b;FORM - 7

[See Rules 62, 63 (6), 66 (1), 68, 69 (2) & (3), 71 (1) & 73 (1) & (7)]
Form for Assessing Pension and Gratuity
PART – I
1
1. Name of the Mpl. Employee - ANURADHA KHANNA
(in block letters)
2. Father’s name (and also 15/08/1955’s in - Lajpat Rai Khanna
the case of a female Mpl. Servant)

3. Date of birth (By Christian era) 03/08/1962

4. Permanent residential address - H. No. 443-444, Double Story, New
showing village/town/district and state Rajinder Nagar, Delhi-60
5. Present or last appointment including
Name of Est
(i) Substantive
(ii) Officiating, if any Substantive

6. Date of beginning of service - 05/01/1988

7. Date of ending of service - 31/08/2022
8. (i) Total period of military service - -No-
for which pension/gratuity was
sanctioned
(ii) Amount and nature of any - -No-
pension/gratuity received for
the military service
9. Amount & nature of any pension - -No-
/gratuity received for previous civil
service

10. Govt. under which service in Col. 8 has - NA

been rendered in order of employment

11. Interruption and non-qualifying service - NA

under the Corpn

12. Length of qualifying service under the - Y--M—D

Corpn. as per part-II
13. Date from which pension is to be - 01/09/2022
commence
14. Detail of Government dues recoverable - Not recovery
out of gratuity---
License fee for the allotment of
Government accommodation No.
[See sub-rules (2), (3) and (4) of Rule
72]

15. Details of amount still outstanding Dues - Nil

referred to in Rule 73

\16. Date of death in case of family pension - NA

17. G. P. F. No. - CR-83744

PTO

-2-

18. If the department or judicial proceedings are - No RDA of Police case

 instituted against the municipal servant against him
before retirement whether it is prepared to
draw full pension, if not state the deduction
in percentage of the full pension.

Place: Sig. of Head of the Office

Date:

PART-II
Details of service showing in chronological order, including period of
interruption/non-qualifying services/service not verified with reference to the
payment record or service book (service in Pakistan admitted by the deptt. may be
shown distinctively).
Sh./Sh./Km. Anuradha Khanna

Date of Birth : 03/08/1962

Deptt. Apptt. Officiatin Date of Date of Period of Period Remar

g/ beginning ending non-qual- of net ks
substanti of service of fying quail-
ve service service fying
service
Substantive

31/08/2022
Education

05/01/1988
Principal
Deptt

-Nil- Y--M--D

1 2 3 4 5 6 7 8

1. Total period of services - Y--M--D

2. Total period of non-qualifying service - Nil
3. Total length of qualifying service- Y--M--D

Service which qualifier for pension date of beginning and date of ending of such
service should be indicated :
(2) The Sanctioning Authority should record briefly in Col. 8 his
rePrincipalns for disallowing any service claimed.
PART-III
Audit Enfacement/Payment Order

1. Class of Pension -

2. Amount of Pension per month -

3. Amount of family pension -
4. Amount of D.C.R.G. -

5. Date of cessation family Pension at -

enhanced rates

6. Date of cessation of family Pension -

payable to minors

7. Date of commencement of pension -

Dy. Chief Accountant

Municipal Corporation of Delhi

4 To be submitted in Triplicate
 MUNICIPAL CORPORATION OF DELHI
(OFFICE OF THE O.A.-CUM-F.A.)

OPTION FORM

I, Anuradha Khanna, Wife/Son/Daughter of Lajpat Rai Khanna Opt to draw

my pension through bank and give below necessary particulars to enable you to
make arrangements in this regards
Particulars of Pensioner:-

(a) Name (In Block Letters - Anuradha Khanna

(b) P.P.O. No -
(c) Present Address - H. No. 443-444, Double Story,
New Rajinder Nagar, Delhi-60

Particulars of Authorized Bank

(Punjab National Bank in Delhi or
PNB BANK in all over India)

(a) Name of the Bank - PNB

(b) Branch where payment desired - New Rajinder Nagar Delhi-
110060
(c) Pensioner’s Saving/Current - Pensioner Saving account
Account No at the Branch to
which pension is to be credited
0991000100411888
PUNB0062900
110024071

(Signature of D.D.O. (Signature of Pensioner)

