
specify and should be in whole rupees. Absence of information will be understood as no dues for
recovery

20 LPC is enclosed/LPC will be sent after retirement

CERTIFICATE
(As per Cir.Memo.No.42/PSC/2012, Dt: 17.02.2012 of Finance(PSC)Department)

Certified that in the capacity of pension sanctioning authorities, that they have verified the services with
reference to pay rolls, pay fixations, including the automatic advancement schemes, appointments/pay fixations
from time to time till the date of retirement.

Pension Sanctioning Authority

 PART - II (B)
SANCTION OF PENSION
a) Certificate of competency to accord sanction (applicable in case of sanction of Pension to non gazetted officers
including Class - IV employees)

i) I am declared by the Head of the Department to be the Head of an office to accord sanction in this case
under the powers delegated modified orders issued by G.O.Ms.No.132, F&P (FW.PSC) Department dated
18-9-2000 and read with G.O.Ms.No.262 F&P (FW.PSC) Dept, dt 23-11-98.

OR
ii) I am the next Gazetted Authority in the hierarchy to the Head of the office in this case who is a non-
gazetted officer and hence, I am competent to accord sanction under the powers delegated modified
orders issued by G.O.Ms.No.132, F&P (FW.PSC) Department dated 18-9-2000 and read with
G.O.Ms.No.262 F&P (FW.PSC) Dept, dt 23-11-98 & G.O.Ms.No.208 Finance(PSC) Dept, dt 04.06.2010

(Strike off whichever is not applicable)

b) Sanction Order :

Pensionary benefits including commutation found admissible under the rules may be authorized. It is verified
from the records in my custody and certify that no disciplinary or judicial proceedings are pending /
contemplated against retiring / retired government servant to whom I am the authority for sanction of
Pension.

i) Service Pension Rs.20,135.00

ii) Retiring Gratuity Rs.887,288.00
iii) Commutation Rs.800,922.00
iv) Family Pension
a) Enhanced Family Pension Rs.20,135.00 upto 30-06-2025
b) Normal Family Pension Rs.12,081.00 from 01-07-2025
(v) Under Revised Pay Scales :

Signature and Designation of

Office Seal Pension Sanctioning Authority
Date:

Note 1 This is to be prepared in duplicate by the Pension Sanctioning Authority. One for the record of Pension
Sanctioning Authority and the other one to be sent to Accountant General/Local fund Audit Officer.

Note 2 The Pension Sanctioning Authority should satisfy about the correctness of the particulars of family
furnished by the Government Servant/Applicant in Part-I

Note 3 If the Pensionary benefits are not to be released Part-II-B(b) shall be struck off.

Note 4 If there is any likelihood of delay. Anticipatory Pension/Anticipatory Gratuity as per Rule 51 of A.P.
Revised Pension Rules 1980 shall be drawn and paid by the Head of Office to the beneficiary without any
delay.
Note 5 Heads of Departments are those listed in Appendix-I mentioned in Article 6 of A.P. Financial Code Volume
-I / Subsidiary Rule 32(ii) of FR 9.
 ANNEXURE - I
DESCRIPTIVE ROLLS
A. SPACE FOR PHOTOGRAPHS

Single Photo Joint Photo

Service Pensioner/Family
Joint Photo of Service Pensioner with Family Pension
Pensioner/Gratuitant/Guardian of
beneficiary/Guardian with Minor or Handicapped Child.
Minor or Handicapped Child.

