OPTION FORM FOR DIRECT CREDIT OF PENSION THROUGH BANK ACCOUNT Pension information (to be filed in by the pensioner) PPO No, Personnel No. | {from where PPO Original issued) Name of Pensioner/Family Pensioner | Father / Husband Name ‘Spouse/Father /Mother Name Fensioner’s CNC. No. Postal Address Rank/Designation/Grade at the time of Retirement | Ministry / Division/office/Deptt/Centre Existing GPO/NBP with PSB A/C No. Desirous to draw Pension from Bank by Cheque (Under Direct Credit System) Indemnity Bond to the bank "hereby opted to draw a pension through “Direct Credit System” and have olso submited + The pensioner shall produce an indemnity Bond and to keep the bank indemnified about blities with all sums of money whatsoever including mark — up of his/her pension account. ‘The pensioner would further undertake that his/her legal heirs, successor, executor shall be Viable to refund excess amount, if any credited to his / her Account either in full or in installments (as agreed mutually) equal to such excess amount. Pensioner’s Signature / Thumb Impression. _{Account Verification {to be verified by the Bank). Name of Pensioner / Account Tite Name Dated: Mobile NO. of Pensioner: ‘Account No. Branch Name / Address Branch Code Regional / Main Branch Name / Address Regional / Main Branch Code Indemnity Bond submitted by the PensionerINDEMNITY BOND 3 ‘The Manager, ___ (Name of Bank) (Branch & Code) a — a et Jn compliance with the B's instruction for payment of pension through your bank branch | / we agree to indemnify you and keep you indemnified about liabilities with all sums of money whatsoever Including mark ~ up of my Pension Account, The pensioner would further undertake that his / her legal heirs, successor, executor shall be liable to refund excess amount, if any credited to his / her Account either in ful or in installments (as agreed mutually) equal to such excess amount. Co-tndemnifier / Nominee / Successor / Signature . Name of Pensioner Next of Kin: ENIENO. anne Date of Retirement . Address: Z PPO No. Signature: Bank Account No. CNC. No. Witness = 2 CINLC. No. Signature: Date: (Note: The indemnity Bond must be prepared on Stamp Paper valuing Rs. 20/- or more.)