With Official Seal)

Dated………………
 MUNICIPAL CORPORATION OF DELHI
EDUCATION DEPARTMENT, KAROL BAGH ZONE

NO.D /ADE/KBZ/2022 Dated_________

2

OFFICE ORDER

Sub:- Payment of Leave encashment Smt. Anuradha Khannar, MC Pry School,

MC Pry School, R-Block, New Rajinder NagarEducation deptt Karol bagh Zone
his/ /retired on 31/08/2022

Smt Anuradha Khanna , working was a Principal in MC Pry School, R-Block,

New Rajinder Nagarretired on 31/08/2022. As per records he/she has Earned leave
due = days and HPL due on = Total leave______________ which is
encasheble at his/her credit. Administrative approval has already been accorded
by DC/KBZ dated___________ for payment of leave encashment which is attached
alongiwith.

Hence it is requested that days Earned Leave which is encashable may be paid
to Smt. Anuradha Khanna as per rules.

Total Earned Leave due as on 31/08/2022 = days

Total Half Pay Leave (HPL) due as on 31/08/2022 = days

Asst Chief Accountant

ADE/ DDO/ KBZ
 FORM OF APPLICATION FOR COMMUTATION OF PENSION WITHOUT
MEDICAL EXAMINATION (UNDER MINISTRY OF FINANCE OFFICE
MEMORANDUM NO. 14(5)-EV(A)/76 DATED DECEMBER 1977)

The Deputy Director Education

Deptt Karol Bagh Zone

Affix here a
passport
Subject :- Commutation of Pension without Medical Examination. size photograph

Sir, Duly
attested by
I furnish below the relevant particulars and request that I may be
permitted to commute a part of my pension and photograph is pasted Head of
on this application and an unattested copy in enclosed :- Office

1. Name in Block letters - Anuradha Khanna

2. Date of Birth - 03/08/1962

3. Date of superannuation on attaining - Superannuation

the age of 58 years (or 60 years in the
case of Group ‘D’ employees )

4. Designation post held at the time of - PRINCIPAL, Edu Karol Bagh

superannuation and the name of the Zone
Deptt
5. Amount of pension sanction and - Final
whether it is provisional or final

6. Class of pension defined in Chapter-V - Superannuation

of the CCS (Pension) Rules, 1972

7. Name of the treasury through which - ACA/KBZ

the pension is being drawn

8. Name of the treasury through which - ACA/KBZ

the commuted value is desired to be
paid
9. Designation of the Accounts Officer - ACA/KBZ
and the number and date of the
P.P.O., if issued

10. Amount (In whole rupees) or - 40%

percentage pension proposed to be
commuted
 -2-

11 Amount (In whole rupees) or - 40%

percentage pension proposed
to be commuted

Place ; New Delhi Signature

Full Postal Address

Dated : 2019

Note:- The photographs are required to be submitted if the pension is desired otherwise
then through the account Officer of the Ministry/Departments/ Office from which
the Government Servant retired.

PART-II

Forwarded at the Account Officer (Pension) for authorising the payment of

the Commutation.

Signature
Name & Address of the
Head of Office

Signature__________________

Name & Address of the

Head of Department
 2
NORTH MUNICIPAL CORPORATION OF DELHI

Left/Right thumb and fingers impression of Sh. Anuradha Khanna,

Principal, Education deptt karol bagh zone retired on 31/08/2022

1. Date of birth - 03/08/1962

2. Height - 5’ 4” Feet

3. Personal Marks , If any , on had of face - A burn mark over back of RT.
Elbow joint.
4. Left hand thumb and finger impression :-

Small Right Middle Index Thumb

Finger Finger Finger Finger
 FORM--3
(See Rule 54 (12)
Details of Family

Name of Municipal Servant - Anuradha Khanna

Designation - Principal

Date of Birth - 03/08/1962

Date of Appointment - 05/01/1988

Details of the members of my family as on - 31/08/2022

S. Name of the Members Date of Relationship Initial of Remarks

No. of the family* Birth with the Officer the head
of
officer
1 2 3 4 5 6

1 Naveen Khanna 03/08/1962 Brother

I hereby undertake to keep the above particulars upto date by nothing
to the head office any addition or alteration.