(Attestation has to be done across the Photos by a Gazetted Officer of AP Government in Service)

B. SPECIMEN SIGNATURE OF :

(I) Service Pensioner :

Speicimen Signature of Smt.K. Gangamma
Daughter of Sri Kotaiah

(II) Family Pensioner/Gratuitant/Guardian of Minor or Handicapped Child:

Speicimen Signature of Smt K. Shirisha
Daughter of Smt K. Gangamma

C. PERSONAL IDENTIFICATION MARKS OF :

(i) Service Pensioner : Smt K. Gangamma, Office Subordinate
1. A mole on the left side palm
2.
(ii) Family Pensioner/Gratuitant/Guardian of Minor or Handicapped Child :
Smt K. Shirisha
1.
2.
 D Left hand thumb and finger impressions of Service Pensioner / Family Pensioner / Gratuitant /
Guardian of Minor or Handicapped Child:

(To be given by the illiterate or those unable to sign and for others it is optional)

Details Thumb Finger Fore Finger Middle Finger Ring Finger Little finger

Service Pensioner

Family Pensioner

Gratuitant

Guardian of
Minor /
Handicapped
Child.

Place : Attested by
Date : 27-05-2020

Name : Sri Prashanth J. Patil

Designation : District Collector
Office Seal:

(Attestation has to be done by a Gazetted Officer of AP State Government in Service)

Note 3 Copies will be forwarded to Accountant General/Local Fund Audit Officer by Pension Sanctioning
: Authority and one will be retained by the Pension Sanctioning Authority.
SIGNATURE OF THE DISTRICT COLLECTOR
 ANNEXURE II
NOMINATION
( The Government servant may use separate forms, if he wishes to make different nominations for
each type of payment mentioned below)

I here by nominate the person / persons mentioned below and confer on him / her / them the right
to receive Life Time Arrears of Pension, Retirement Gratuity that may be sanctioned by Government, in
the event of my death while in service and right to receive on my death Life Time Arrears of Pension.
Retirement Gratuity, Commuted value of Pension. Death Relief having become admissible to me on
retirement which may remain unpaid at my death.

the nominee(s) in Col.1.

payable to each in Col.1

payable to each in Col.6

need not be mentioned
happening of which the

relationship and age of

of nomination to him /
become invalid (Death

the right conferred on

shall pass in the event

Name and address of

her / them becoming

Contingencies on the
Government Servant

nominee(s) to whom
Age / Date of Birth
Relationship with

Amount or share
Amount of share

nomination shall

Name, address,
the alternative
Nominee(s).

ineffective
1 2 3 4 5 6 7
Daughter

21 Years

Equal
100%

K. Shirisha, 2. -
-

This nomination supersedes the nomination by me earlier on------------

NB: The Government servant shall draw lines across the blank space below the last entry to prevent
insertions of any name after he/she has signed

Dated this…………………………… day of …………………………… at

Witness:-
1. Signature: ( K. GANGAMMA )
Name and Address Signature of the Government Servant
Designation : Office Subordinate
Office of Collectorate, Nalgonda,

2. Signature: Countersigned
Name and Address

Signature of
Head of Office/Department:
Date :
Office Seal : Name & Designation :

Note (1) : The Government servant who has a family may nominate one member or more than one member of the family as defined in Rule 46(5) of AP
Revised Pension Rules, 1980
Note (2) : The Government servant who has a family may nominate one member or more than one member of the family as defined in Rule 46(5) of AP
Revised Pension Rules, 1980
Note (3) : The Government servant may not that the nomination with signature of two witnesses shall only have the legal validity of a WILL.
Note (4) : This nomination form is to be submitted by the employees in triplicate, one for use of the pension sanctioning authority and two copies to be
forwarded to the forwarded to the Account General Local Fund Audit Offices.

Note (5) : For the purpose of Rules 46, 47, 48 and 49 of Revised Pension Rules 1980, family in to a Government servant means:-
(i) Wife or wives in the case of a male Government Servant (ii) Husband in the case of a female Government Servant (iii) Sons including step sons,
posthumous son and adopted sons (Whose personal law permits such adoption) (iv) Unmarried daughters including step daughters posthumous
daughters and adopted daughters (Whose personal law permits such adoption) (v) Widowed daughters including daughters and adopted
daughters (vi) Father including adoptive parents in the case of individuals whose personal law permits adoption (vii) Mother (viii) Brothers below
the age of 18 years including step brothers (ix) Unmarried sisters and widowed sisters including step sisters (x) Married daughters and (xi) Children
of a predeceased son.
 BY REGISTERED POST
ANNEXURE III

