(Filled by the Applicant)

Part-B
EMPLOYEE CODE: WNPX5153 APPLICATION NO.: 12022203584
EMPLOYEE DEPTT. : SCHOOL EDUCATION DEPARTMENT DATE OF e-SUBMISSION: 02-Sep-2022

e-SUBMITTED
Part-I
Form of Application for Commutation of Pension Without Medical Examination

I furnish the relevant particulars and request that I may be permitted to commute portion of my pension as indicated below:-

1.Name of Employee: ASHIS KUMAR DAS

2.Date of Birth: 04-Jan-1963
3.Date of Superannuation on attaining the age of 60 Years: 31-Jan-2023
4.Designation of the post held at the time of Superannuation: GROUP-D
5. Name of the Present Institution/Office: ICHAPUR NORTHLAND HIGH SCHOOL

6.Class of pension as defined in the West Bengal Non-Government Educational Institution Employees’ (DCRB) Scheme, 1981:
SUPERANNUATION PENSION
7.Name of the Treasury through which pension is being/will be drawn and commuted value of pension will be drawn: HOOGHLY-I

8. Designation of the Audit Officer : Director of Pension,Provident Fund and Group Insurance

9.Percentage of pension proposed to be commuted: 30%

(LTI/Signature of Applicant)
ASHIS KUMAR DAS
Employee`s post: GROUP-D
ICHAPUR NORTHLAND HIGH SCHOOL

PART-II

(PSA Office only)

Forwarded
To The Director,
Directorate of Pension, Provident Fund & Group Insurance,

West Bengal (Audit Officer) for authorising the payment of the commuted value, Part-I of Part-B has been recieved by this office on 17-Nov-2022.

Signature of the competent authority

(District Inspector of Schools, Secondary Education)
Date:- 17-Nov-2022 Official Seal
DISTRICT: BARRACKPORE

Generated By: WNPX5153

Dat 30/01/2023 3.42 pm