(Signature of Mpl. Servant)

Place: - New Delhi

Dated:-

DDO/KBZ

*Family of the purpose means family as-defined in clause (b) of sub-rule (4)
of Rule 54 of the C.C.S. (Pension) Rules 1972.

Note: - Wife and 15/08/1955 shall include respectively judicially separated wife and
15/08/1955.

0FORM-5
[See Rule 59 (1) (c) and 61 (1)]
 Particulars to be obtained by the head of Office from the retiring Municipal
Servant eight months before the date of his retirement.

1. Name - Anuradha Khanna

2. (a) Date of Birth - 03/08/1962

(b) Date of retirement/Death - 31/08/2022

3. Two specimen signature duly - Attached

attested (to be furnished in a
separate sheet) duly attested by a
Gazetted Government Servant

4. Two slips showing the particulars of - Attached

height and personal identification
marks duly attested

5. Three copies of passport size joint - Attached

photographs of the Mpl. Servant
with his/her wife/15/08/1955

6. Address after retirement - As under

7. Present Address - H. No. 443-444, Double

Story, New Rajinder
Nagar, Delhi-60
8 Details of the family in Form-3 - Attached

Signature _________________

Designation :- PRINCIPAL
DDO/KBZ Deptt./Office :- Edu/ KBZ

Two slips each bearing the left hand thumb and finger impressions duly
attested. May be furnished by a person who is not literate enough to sign his name.
If such a Mpl. Servant on account of physical disability is unable to give left hand
thumb and finger impression, he may give the thumb and finger impressions of the
right hand. Where a Mpl. Servant has lost both hands he may given his toe
impressions, Impression should be duly attested.

Only 3 copies of passport size photographs of need be furnished. If the Mpl.

Servant is government by Rule 54 of CCS (pension) Rules, 1972.Where it is not
possible for a Mpl. Servant to submit a photograph with his wife/her 15/08/1955,
he/she may submit separate photographs. The photograph shall be attested by the
Head of Office.

Any subsequent change of address should be notified to the Head of

Office/audit Office.

Applicable only where Rule 54 of the CCS (Pension) Rules, 1972 applies to
the Mpl. Servant.
 CONSOLIDATE NO DUES

Certified that nothing is due against Sh/Smt/Km of Smt Anuradha Khanna,

Principal, MC Pry School, R-Block, New Rajinder Nagar, retired/expired on
31/08/2022 except the followings

This certificate is issued on the basis of No Dues Certificates received from

all the concerned departments. It is further certified that no enquiry/R.D.A. is
pending against Sh/Smt/Ku Anuradha Khanna, Principal and also certified that no
municipal accommodation was allotted to him/her.

DDO/KBZ

Office Seal __________________

__________________

__________________
 FORM-6
[See Rules 60(1), 6393), 69 & 73(70]

Form of order Intimating Reduction or No Reduction in the Amount of

Pension

1. Name of the Municipal Servant - Anuradha Khanna

2. Father’s/Husband name (also - Lajpat Rai Khanna

15/08/1955’s name in case of female
municipal Servant)

3. Present or last appointment including - (i) Substantive

name of establishment (ii) Officiating, if any

4. Order of the authority concerned in - As per CCS Pension

terms of Rule 6 of the C.C.S. Rules 1972
(Pension) Rules

The undersigned having satisfied himself that the service of Sh./Sh./km

Anuradha Khanna has been satisfactory, hereby orders that no reduction in
the amount of pension/death-cum-retirement gratuity/service which may be
determined under the C.C.S. (Pension) Rules, 1972 shall be made.

(i) Drawing & Disbursing Officer (ii) Signature & Designation of

Appointing Authority

Designation : …………………….

_____________
Office Seal : …………………….. DC/ KBZ
(Authority to whom power has been
Delegated under sub-rule (2) of
Rules 6 of the C.C.S. (Pension)
DDO/KBZ Rules, 1972.

*Delete whichever is not applicable

OR
The undersigned having satisfied himself that the service of
Sh./Sh./Km__________________ has not been satisfactory hereby orders that the
full pension or gratuity or both which may be determined under the C.C.S. (Pension)
Rules, 1972 shall be reduced by the specified amount or percentage indicated
below :-

Amount of reduction in the Pension……………………………………………….