From
Sri Prashanth J. Patil
District Collector
Collectorate,
Nalgonda

To
The Accountant General ( A&E )
Audit Office , LFA, Hyderabad
Andhra Pradesh

( Disciplinary Authority / Appointing

Authority / Head of the Department )

Sub : - Pension – Sanction of Pension and Other Retirement Benefits in respect of Smt.K.
Gangamma, Office Subordinate, O/o the Collectorate, Nalgonda, , - Regarding

***

I am to inform you that the Pensioner/Family pension application from Smt K. Gangamma,
Office Subordinate O/o the Collectorate, Nalgonda, retires on 30-06-2020 as Office Subordinate was
forwarded to AGAP/LFA on 27-05-2020. As per the records held by me no disciplinary / judicial
proceedings are pending/contemplated against the above retiring/retired government employee.

I request you to verify whether any such case is pending against the above employee which
entails withholding or with-drawing pension or part of pension permanently or for specified period as
laid down under rule 9 of RPRs 1980. If so the AG(A&E) / Dy. Accountant General (Pension), O/o the
AG(A&E) A.P., Hyderabad / Local Fund Officer may be intimated accordingly by name either by
Registered post or through a special messenger within one month from the date of issue of this letter
for withholding pensionary benefits as contemplated in Govt. Memo. No. 33764/55/PSC/93, Finance &
Planning (FW-PSC) Department, dt. 15-10-1993 and reiterated in Government
Memo.No.37254/361/A2/Pen-I/98, Finance & Planning (FW-Pen.I) Department, dated 4-7-1998.
Copies of such orders shall also be sent to the concerned Treasury Officers / PPO for withholding the
pensionary benefits. In this connection the instructions issued in para 2, Part – II B of G.O.Ms.No 263,
Finance & Planning (FW – PSC) Department, dt 23-11-1998 may be scrupulously followed.

Yours Sincerely

Station : 12/30/1899
Date : . 5/27/2020 ( Pension Sanctioning Authority )
 LAST PAY CERTIFICATE
1 Last pay certificate of Smt K. Gangamma, Office Subordinate O/o Collectorate,
Nalgonda, who retires from the service on 30-06-2020.

2 She has been paid up to 30-06-2020 at the following rates.

Basic Pay Rs. ###

D.A. Rs. ###

3 She made over charge as Office Subordinate of the Office of Collectorate, Nalgonda on
the after noon of 30-06-2020
4 Recoveries are to be made from the pay Government Servant as detailed on the
reverse
5 She has been paid leave salary as detailed above deduction have been made as noted
on the reverse.

PERIOD RATE AMOUNT

From………………… to ……………………… Rs………………… A month …………………………

From………………… to ……………………… Rs………………… A month …………………………
From………………… to ……………………… Rs………………… A month …………………………
6 She is entitled to draw the following.
7 She is also entitled to joining time for ……… ……… ……… ……… days
8 The details of the income-tax recovered from her upto the date from the beginning of
the current year are noted on the reverse

Signature of the
Certifying Officer

NO DUE CERTIFICATE

Certified that no amounts are due from Smt K. Gangamma of Collectorate,

Nalgonda, , who retired service on the afternoon of 30-06-2020

Signature of the
Certifying Officer
 APPENDIX
DETAILS OF RECOVERIES
Nature of recovery ……………………………………….……………………………………………………………………

Amount Rs ….………………………………………………..…………………………………………………………………..
To be recovered in …………………………………………………………………………………..…… Installment

DEDUCTIONS MADE FROM LEAVE SALARY

From ………….…….……… to ………….…….……… on account of ………….…….……… Rs ………….…….………

From ………….…….……… to ………….…….……… on account of ………….…….……… Rs ………….…….………

From ………….…….……… to ………….…….……… on account of ………….…….……… Rs ………….…….………

From ………….…….……… to ………….…….……… on account of ………….…….……… Rs ………….…….………

Name of the Gratuity Fee Fund and other amount of Income

month Pay etc. deductions Tax Remarks

April

May

June

July

August

September

October

November

December

January

February

March
 NO DUES CERTIFICATE

Certified that no dues are pending agaist Smt K. Gangamma, Office Subordinate

of Collectorate, Nalgonda, , who retired from service on the afternoon of 30-06-2020

as per the records available in this office as on upto date.

