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Name of the Government Servant Fathers/Husband Name Designation Post Held in Date of Birth ZPHIGH SCHOOL
Sri K.VENKATRAO SCHOOL ASSISTANT
THE HEAD MISTRESS ZP HIGH SCHOOL JAGGAPURAM EDLAPADU MANDAL DIST
Date of entering in to Serice
Date of Retirement
EMPLOYEE PAY PARTICULARS
Basic Pay Scale CCA 75 HMA 27700 18030-43630 D.A % GIS PP STO 24.82 60 95 HRA APGLI FPI CHILAKALURIPET
30 125 0
Name of the Pension Disbursing Authority K.L.RAVINDRANADH Permanent Address
pandaripuram d.no.4-4/4 BEHIND SRINIVAS THEATRE CHILAKALURIPET 522616 K.L.Ravindranadh pandaripuram d.no.4-4/4 Behind srinivas theatre chilakaluripet SBI Chilakaluripet 123456465
Address After Retirement
Name of the Paying Bank Branch Name & Code Account. No
K.V.NAGARAJU, ZPHIGH SCHOOL, JAGGAPURAM 9441173101,8121813151
ANNEXTURE-III Dtls of Recoveries certificates LPC THUMB IMPRESSIONS
Name of the Nominee Relation ship with Govt Servant Age 45 Years Full Amount NOMINATION Smt.prameela Wife ANNEXURE-I APPLICATION PART-II(A),(B)
Amount of Share payble
FAMILY MEMBERS DETAILS
Name of the Member Smt.prameela Ramakrishana krishnavamsi Date of Birth 07.05.1963 20.02.1989 04.05.1994 Relationship WIFE SON SON Married/ Unmarried Married Un-Married Un-Married whether Employee or not Yes Not Not
. . Personal Identification Marks 1.Amole on the route of fore finger 2. A mole on the righ Ear
FORM OF APPLICATION FOR SERVICE PENSION / FAMILY PENSION RETIREMENT GRATUITY / SERVICE GRATUITY / COMMUTATION ( To be furnished in duplicate ) G.O.Ms.No. 100,Finance(Pension.I) dated: 06 - 04 - 2010 G.O.Ms.No. 101,Finance(Pension.I) dated: 06 - 04 - 2010
PART - I : Information to be furnished by Government Servant / Applicant
( The Pension Sanctioning Authority shall forward the application duly processed to the A.G.( A & E ) / L.F. Authority within a period of 30 days )
a) Name of the Government Servant b) Post held
SCHOOL ASSISTANT ZPHIGH SCHOOL JAGGAPURAM
Name of the applicant ( In case of death of Govrnment Servant ) Permanent Address
K.L.RAVINDRANADH SCHOOL ASSISTANT ZPHIGH SCHOOL JAGGAPURAM, EDLAPADU (MANDAL) GUNTUR(DIST) K.L.RAVINDRANADH pandaripuram d.no.4-4/4 BEHIND SRINIVAS THEATRE CHILAKALURIPET 522616
Address after retirement
Commutation of Pension a) Whether willing to commute 1/3 rd or 40% of monthly pension subject to AP Civil Pension (Commutation) Rules,1944 YES / NO Willing 40% to commute, i.e.,
b) If the answer is 'NO', specify the fraction less than 1/3 rd
a) Name of the Pension Disbursing Authority
b) Name of the bank paying from where Pension Payment is desired by the Pensioner/Family Pensioner/Gratuitant
Name of the Bank and Branch & Code SBI,Chilakaluripet
List of Family Members
Marital / Employment status of the children of the applicant/ deceased Govt.Servant
Relationship with the Government Servant
Name of the Family member
Date of Birth
Whether employed or not; Give details of employment
1 2 3 4 5
Smt.prameela Ramakrishana krishnavamsi 0 0
Yes Not Not 0 0
20.02.1989 Un-Married 04.05.1994 Un-Married 0 0
Instructions: 1. The Government servant is instructed to fill up the proforma very 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. The "family" for the purpose mean "wife" or "husband" as the case may be, "son" and "Unmarried daughters" as laid down in Rule 50(12)(for Family Pension) and Rule 46 (5)(for Gratuity) of A.P.Revised Pension Rules, 1980. In case of death while in service of the Government Servant, the answer "Married" in case of daughter will be understood that the daughter is already marriedas 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 excess of the amount to which I was entitled under the Rules. I solemnly affirm that the particulars given by me in Part-I 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. 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: JAGGAPURAM Date: 27/Jul/2011 Signature of the Government Servant / Applicant (K.L.RAVINDRANADH) SCHOOL ASSISTANT ZPHIGH SCHOOL JAGGAPURAM, EDLAPADU (MANDAL)
TO BE FILLED IN BY THE HEAD OF THE OFFICE
Application for Pension / Gratuity etc. in Part - I is received on ____________________ ( date to be recorded )
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.