Amount of reduction in the Gratuity ………………………………………………

Signature and designation of

the Appointing Authority
 Photocopy attested
Bank A/C No

FORM-I

(As referred to in para (II) of the Accountant procedure )

M.C.D Employees Group Insurance Sheme-1980

Receive a sum of Rs __________ (Rupees ______________________________

__________________________) being the told entitlement of
Rs _____________ From the Insurance fund /or of Rs_________________
Form the saving fund accrued to.

Name : Anuradha Khanna

Designation : PRINCIPAL
Group of insurance Scheme 1980
Date of Membership-
Date of retirement/ expired - 31/08/2022
Date_____________ Signature(s) of Recipient

Name in block letters

_________________

For use in Department Office

Relevant Bio- Data of the Member:-

1. Type of the Group of the Member (i.e lowest group)
D/C/B/A of in dally joining the scheme on 1.1.92 year of

2. requiring member of higher Group.

C-19______________
D-19______________
A-19______________
Amount due (detailed calculated to be given
(a) Amount due (detailed calculated to be given)
(b) Amount of subscription.
(c) Amount of interest .
(d) Total (a) +(b)
(e) Countersigned for payment of Rs _______________to claimed
crossed cheques/ Demand Drafts to issue in favour of _________.

Signature _________
Dated_____________
 1

FORM-I

Dy Director Education
Karol Bagh Zone

Sub :- Application for payment of accuinuuation under MCD Employee

group Insurance scheme, 1980.

Sir,
I have been a member of MCD Employee Group of Insurance Scheme ,
1980 since 01/01/1989 to 31/08/2022 I have retired from service I have ceased
to be in employment with the Municipal Corporation of Delhi wef 01/01/1989 to
31/08/2022 I was holding the post of Principal . Before retirement / cessation
of the employment with the municipal corporation of Delhi . I request that the
amount due to me under MCD employee Group Insurance Scheme to be paid to
me.

Destination & Address of : Principal Your’ Faithfully

The office

Month & the Year of becoming a

Residence address

Member of the Scheme may be

Indicated here.

G.P.F No CR-83744
-----------------------------------------------------------------------------------------------------------
CERTIFIED THAT:-

Sh./Smt. Anuradha Khanna was enrolled as member of the Group

Insurance Scheme 1980 wef 01/01/1989 to 31/08/2022 and he/she remained
member of that scheme till the date of hi/her retired i.e 31/08/2022.

Regular deduction of GIS subscription of Rs_______________ per month

was made out of the salary of Sh/Smt Anuradha Khanna wef 01/01/1989 to
31/08/2022 and not arrears to this effect are outstanding.

DDO/ KBZ
-----------------------------------------------------------------------------------------------------------
Certified that there are no arrears on account of subscription towards GIS
against Sh/Smt Anuradha Khanna retired on 31/08/2022. According to register
‘G’ maintained as per para 5 of the accounting procedure circulated vide No
CA/F&G/82/224 dated 12/01/1982.

Asst Chief Accountant

With seal
 Sh. Satbir Singh, ASO
Education Deptt Karol Bagh Zone
REG:- Terminal Benefits
DOR- 31/12/2020
 E.C.S PERFORMA
EDUCATION DEPTT, KAROL BAGH ZONE

4
FATHER’S/ NAME OF
GPF NAME OF TYPE OF 9 DIGIT CODE/
OFFICE DEPTT 15/08/1955 BANK & ACCOUNT NO REMARKS
No EMPLOYEE ACCOUNT IFSC
NAME BRANCH

New Rajinder Nagar

Anuradha Khanna

Pensioner Saving
0991000100411888
Karol Bagh Zone

Lajpat Rai Khanna

Education Deptt/

Delhi, 110060
PNB Bank

Account

PUNB0062900
CR-83744

110024071
DDO/KBZ
 FORM—A 3

(See Rule 5)

To
Pension Disbursing Authority/Head of Office,
(Name of Bank/Treasury/Post Office/Accounts Officer etc.)

Place : Delhi
I, Anuradha Khanna, (Name of Pensioner) hereby nominate the person name below
under rule 5 of the Payment of Arrears of Pension (Nomination) Rules. 1933.

