REOUIRED,!N TRIPLICATEICNo :

Name :

Address:

To

Addl Dte Gen of Manpower(Policy & Planning)/tutP 5(B)Adjutant General's BranchIntegrated HQ of MoD (Army)Wing No 3, Ground Floor, Room No 21,West Block-III, R K Puram tNew Delhi- 1 10066

Tele No:

Mobile No :

Appendix-I

Passport sizephot,ographs ofthe pensionerand his spouseduly attested

SUB: ENDORSEMENT OF FAMILY PENSION ENTITLEMENT IN THE PENSIONPAYMENT ORDER OF LIVING ARMED FORCES PENSIONERS

With reference to Deptt of pension and pensioners Welfare OM No 1/1U85-p&pWdated 28.10.87 and Ministry of defence oM No 6(4)/87/r369/B/D(pen/sers) dated30.6.88. I hereby apply for endorsement of entitlement of family pension in the ppo.The requisite particulars are given below :-

Name of Pensioner

(ii) Regt No/IC No

(iii) Rank last held

(iv) Date of retirement/discharge

(v) Name of record Office in caseof personnel blow officer rank.

(vi) Original PC/PPO No & year(in case of pension circularquote pension circular No, partapd Qiscriptive Sl No)

(vii) Particulars of PensionDischarge Authority :-

(a) Station(b) Treasury IDPDO/IAO/Bank/Post Office(c) Bank branch with full addressand SB A/C No

(viii) Particulars of pay last drawn atthe time of retirement.

...2/

2

(ix) Family pension from other sourr:es :

(a) Whether a family pensiorr is alreadysanctioned by any other pensiott sanctioningauthority and if so, the name ol the pensionsanctioning authority, PPO No itnd the particularsof the pension disbursing Authority.

(b) Whether Family is eligible fgr family pensionfrom any other source and if so, the authority whowill sanction the pension.

(c) In case the family is sanctic ned pension or iseligible for family pension from anrt other source, anoption to receive family pension fo'the spell ofservice for which the pension has been sanctioned videPPO/PC No quoted above, foregoing family pensionadmissible from any other sources should be enclosed.

(x) Details of family, in terms of pension rules, etigiUtefor family pension.

SINo

Name(s) and address ofmembers of family

Relationshipwith - theoensioner

Date ofmarriage

Marital status(in case ofdauqhters)

Date of birth

(xi) Attested joint photographs of Smt -----:is pasted above.

(Attestation can be done by any Gazetted Officer, pension Disbursing Officer, Head of officeof retired official, village Sarpanch, Block Development Officer, MLA/MLC etc).

(xii) Signature of or thumb impression ofspouse.

(xiii) Marks of identification.

Signature of or left handThumb impression of thePensioner (in case ofFemale Right Hand Thumb)

SiqnatureWitness : Name

1.,t,.- I\

4

2.

Full adress

IIThe pafticulars furnished above have been verified from th records available

could be verfied at our end.

(Signature of the eonfeankers)With officer stamP I

:IIThe particulars furnished above have been verified with reference to service per records.

i';

Ordinary familypension @ Rs,{t

..,i,..;;,

(S ig natu re R/O/ConcernedService Heaadqua rters.

IV

PM sanctioned vide PCDA (P) PPO NO :

ONLY ONEE COPY REQUTREp

Spouse I I FamilyPENSIONER(Tick Category)

Officer [] Pensi'ner |-]

terms of para 12 of GOl,Nov 2008. Data Sheet

TelephoneMobile

To

lr ameF ddressC ity

Date :

Addl Dte Gen of Manpower (Policy & PlanninSt)/MP 5(b)Adjutant General's Branch, lntegrated HQ of lloD(Army)Wing No 3, Ground Floor,West Block-lllRK Puram, New Delhi-66

NOTIFICATION OF DATE OF BIRTH IN THE PPO FOR ADDITIONAL PENSIONON ATTAINING 80 YEARS OF AGE AND ABOVE BY OFFICER/SPOUSE/FAMILY

PENSIONERS

Dear Sir,

1. ln order to record Date of Birth in PPO for additional pension inMoD Revised Pension letter 17(4)12008/(1)/D(Pen/Policy) dated 11

designed by PCDA(P) for issue of corrigendum PPO is provided below :-

Details of Officer.(a)(i)(ii)(iii)(iv)(v)

Rank NameDate of retirementService No

Original PPO NoLatest Corrigendum PPO NoDate of birth (DD/MMATY)

Spouse(i) Name(ii) Date of Birth (DD/MMiYY)

(c) Familv Pensioner(Parents/UnmarriedAl/idowed/Divorced Daughter/ HandicappedChild) (Only if applicable)

(i) Name(ii) Date of Birth (DD/MMATY)

(.q) Bank Details (To be ascertained from the Bankersl.(i) BSR Code of Link Branch(ii) Link Branch & Address(iii) Pension Bank A/C No(iv) BSR Code of Pension Paying Bank(v) Address of Branch PayinE Pension(vi) Pension Paying Bank City PIN Code No

Necessary Documents duly attested by Gazetted Officers are attached(Copy of any one ofPAN Card/Matriculation certificate/Passport/ECHS Card, Driving License as proof of birth ofSpouse/family pensioner alongwith copies of Original and Corrigendum PPOs)

(b)

.l{I

I

Enclosufeg l-

Proof of birth.Copies of Original and Corr PPOs.

Yours sincerely,