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. ----
Name 1) -------
Date of Birth
Place: JAGGAPURAM Date: Signature of the Head of the Office
PART - II ( A ) : Information to be filled up by the Pension Sanctioning Authority
1. Name of the Government Servant and Post held
K.L.RAVINDRANADH SCHOOL ASSISTANT ZPHIGH SCHOOL,JAGGAPURAM K.VENKATRAO
Father's Name / Husband's Name Name of the Applicant ( In case of death of Government servant ) Date of Birth of the Govt.Servant
Date of entering in to service
SCHOOL ASSISTANT ZPHIGH SCHOOL JAGGAPURAM, EDLAPADU (MANDAL) GUNTUR(DIST) Rule 33 Superannuation Pension (Rule 42) Rule 34 Retiring Pesion (Rule 43/44) Rule 35 Pension on absorption under a corporation Rule 37 Invalid Pension Rule 38 Compensation Pension Rule 39 Compulsory Retirement Pension Rule 40 Compassionate Retirement Pension Rule 43 Retirement on completion of 20 years of qualifying service Rule 44 Retirement on completion of 33 years of qualifying service Rule 46 Retirement Gratuity Rule 50 Family Pension YES / NO YES / NO
Date of Retirement / Death Designation and office from which the Govt.Servant retires/retired/died
The rule applicable: a) The relevant Rule under the A.P.Revised Pension Rules, 1980 applicable ( tick the rule numbers applicable and strike out the rest )
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 9. TOTAL SERVICE ( 6 - 5 )
NIL 27Years -1Months- 19Days
10. Period of non-qualifying service a) E.O.L. ( Exceeding 3 Years ) b) Suspension Period c) Dies - Non d) Boy Service e) Any other service not qualifying for pension Total Non-Qualifying Service ( a to e )
NILL NILL NILL NILL NILL NILL NILL
11. 12. 13. 14.
Net qualifying service ( 9 - 10 ) Weightage, if any Total qualifying service for calculation pension ( 11 + 12 ) Last Pay drawn ( Rule 31,46(4),50(12)(c) of APRPRs,1980) Para 4 of G.O.Ms.No. 87,Fin.&Plg(FW-Pen.I)Dept.dt:25-05-1998 Calculation of Service Pension / Service Gratuity(Rule 45 of APRPRs,1980) Calculation of Retirement/death Gratuity (Rule 46 of APRPRs,1980) Calculation of Family Pension a) Enhanced Family Pension b) Normal Family Pension
27Years -1Months- 19Days 5.Years 32 Years 1 Months 19 Days Years
/ Rs 27700/-
Rs 13431/27700x64/66x1/2 =13431
(B.P x Service Units /66 x 1/2 B.P: Rs 27700, DA@24.824%= Rs 6876 ( 27700+6876) x 64 x1/4 = Rs 553216 .
Rs 13431/Rs 8310/(B.Px30/100)
Period of Payment of Pension a) Service Pension b) Enhanced Family Pension c) Normal Family Pension From From From
As applicable to the case under consideration
till death to to
Government dues to be recovered in respect of
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 Govt.Quarters 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 Issuing Authority. Amounts for recovery should be specified and should be in whole rupees. Absence of information will be understood as no dues for recovery.