1. Name and address of the nominee - Naveen Khanna

2. Relationship with pensioner - Brother

3. Date of birth - 03/08/1962

4. If nominee is minor - NA
Name and address of person who
may receive the said pension during
the nominee’s minority

5. Name and address of the other - NA

nominee in case the nominee under
column (i) above predecessor the
pensioner

6. Relationship with pensioner - NA

7. Date of birth - NA

8. Name and address of who may - NA

receive the pension during the other
nominee ‘s minority

9. Contingency on happening of which - NA

nomination shall become invalid

Place____________ Signature (or thumb

Date____________ impression if illiterate) and
Witness : Signature___________________ name of pensioner
Name & Address ___________________

Signature of Pension Disbursing Authority/

Head of Office.
(Acknowledgement to be sent by the Pension Disbursing Authority/Head of Office)
Certified that application/nomination has been received from________________
(name of pensioner) whose address is ________________________________

Signature of Pension Disbursing

Authority/Bank/Treasury/P.O./
Place……………… Accounts Officer/Head of Office

Date………………. Full Address…

 Form CE-I (G-13)
MUNICIPAL CORPORATION OF DELHI
CONTINGENT BILL

A-Bill No : `
B-Detailed Bill of
contingent Charges Head of Account :
Total Allocation :
Mont
Acc Head of h of Previous Expenditure :
oun Account ____ Expenditure of this Bill :
t Chargea ____
Cod ble ____ Total upto date expenditure:
e
No of
Vouc
her_
____
___

S. Descripti Amou
N on of nt
o charges
of , number Rs
S & date of P.
ub authority
– of all
V charges
ou requiring
ch special
er sanction

An
amount
is to be
paid to
Sh.
Anurad
ha
Khanna,
PRINCIP
AL,
Educati
on Deptt
Karol
Bagh
Zone ,
retired
on
31/08/20
22 on
account
of
pension
commut
ation bill
against
PPO No
_______
_____/K
BZ
 PNB, Sector -12 A, Dwarka, Delhi-
110075
A/C No - 4765000100087714
MICR No – 110024450
IFSC-PUNB0476500
Total in words: Gross (A)
Less : Deductions (T.D.S, others (B)
Net (A-B)

Paid from Bank Account__________ Challan No __________Account___________

Received payment
Paid to Bank Account _____________ No
Name_________________
Dated_____________
Office__________________

Note:- Certificate on the back of form CE-1 (G-13) needs no revision

Form CE-I (G-13)

MUNICIPAL CORPORATION OF DELHI
CONTINGENT BILL

A-Bill No : `
B-Detailed Bill of
contingent Charges Head of Account :
Total Allocation :
Acc Head of Mont
oun Account h of Previous Expenditure :
t Chargea ____ Expenditure of this Bill :
Cod ble ____
e ____ Total upto date expenditure:

No of
Vouc
her_
____
___

S. Descripti Amou
N on of nt
o charges
of , number Rs
S & date of P.
 ub –Voucher authority of all charges requiring
special sanction
An amount is to be paid to
Smt. Anuradha Khanna, Principal,
MC Pry School, R-Block, New
Rajinder Nagar-II Education Deptt
Karol Bagh Zone retired on
31/08/2022 on account of DCRG Bill
against PPO No ___________
__________________/KBZ

PNB Bank, New Rajinder Nagar,

Delhi-60
AC No - 0991000100411888
IFSC - PUNB0062900
MICR - 110024071
,
Total in words: Gross (A)
Less : Deductions (T.D.S, others (B)
Net (A-B)

Paid from Bank Account__________ Challan No __________Account___________

Received payment
Paid to Bank Account _____________ No
Name_________________
Dated_____________
Office__________________

Note:- Certificate on the back of form CE-1 (G-13) needs no revision

Form CE-I (G-13)

MUNICIPAL CORPORATION OF DELHI
CONTINGENT BILL

A-Bill No : `
B-Detailed Bill of
contingent Charges Head of Account :
Total Allocation :
Acc Head of Mont
oun Account h of Previous Expenditure :
t Chargea ____ Expenditure of this Bill :
Cod ble ____
e ____ Total upto date expenditure:

No of
Vouc
 her________

S.No of Description of charges , number & date Amount

Sub –Voucher of authority of all charges requiring Rs P.
special sanction
An amount is to be paid to
Smt. Anuradha Khanna, Principal, MC
Pry School, R-Block, New Rajinder
Nagar-II, Education Deptt Karol Bagh
Zone retired on 31/08/2022 on account
of full & final payment of GPF against
GPF No CR-83744

