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.