Signature of the

NO ALLEGATIONS CERTIFICATE

Certified that no allegations are pending agaist Smt K. Gangamma, Office

Subordinate of Collectorate, Nalgonda, , who retired service on the afternoon of 30-06-

2020 as per the records available in this office as on upto date.

Signature of the
 RESPONSIBILITY CERTIFICATE

I, K. Gangamma, D/o Kotaiah to be retired as Office Subordinate of

Collectorate, Nalgonda, , do here by declare that, if any amount to be excess paid due

to erroneous calculation, noticed at a later date, I shall be ready to refund the same

without any objection.

Signature of the Pensioner K.

Attested
Gangamma

AUDIT OBJECTIONS CERTIFICATE

Certified that there are no audit objections pending in respect of Smt K.

Gangamma, Office Subordinate of Collectorate, Nalgonda, ,

Signature of the
 LEAVE CERTIFICATE

Certified that Smt K. Gangamma, Office Subordinate of Collectorate,

Nalgonda, , has not availed any leave / has availed the following kind of leave during

the period of her service.

1

Signature of the

SUSPENSION CERTIFICATE

Certified that Smt K. Gangamma, Office Subordinate of Collectorate,

Nalgonda, , has not been suspended any time during her service.

Signature of the
 CERTIFICATE UNDER ACT OF 1982

Certified that Smt K. Gangamma, Office Subordinate of Collectorate,

Nalgonda, , was not sanctioned 130-250/150-300 grade under trained graduate

teacher and no amount is to be recoverable from under act 14 of 1982

Signature of the

RECOVERIES UNDER ACT 14 OF 1992

Certified that Smt K. Gangamma, Office Subordinate was sanctioned 130-

250/150-300 grade with effect from though she was untrained graduate by
virtue of Court order / Department order claim amount is recoverable from him as per
act 14 of 1992.

The amount has been recovered and recorded in the Service Book at Page No
a)
( )

b) The amount has been recovered

c) Not Applicable
Signature of the
 OPTION FOR GRATUITY UNDER A.P. REVISED
Pension Rules 1980 Under G.O.235, F & P, Dated 01-06-1993 & as per
Amended G.O.Ms.No.14, Finance & Planning, dated 30-01-1999
G.O.Ms.No.157, Fin. & Plg, dated 16-09-1999 and
G.O.(p) No.249, Finance ( Pension-1) Dept., dated 004-10-2005
G.O.Ms.No.51, Fin. & Plg, dated 01-04-2011

I, K. Gangamma D/o Kotaiah holding the post of Office Subordinate in the office of

the Collectorate, Nalgonda, , do hereby elect for calculation of gratuity under A.P. Revised

Pension Rules, 1980 as per the following formula.

i) 1/4 pf pay last drawn for every six monthly period of service subject to the limit

of 16 1/2 months pay last drawn or Rs.80000/- whichever is less

OR

ii) 3/4 pf pay last drawn for every six monthly period of service subject to the limit

of 12/375 months pay last drawn of Rs.175000/- whichever is less

The option hereby exercised is final

Date : 27-05-2020 Signature

Station : Name : K. GANGAMMA

Designation : Office Subordinate

Office in which employed :

Collectorate, Nalgonda, ,

COUNTER SIGNED

HEAD OF THE OFFICE / DEPARTMENT

Note: Strike out whichever is not applicable.