PNB Bank, New Rajinder Nagar, Delhi-

60
AC No - 0991000100411888
IFSC - PUNB0062900
MICR - 110024071

Total in words: Gross (A)

Less : Deductions (T.D.S, others (B)
Net (A-B)

Paid from Bank Account__________ Challan No __________Account___________

Received payment
Paid to Bank Account _____________ No
Name_________________
Dated_____________
Office__________________

Note:- Certificate on the back of form CE-1 (G-13) needs no revision

-2-

Sub Details of expenditure and name of sanctioning Amount

Voucher office and his order No and date
No Rs. P.
 Deduct on the basis of Bill No dated
Total (Rs in words) (
Total expenditure

Date__________________ Amount Received

Name_______________
Office_______________
I am satisfied that the advance paid in excess of the amount mentioned in this bill
has been made and the expenditure mentioned in this bill is actually incurred and this
amount will be paid on receipt of the same.

Date__________________ Name_______________
Office_______________
Pay
Rs._______________________________________________________________

Checked by Accountant for Chief Accountant

Municipal Corporation of Delhi

ABSENTEE STATE IN RESPECT OF SMT. ANURADHA KHANNA, PRINCIPAL,

EDUCATION DEPTT KAROL BAGH ZONE
RETIRED ON 31/08/2022

05/01/1988 to 31/08/2022 - Nil

 UNDERTAKING

I, Anuradha Khanna, Principal, MC Pry School, R-Block, New Rajinder Nagar,

Education Deptt, Karol Bagh Zone retired on 31/08/2022 and now I am unwilling to
commute my pension and wishes to draw my full pension.

Signature of Pensioner DDO/ KBZ

To
The Branch MaNagar
PNB Bank, New Rajinder Nagar Delhi-110060

Dear Sir/ Madam

Payment of pension under A/C No 0991000100411888 through your bank

I consideration of your having at my request, agreed to make payment of

pension due to me every month by credit to my account with you, I the undersigned
agree and undertake to refund or make good any amount to which I am not entitled or
any amount which may be credited to my account in excess of the amount to which I
am or would be entitled. I further hereby undertake and agree to bind myself and my
heirs , successor, executor and administrator to indemnify the bank from and against
any loss , suffered or incurred by the bank in so crediting my pension to my account
under the scheme and to forthwith pay the same to the bank and also irrevocably
authorize the bank to recover the amount due by debit to my said account or any other
account / deposits belonging to me in the possession of the bank .

Yours faithfully

Signature______________
Name : Anuradha Khanna
Address: H. No 443-444, Double
Story, New Rajinder Nagar,Delhi

Witness
(1) (2)

Signature______________ Signature______________
Name : Deepak Kumar Name: Lalit Kumar
Address: Education Deptt Address: Education Deptt
Karol Bagh Zone Karol Bagh Zone
Date : /06/2022 Date : /06/2022

FORM FOR AVAILING MEDICAL FACILITIES UNDER MUNICIPAL HELD SCHEME

OR FIXED MEDICAL ALLOWANCE AFTER RETIREMENT

1. Certify that Smt. Anuradha Khanna D/O Lajpat Rai Khanna is drawing
pension/ Family pension vide PPO No ________________________ through PNB
Bank New Rajinder Nagar, Delhi through account No 0991000100411888 after
having retired /expired on 31/08/2022 from municipal service as on 31/08/2022 from
Education Deptt, Karol Bagh Zone, .

2. I am residing at- H. No. 443-444, Double Story, New Rajinder Nagar, Delhi-60

3. I am Not employed / I am working with Not Employed

Please Tick which is applicable

 4. I want to avail medical facilities being give by the Health Deptt, North DMC to
the municipal pensioner/ Family Pensioner

5X I want not availing medical facilities being give by the Health Deptt, North DMC
to the municipal pensioner/ Family Pensioner/ I what fixed medical allowance

6. My spouse/ any family member is employed (Yes/Not) if yes the letter of

concerned deptt/ Organization that neither medical claim of you will be
reimbursed not your name is include in medical/health card issued by
concerned deptt/ Organization of your spouse /any family member be attached I
want granted fixed medical allowance.