L.P.C. enclosed / L.P.C. will be sent after retirement
PART - I I ( B )
SANCTION OF PENSION
a. Certificate of competency to accord Sanction ( applicable in case of sanction of Pension to non-gazetted officer including Class - IV employees ) : I am declared by the Head of the Department to be the Head of Office to accord sanction in this case under the powers delegated vide G.O.Ms.No.262, Finance & Planning (FW-PSC) Department, dated: 23.11.1998. I am the next Gazetted Authority in the heirarchy to the Head of Office in this case who is a non-gazetted Officer and hence, I am competent to accord sanction under the powers delegated vide G.O.Ms.No.262, Finance & Planning (FW-PSC) Department, dated: 23.11.1998. ( Strike off whichever is not applicable ) b. SANCTION ORDER : Pensionary benefits including commutation found admissible under the rules may be authorised. 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) ii) Service Pension: Retiring Gratuity:
Rs 13431/( 27700+6876) x 64 x1/4 = Rs 553216 .
iii) Commutation: iv) Family Pension a) b) Enhanced Family Pension Normal Family Pension
(Rs 13431/-x40/100)x12x9.182=Rs 591909/--
Rs 13431/Rs. Rs
Office Seal: Date:
Signature and Designation of Pension Sanctioning Authority
Note 1 :
Note 2 : Note 3 : Note 4 :
Note 5 :
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 the Accountant General / Local Fund Audit Officer. The Pension sanctioning Authority should satisfy about the correctness of the particulars of family furnished by the Government Servant / Applicant in Part - I. If the Pensionary benefits are not to be released, Part - I I (B)(b) shall be struck off. 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. Heads of Departments are those listed in Appendix-I mentioned in Article 6 of A.P.Financial Code Volume-I / Subsidary Rule 32 (ii) of FR 9.
ANNEXURE - I
A. SPACE FOR PHOTOGRAPHS:
Service Pensioner / Family Pensioner / Gratuitant / Guardian of Minor or Handicapped Child.
Joint Photo of Service Pensioner with Family Pension beneficiary / Guardian with Minor or Handicapped child.
( Attestation has to be done across the Photoes by a Gazetted Officer of A.P.Government Service )
SPECIMEN SIGNATURE OF : Service Pensioner
Specimen Signature of Sri/Smt/Kum. Son / Wife / Daughter of
Family Pensioner / Gratuitant / Guardian of Minor or Handicapped Child :
Specimen Signature of Sri/Smt/Kum
PERSONAL IDENTIFICATION MARKS OF : Service Pensioner: Sri/Smt/Kum 1) K.L.RAVINDRANADH
Family Pensioner / Gratuitant / Guardian of Minor Handicapped child : Sri / Smt / Kum. Smt.prameela
LEFT HAND THUMB AND FINGER IMPRESSION OF SERVICE PENSIONER / FAMILY PENSIONER / GRATUITANT / GUARDIAN OF MINOR OR HANDICAPPED CHILD :
( to be given by the illeterate or those unable to sign and for others it is optional )
Guardian of minor/ Handicapp ed child
Place : JAGGAPURAM Date:
Attested by Signature:
Office Seal :
(Attestation has to be done by a Gazetted Officer of A.P.State Government Service )
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.
ANNEXURE - I I
( 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 which having become admissible to me on retirement which may remain unpaid of my death.
1. Name and address of Nominee (s)
2. Relationship with the Government Servant
4. Amount of share payable to each in column - 1 5.Contingencies on the happening of which the nomination shall become invalid ( Death need not be mentioned ) 6.Name and address, relationship and age of alternative nominee(s) to whom the right conferred on the nominee(s) in Col.1 shall pass in the event of the nomination to him/her/ them becoming ineffective.
7. Amount of share payable to each in Col.6
== NOT APPLICABLE ==
This nomination supercedes the nomination made by me earlier on_________________ Note: The Government Servant shall draw lines across the blank space below the last entry to prevent the insertions of any name after he/she has signed.
