APPLICATION FORM FOR REVISION OF PPO

1. Name of the Applicant :-………………………………………………………………………

(In block letters)
2. Full postal address :- ………………………………………………………………………
3. Name of tha Railway pensioner :- ………………………………………………………………………
4. Designation & Department :- ………………………………………………………………………
5. Date of Retirement :- ………………………………………………………………………
6. Death of Railway Servant :- ………………………………………………………………………
7. Name of the Spouse :- ……………………………………………………………..……….
:- (DOB With Proof)………………………………………….
8. (i) Unmarried Daughter :- ………………………………………………………………………
(ii) Widow/ Divorce Daughter :- ………………………………………………………………………
9. (i) Aadhar Number Pensioner :- ………………………………………………………………………
(ii)Adhaar Number Family Pensioner :-……………………………..……………….………………
10. Pensioner’s PAN Number :- ………………………………………………………………………
11. Pensioner’s Email ID :- ………………………………………………………………………
12. Pay at the time of Retirement.
Scale :- ………………………………………………………………………
13. PPO No. :- ………………………………………………………………………
14. Name of the Authority which :- ………………………………………………………………………
issued PPO(enclose copy) ………………………………………………………………..………
15. Name of the Bank & Address :-………………………………………………………………………

16. A/C No. :- ………………………………………………………………………

17. Documents required

(a) Copy of PPO at the time of retirement
(b) Revised PPO as on 01/01/96, 01/01/2006
(c) Proof of date of birth of spouse & dependants
(d) Copy of Adhaar Card of Pensioner & Spouse
(e) Copy of PAN Card.

Signature

(Pensioners/Family Pensioner/Dependent)

Mobile No. ……………………………………………….