ANNEXURE-I

(TO BE USED IN THE OFFICE OF THE HEAD OF THE SCHOOL, SECONDARY EDUCATION)
Application No:12022203584

Pension papers of Sri. ASHIS KUMAR DAS, Secondary Education(BARRACKPORE) received from Applicant have been duly checked. Observations are
appended below:-
Sl.No Description Action
YES
1 Whether Comprehensive Form Part-A has been duly filled up and submitted

YES
2 Whether Comprehensive Form Part-B has been duly filled up and submitted

Whether Nomination for DCRG (or List of family members certified by competent authority, YES
3
if applicable) has been duly filled up and submitted
Whether Nomination for LTA Pension (legal hair certificate from competent authority, if YES

e-Pension
4
applicable) has been duly filled up and submitted
Whether three sets of specimen signature duly attested by Gr-A/ erstwhile Gazetted Officer YES
5
have been submitted
Whether three copies Single/ Joint Photographs duly attested by Gr-A Officer/ YES
6
Headmaster/ Headmistress of the Institution have been submitted
Whether any departmental proceeding/ court case is pending/ disposed off against the Not Applicable
7
employee
Whether Invalidation Certificate from the competent authority/ Death certificate/ M.C Not Applicable
8 Resolution in support of retiring pension/Govt. order relating to any special case like
disappearance etc. has been furnished
NO
9 Special Comments, if any

Submitted to the Head of the Institution, Secondary Education, ICHAPUR NORTHLAND HIGH SCHOOL for doing the needful.

Signature of the operator

The case is forwarded here with to the District Inspector of Schools, Secondary Education, BARRACKPORE.

Authenticated and secured through DSC/OTP by: SIDDHARTHA KAR

Designation: Head of the Institution, Secondary Education
ICHAPUR NORTHLAND HIGH SCHOOL
Forwarded to the PSA vide Memo No: 12345ASHIS e-Submission Date:26-09-2022
Date: 26-09-2022

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