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REOUIRED,!

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

SUB: ENDORSEMENT OF FAMILY PENSION ENTITLEMENT IN THE PENSION


PAYMENT ORDER OF LIVING ARMED FORCES PENSIONERS

With reference to Deptt of pension and pensioners Welfare OM No 1/1U85-p&pW


dated 28.10.87 and Ministry of defence oM No 6(4)/87/r369/B/D(pen/sers) dated
30.6.88. I hereby apply for endorsement of entitlement of family pension in the ppo.
The requisite particulars are given below :-

Name of Pensioner

(ii) Regt No/IC No

(iii) Rank last held

(iv) Date of retirement/discharge

(v) Name of record Office in case


of personnel blow officer rank.
(vi) Original PC/PPO No & year
(in case of pension circular
quote pension circular No, part
apd Qiscriptive Sl No)

(vii) Particulars of Pension


Discharge Authority :-

(a) Station
(b) Treasury IDPDO/IAO/
Bank/Post Office
(c) Bank branch with full address
and SB A/C No

(viii) Particulars of pay last drawn at


the time of retirement.

...2/
2

(ix) Family pension from other sourr:es :


(a) Whether a family pensiorr is already
sanctioned by any other pensiott sanctioning
authority and if so, the name ol the pension
sanctioning authority, PPO No itnd the particulars
of the pension disbursing Authority.
(b) Whether Family is eligible fgr family pension
from any other source and if so, the authority who
will sanction the pension.
(c) In case the family is sanctic ned pension or is
eligible for family pension from anrt other source, an
option to receive family pension fo'the spell of
service for which the pension has been sanctioned vide
PPO/PC No quoted above, foregoing family pension
admissible from any other sources should be enclosed.

(x) Details of family, in terms of pension rules, etigiUte


for family pension.

SI Name(s) and address of Relationship Date of Marital status Date of birth


No members of family with - the marriage (in case of
oensioner dauqhters)

(xi) Attested joint photographs of Smt -----


is pasted above. :

(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.

(xiii) Marks of identification.


Signature of or left hand
Thumb impression of the
Pensioner (in case of
Female Right Hand Thumb)

Witness : Name Full adress Siqnature

1.
,t,.- I
\
4

2.
II
The pafticulars furnished above have been verified from th records available
could be verfied at our end.

(Signature of the eonfeankers)


With officer stamP I
:II
The particulars furnished above have been verified with reference to service per records.
(S ig natu re R/O/Concerned
Service Heaadqua rters.
i IV
';
Ordinary familypension @ Rs, PM sanctioned vide PCDA (P) PPO NO :

{t
..,i,
..;;,
ONLY ONEE COPY REQUTREp

PENSIONER Officer [] Spouse I I Family Pensi'ner |-]


(Tick Category)

Telephone lr ame
Mobile F ddress
C ity
Date :

To

Addl Dte Gen of Manpower (Policy & PlanninSt)/MP 5(b)


Adjutant General's Branch, lntegrated HQ of lloD(Army)
Wing No 3, Ground Floor,West Block-lll
RK Puram, New Delhi-66

NOTIFICATION OF DATE OF BIRTH IN THE PPO FOR ADDITIONAL PENSION


ON ATTAINING 80 YEARS OF AGE AND ABOVE BY OFFICER/SPOUSE/FAMILY
PENSIONERS

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 :-

(a) Details of Officer.


(i) Rank Name
(ii) Service No Date of retirement
(iii) Original PPO No
(iv) Latest Corrigendum PPO No
(v) Date of birth (DD/MMATY)

(b) Spouse
(i) Name
(ii) Date of Birth (DD/MMiYY)

(c) Familv Pensioner(Parents/UnmarriedAl/idowed/Divorced Daughter/ Handicapped


Child) (Only if applicable)
(i) Name
(ii) Date of Birth (DD/MMATY)

(.q) Bank Details (To be ascertained from the Bankersl.


(i) BSR Code of Link Branch
(ii) Link Branch & Address
(iii) Pension Bank A/C No
(iv) BSR Code of Pension Paying Bank
(v) Address of Branch PayinE Pension
(vi) Pension Paying Bank City PIN Code No

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
{
I

Enclosufeg l-

Proof of birth.
Copies of Original and Corr PPOs.