Dated this ………………………… day of …………………… ,200….. at ………………………………………………………………………….. WITNESS: 1. Signature, Name and Address :
2. Signature, Name and Address :
Signature of the Government Servant Name : K.L.RAVINDRANADH Designation: SCHOOL ASSISTANT
ZPHIGH SCHOOL JAGGAPURAM EDLAPADU (Mandal)
GUNTUR (District) "Countersigned" Signature of the Head of Office/Department : Date: Name and Designation: Office Seal:
Note:1) Note:2) Note:3) Note:4)
The Government Servant who has a family may nominate one member or more than one member or the family as defined in Rule 46(5) of AP Revised Pension Rules, 1980. The Government Servant who has no family may nominate a person or persons, or a body of individuals, whether incorporated or not. The Government servant may note that the nomination with signature of two witnesses shall only have the legal validity of WILL. 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 Accountant General/ Local Fund Audit Officers. For the purpose of Rules 46,47, and 49 of AP Revised Pension Rules,1980, Family in relation 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, adopted daughters ( whose personal law permits such adoption ) v) Widowed daughters including step daughters and adopted daughters. vi) Father including adoptive parents in the case of individuals whose personal law permits 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 pre-deceased son.
ANNEXURE - III
BY REGISTERED POST
From: THE HEAD MISTRESS ZP HIGH SCHOOL JAGGAPURAM EDLAPADU (Mandal) GUNTUR (District) ( Pension Sanctioning Authority )
To The Accountant General ( A & E ), Andhra Pradesh, Hyderabad - 4.
( Disciplinary Authority / Appointing Authority / Head of the Department )
Sub:- Pension - Sanction of Pension and other Retiring Benefits in respect of Sri / Smt / Kum. K.L.RAVINDRANADH ,Designation, SCHOOL ASSISTANT, ZPHIGH SCHOOL, JAGGAPURAM. Regarding
***** I am to inform you that the Pension / Family Pension application form of Sri./Smt./ Kum./ K.L.RAVINDRANADH retired / retiring on 29.11.2007 as SCHOOL ASSISTANT was forwarded to AGAP / LFA on _______________________ as per the records held by me, no disciplinary / Judicial proceedings are 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 withdrawing 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), AP, 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 with holding pensionary benefits as contemplated in Govt.Memo No.33764-A/55/PSC/93, Fin.& Planning (FW-PSC) Department, dated: 15-10-1993 and reiterated in Govt.Memo.No.3725/ 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 with holding 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, dated: 23-11-1998 may be scrupulously followed.
Station: JAGGAPURAM Date: PENSION SANCTIONING AUTHORITY THE HEAD MISTRESS ZP HIGH SCHOOL JAGGAPURAM
Appendix - 2 ( Refered to Paper 21-1 ) See Article 62, Hyderabada Civil Service Regulations, NEW APTC 161 Any Pay Manual of Pension 1975, see page No. 67
LAST PAY CERTIFICATE
1. 2. Last Pay Certificate of He has been paid upto Scale of pay K.L.RAVINDRANADH, SCHOOL ASSISTANT of the ZPHIGH SCHOOL JAGGAPURAM
29.11.2007 at the following rate: 18030-43630
Deductions Rs.60=00 Rs.125=00 Rs.200=00
Basic Pay HRA D.A24.824% CCA FPI PP HMA OTHERS TOTAL
PARTICULARS: Rs.27700=00 Rs.2770=00 Rs.6876=00 --Rs.95=00 Rs.75=00 Rs.37516=00
GIS APGLIS PT
He made over charge of on the after noun of
SCHOOL ASSISTANT 29.11.2007
Recoveries are to be made from the pay of the Government Servant as detailed on the recoveries. He has been paid leave salary as detailed above Deductions has been made as : PERIOD From From From RATE AMOUNT
_______________ to _____________________ to Rs. ___________ a month. _______________ to _____________________ to Rs. ___________ a month. _______________ to _____________________ to Rs. ___________ a month.
6. 7. 8.
He is entitled to draw the following : He is also entitled to joining time for _______________________________________ The details at the Income-Tax recovered from him/her upto the date from begininig to the current year are noted on the recovers.
DETAILS OF RECOVERIES
Name of the Recover ________________________________________ Amount of Rs. ______________________________________________ To be recovered in __________________________________ installments.
