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Annex-A
| Sr.No | Name | Relationship | CNIC # | Age | Marital Status | Action |
|---|
Same as current residential address
PDF Form
Annex-A
CERTIFICATE INFORMATION TO BE GIVEN BY THE PENSIONER
Descriptive Roll (list of family members)
I hereby undertake to refund any outstanding amount/liability established against the deceased government servant/pensioner during his service or thereafter and if so, the same may be deducted at source / adjusted against my family pension I gratuity. (Applicable in case of Family Pension)
Signature of the person
claiming Family pension
I hereby solemnly declare that I. Mst./Mr./Ms
I am a bonafide entitled family member to receive pension of late
Mst./Mr./Ms
S/o/W/o
who
expired on
while in service/after retirement and who was in receipt of
pension/family pension, as the case maybe
i. Death Certificate is Attached
ii. PPO / FPPO (in case of pensioner's death certificate is
attached)
(Applicable in case of Family Pension only)
Signature of the person
claiming Family pension
Form D-II
FAMILY PENSION FORM
Subject:- GRANT OF FAMILY PENSION IN THE CASE OF DEATH OF PENSIONER
1) Mst./Mr./Ms S/o/W/o residing at Designation at the time of retirement drawing family/pension@ per month vide PPO/FPPO No. drawing pension from bank/bank branch certificate is attached].
| Net Pension @ | |
|---|---|
| Increases @ | |
| Total Pension @ |
2) Orderly Allowance (if any) Rs.
3) His Date of Birth was , Date of retirement from government service
4) Enclose original PPO / FPPO of deceased pensioner.
5) No Demand /Recovery was due against him or recovery / demand amounting to RS. is recoverable against him which needs to be recovered from family pension.
6) Advances drawn (if any) stand repaid in full, alongwith interest.
7) Descriptive Roll, undertaking to make good Government losses is enclosed at Annex-A.
8) As per record, it verified that Mst/Mr/Ms. CNIC No. and contact No. is bonafide entitled for family pension of Mst./Mr./Ms
9) Family pension to be determined by the Accountant General, Punjab/DAO,in favour of Mst./Mr./Ms ,CNIC No. , Contact No. . (name and relationship with deceased)
Bank Account No in which family pension is to be credited
(Attested copy of CNIC of both pensioner and deceased pensioner and the claimant of family pension attached)
"(the bank account should be verified by the Manager of the concerned bank)
Signature with stamp
Pension Sanctioning Authority
Note:-The sanction accorded, as above, is subject to change on account of any additional information reported
CC
1)Accountant General, Punjab_______/DAO________ with the request to endorse a copy of the Family PPO to this department/office.
2)Mst./Mr./Ms ,You are hereby informed that get full year monthly family pension shall be transfer-credited by Accountant General, Punjab/DAO in the bank account No. However, if you, subsequently want to receive your family pension in any other bank account, you may inform the Accountant General, Punjab/DAO in writing, after due attestation by a gazetted officer.
Form C
LIFE CERTIFICATE FORM
TO WHOM IT MAY CONCERN
This is to clarify that Holder of PPONo. CNICNo. whatsoever specimen signature/thumb impression and address below is alive to date
___________________________
(Pensioner Signature /Thumb Impression)
Address
Date
Phone No
___________________________
(Signature of attesting officer with date)
Name ______________________________
Address ____________________________
___________________________________
Phone No ___________________________
___________________________
(Official Stamp of attesting officer)
NOTE-1:- THIS CERTIFICATE IS TO BE REASSIGNED BY CLASS- GAZETTEDOFFICER / MILITAY COMMSSIONEDOFFICER / MAGISTRATE / SUB-REGISTERAR / PENSIONED OFFICER / MUNSIF / MEMBER OF THE CENTRALOR OR PROVINCIAL LEGISLATURE ASSEMBLIES / MANAGER OF THE SCHEDULED BANK
NOTE-2:- THIS CERTIFICATE MAY BE FURNISHED TO THE AG / DAO IN PERSON OR A THOUGH PRESENTATIVE OR BY THE POST/COURIER OFFICER
OPTION FORM FOR DIRECT CREDIT OF PENSION THROUGH BANK ACCOUNT
Pensioner information (to be filled in by the pensioner)
| PPO No: | |
|---|---|
| SAP Personnel No: | |
| Accounts Office: | |
| Name of Pensioner: | |
| Father/Husband Name: | |
| Family Pensioner Name: | |
| Spouse/Father/Mother Name: | |
| Pensioner CNIC #: | |
| Family Pensioner CNIC #: | |
| Residential Address (Current): | |
| Residential Address (Permanent): | |
| Designation & Grade at the time of Retirement: | |
| Present NBP Address & Code No: | |
| Mobile No: | |
I hereby opt to draw pension through direct credit system
and have also submitted Indemnity Bond* to the bank. | |
Signature/Thumb Impression | Date: |
| Account Title(Name) | |
|---|---|
| Account No | |
| Branch Name/Address | |
| Branch Code | |
| Indemnity Bond submitted by the Pensioner | |
Signature/Stamp of Bank Manager
To be Issued by Accounts Office
Acknowledgement Receipt No __________________
Signature of Officer __________________
Date _______________________
SOLE CERTIFICATE
Certified that Mst. W/o/D/o (Late) (retired)(BS-)(Department) is so sole widow of deceased and she is still widow.
Attested
Department
Area Councilor
Chairman
Union Council
NO MARRIAGE CERTIFICATE
No marriage certificate of Mst. Mr Late , Tehsil District . I Mst: late Mr. Ex Tehsil District do hereby declare that I have not married after the death of my husband and do not intend to remarry in future
Attested
Signature
Ex
Address
HAND THUMB & FINGERS IMPRESSION
Left/Right hand thumb and fingers impression of Mr/MsT. who was working as (Destination) (Department/Office) retired from Govt. service on and died on .
Signature of DDO
SPECIMEN SIGNATURE
Mr/MsT. who is working as (Designation) (Department/Office) retired from Govt. service on and died on .
Signature of DDO
UNDERTAKING
I undertake to abide by the condition that in consequence of payment of pension to me or arrear thereof, if any excess payment is found have been made, I shall refund the same on demand at once and will not claim monthly payment of pension in the event of failure to deposit the excess payment till the claim is adjusted.
Dated __________________
Signature
No Source Certificate
I, being a Pension Sanctioning Authority, hereby certificate that Mst.
retired holding CNIC No.
has no
It is further certified that no other family member except Mst. W/o is entitled for pension during that period
Pension Sanctioning Authority(PSA)
ENTITLEMENT DECLARATION
I hereby solemnly declare that Mst. (Late) am a bonafide entitled family member to the pension of late who expired on while in service / after retirement and who was the in receipt of pension / family pension as the case may
i- Death certificate is attached
ii- PPO/FPPO (in case of pensioner death certificate is attached)
(Applicable in case of Family Pension only)
I hereby declare that no other family member is entitled for the family pension except me.
Attested
Signature of the person
Claiming Family Pension
Name
Cnic
Address
