Annex-A
CERTIFICATE INFORMATION TO BE GIVEN BY THE PENSIONER
Descriptive Roll (list of family members)
| No. | Name | Relationship | CNIC # | Age | DOB | Marital Status | Action |
|---|
PDF Form
Annex-A
Signature
Name
Address
Phone No
I hereby undertake to refund any outstanding amount/liability established against me during or after my service or thereafter and if so, the same may be deducted at source from my pension commutation
Signature
Name
Designation
I hereby opt full pension without commutation or commutation @
% Subject to a maximum of 35%) of my
gross pension
Signature
Name
Designation
Note: This performa must be attested by the PSA
Form B-I
Subject:- NOTIFICATION / ORDERS OF RETIREMENT SUPER ANNUATION PENSION OR RETIRING PENSION SUPER ANNUATION PENSION OR RETIRING PENSION
1) On attainting the age of superannuation Mr/MsT. S/o/D/o residing at Contact No Designation Drawing pay , as under, in BS- Personal no CNIC No presently posted at (office) place of posting shall stand retired from Government service on superannuation retiring pension A/N
| Basic Pay | |
|---|---|
| Special Pay | |
| Personal Pay | |
| Qualification Pay | |
| Technical Pay | |
| Senior Post Allowance | |
| Total pay Rs. |
2) Orderly Allowance (if any) Rs.
3) Date of Birth is , Date of 1st entry into government service is and EOL availed is Total length of qualifying service for pension is Deputation period is (Enclosed an attested copy of last month pay slip, service book and paid challan of pension contributions). Also enclosed original service book/posting profile of government servant
4) No inquiry is pending against him.
5) No Demand /Recovery is due against him
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) Administrative and financial
sanction for grant of pension without commutation or pension with
commutation
@( % ), to be determined by the Accountant General,
Punjab /DAO is hereby accorded in favour of Mr/MsT.
as admissible under the
rules.
(Attested copy of CNIC is attached)
(Subject to option for retiring Government servant.)
(Subject to a maximum of 35% of gross pension.)
Signature
[By name with stamp]
Pension Sanctioning Authority
CC
1)Accountant General, Punjab/ District Account Officer with the request to endorse a cop of the Family PPO to this department/office.The original service book after recording necessary entries regarding issuance of PPO may also be returned to this department/office
2)Mr/MsT. ,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 (Branch and area of the bank may be mentioned!) 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 S/o/D/o , Holder of PPONo. CNICNo. whose 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
NO DEMAND CERTIFICATE
It is certified that Mr/MsT. S/o/D/o who is working as ( Designation ) in ( Department ) is retiring from Government service on (Retirement Date ) Noting is due against him. It is certified that all the amounts due from him have already recovered.
Signature of DDO
NO INQUIRY CERTIFICATE
Certified that there is no Irregularity / No Enquiry pending against that Mr/MsT. S/o/D/o who is working as ( Designation ) in ( Department ) is retiring from Government service on (Retirement Date )
Signature of DDO
NO ANTICIPATORY CERTIFICATE
Certified that no anticipatory pension / Gratuity has previously been sanctioned and paid to Mr/MsT. S/o/D/o who is working as ( Designation ) in ( Department/Office )
Signature of DDO
Undertaking
I, Mr/MsT. S/o/D/o who is working as (Designation) in ( Department/Office ) do under taking abide by the condition that in consequence of payment of pension arrear to me therefore, 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 us adjusted.
Dated:
Signature
Designation
Department/Office
Undertaking
I, Mr/MsT. S/o/D/o who is working as (Designation) (Department) to hereby under refund over payment coming in the Notice of the Govt within one year from the date of issuance of PPO in my favour.
Dated:
Signature
Designation
Department/Office
LEFT HAND THUMB & FINGERS IMPRESSION
Left hand thumb and fingers impression of Mr/MsT. S/o/D/o who is working as (Destination) (Department/Office) retired from Govt. service on
Signature of DDO
SPECIMEN SIGNATURE
Mr/MsT. S/o/D/o who is working as (Designation) (Department/Office) retired from Govt. service on
Signature of DDO
LAST PAY SCALE
Left hand thumb and fingres impression of Mr/MsT. S/o/D/o who is working as (Designation) (Department/Office) retired from Govt. service on
He has been paid upto at the following rates.
| PARTICULARS | RATES |
|---|---|
| Basic Pay | |
| Conveyance All | |
| Medical All | |
| Adhoc All | |
| Adhoc All | |
| Adhoc All | |
| Others | |
| Gross Pay |
| DEDUCATIONS | RATES |
|---|---|
| GB Fund | |
| BF | |
| Group Insurance | |
| I.Tax | |
| PGHSF | |
| Total Dedications | |
| GB Fund | |
| Net Pay |
He has made over charge of the office of the
(Department/Office) on the after-noon of the
Recoveries are to be made from the Pension of the retired Government
servant amounting to Rs.
Copy to
AG / District Accounts Office.