7. I will avail medical facilities available to spouse/family members who is an

employee /pensioner of Govt/PSU/Autonomous Body. I will not avail medical
facilities and FMA.

8. Avail medical facilities or pervious orgainsation (in case of double pension) I will
not avail FMA.

9. There is my one time change in option as provided in the rule and it supersedes
the earlier option given by me I undertake that I shall not be able to change this
option again.

Signature of Pensioner______________
Name : Anuradha Khanna
Contact No : __________________

Certified that the above particulars are correct and verified as per service
records of Municipal employee

DDO/ KBZ

FORM –J
( As referred to in para of the account procedure MCD employee GIS-1980)
Received a sum of Rs 60/- being the total entitlement of Rs______ from the insurance fund of
Rs _________________from the saving fund accrued to

Name - Anuradha Khanna

Designation - Principal
Group Insurance Scheme- 1980 - 01/01/1989 (DOJ-05/01/1988)
Date of Membership - 01/01/1989
Date Retirement - 31/08/2022
Date - 31/08/2022

Signature of Recipient
Name of Block letter

DDO/ KBZ
FOR USE IN DEPARTMENT OFFICER
1. Type of the Group member i.e lowest group vig A/B/C/D on initially joining the
scheme on 01-01-19

2. Year of the requiring member higher group

1. A - 19___________
2. B - 19___________
3. C - 19___________
Amount due (detailed calculation be given
(e) Amount of subscription - ___________
(f) Amount of Interest- - ___________
(g) Total - ___________
(h) Countersigned for payment of Rs_________ to claimant crossed cheque
/demand drafts to issued in favour of claimant.

DDO/ KBZ

FOR USUE IN THE OFFICE OF ACCONT OFFICE (GIS)

Passed for payment of Rs_________Cheque No__________ dated_________

Account officer (GIS) Jr Accountant (GIS) Checked by

 CHECK LIST
(DOR-31/08/2022)
(TERMINAL BENEFITS)
(Sh. Anuradha Khanna, PRINCIPAL, Education Deptt Karol Bagh Zone, North DMC
Ser. Name of Documents Page No Remarks
No

1 No Dues Certificate 01/C to 08/C

2 Bank Details (Pass Book+ Cheque) 9/C to 12/C
3 Aadhar Card of Sh. Sumit S/O Anuradha 13/C
Khanna
4 Aadhar Card of Smt. Poonam W/O Anuradha 14/C
Khanna
5 Aadhar Card of Sh. Anuradha Khanna 15/C
6 Signature of Sh. Anuradha Khanna 16/C
7 Photograph of Sh. Satbir & her wife duly 17/C
verified
8 Absently statement 18/C
9 Undertaking (Medical Allowance) 20/C
10 Consolidate no dues 21/C to 23/C
11 Family Details 28/C to 29/C
12 Undertaking to unwilling to commute my 34/C
pension and wishes to draw full pension
13 Contingent Bill 35/C to 38/C
14 ECS Performa 39/C to 40/C
15 Service verified in service book (At page No 9
2nd SB (Two SB)
 DOB - 03/08/1962
DOA - 05/01/1988
DOR - 31/08/2022
GPF No- CR-83744

Sub:- Administrative approval for the Terminal Benefits of

Sh. Anuradha Khanna, PRINCIPAL, , under Education deptt, Karol
Bagh Zone, North DMC

In the above noted subject it is submitted Sh. Anuradha Khanna,

PRINCIPAL, (BMID-10013198) under Education deptt, Karol Bagh Zone,
North DMC is going to be retired from service on 31/08/2022 on attaining the
age of superannuation for which the payment of all terminal benefits are to
made and the administrative sanction of the competent authority is required to
be sought in this matter. No dues certificate in respect of above named
PRINCIPAL have been obtained from the all relevant department is placed
opposite.

In view of the above this case may be forwarded to competent authority

i.e Worthy Deputy Commissioner, Karol Bagh Zone through AO/ KBZ for
seeking necessary approval. So that the payment of leave-encashment,
Gratuity, , Group Insurance Scheme (GIS) & G.P.F benefits could be made to
above named PRINCIPAL form of the instant case Flagged ‘A,&’ B’ for
Worthy Signature Deputy commissioner, Karol Bagh Zone
Submitted for