EDUCATING MADE FOR THE LEAVE SALARY
From ___________________ to _________________ to Rs.__________ a month.
From ___________________ to _________________ to Rs.__________ a month.
From ___________________ to _________________ to Rs.__________ a month. Fund and other deductions Rs. Ps.
Name of month Rs. Apr-200 May-200 June-200 July-200 Aug-200 Sep-200 Oct-200 Nov-200 Dec-200 Jan-200 Feb-200 Mar-200
Gratuity Fee etc. Rs. Ps.
Amount or Income Tax recovered Rs. Ps.
NO ALLEGATIONS OF PENDING CHARGES CERTIFICATE This is to certify that there are no any kind of allegations or pending charges against Sri./Smt./Kum K.L.RAVINDRANADH, SCHOOL ASSISTANT of the ZPHIGH SCHOOL JAGGAPURAM
NO AUDIT OBJECTIONS CERTIFICATE This is to certify that there are no any kind of Audit Objections / paras pending against Sri./Smt./Kum. K.L.RAVINDRANADH, SCHOOL ASSISTANT of the ZPHIGH SCHOOL JAGGAPURAM
NO DUES CERTIFICATE This is to certify that there are no any kind of dues to be recovered from Sri./Smt./ K.L.RAVINDRANADH, SCHOOL ASSISTANT of the ZPHIGH SCHOOL JAGGAPURAM EDLAPADU (MANDAL) 1) 2) Sales proceedings of A.P Trading Corporation. Nationalised Text books and note books as they are not supplied/supplied to him
NON - SUSPENSION CERTIFICATE This is to certify that Sri./Smt./Kum/ K.L.RAVINDRANADH, SCHOOL ASSISTANT of the ZPHIGH SCHOOL JAGGAPURAM EDLAPADU (MANDAL) has not been suspended any time during his/her service from 10.10.1980 to 29.11.2007
S/o K.VENKATRAO to be retired as ZP HIGH SCHOOL JAGGAPURAM do hereby declare that, if any amount found to be excess paid, due to erroneous calculation, noticed at a later date, I shall be ready to refund the same without any objection in the matter.
SCHOOL ASSISTANT from the office of
Station: JAGGAPURAM Date: "ATTESTED' Drawing Officer Pensioner K.L.RAVINDRANADH SCHOOL ASSISTANT ZP HIGH SCHOOL JAGGAPURAM
OFFICE OF THE ZP HIGH SCHOOL JAGGAPURAM Rc.No. From: THE HEAD MISTRESS ZP HIGH SCHOOL JAGGAPURAM EDLAPADU (Mandal) GUNTUR (District) Sir, Sub:- Forwarding of Pension Papers of Sri K.L.RAVINDRANADH SCHOOL ASSISTANT ZP HIGH SCHOOL JAGGAPURAM Regarding. -x-x-x-xI am herewith forwarding the advance Pension Papers in quadruplicate of K.L.RAVINDRANADH, SCHOOL ASSISTANT of the ZPHIGH SCHOOL JAGGAPURAM EDLAPADU (MANDAL) who is to retire on 29.11.2007 The following documents are sent herewith for authorising pensionery benefits of the pensioner. 1. Part - I : Information of the applicant. 2. List of the Family Members of the applicant. 3. Declaration. 4. Proforma to be filled in by the Head of Office. 5. Part - II ( A ). 6. Part - II ( B ). 7. Annexure - I : Descriptive rolls and ABCD. 8. Annexure - I : Nomination. 9. Annexure - III 10. Last Pay Certificate. 11. i) No allegations and pending charges certificate. ii) No audit objections certificate. iii) Other necessary certificates. 12. Service Register of the pensioner. Date: To The Accountant General ( A & E ), Andhra Pradesh, Hyderabad - 4.
The receipt of the advance pension papers alongwith Service Register may please be acknowledged and necessary arrangements may please be made for issue of Pension Payment Order, Gratuity Payment Order and Commutation Authorisation.
THE HEAD MISTRESS ZP HIGH SCHOOL JAGGAPURAM Copy to : Sri K.L.RAVINDRANADH ZP HIGH SCHOOL