APPLICATION FOR PENSION AND/OR GRATUITY
PART-I
(TO BE FILLED IN AND SIGNED BY THE APPLICANT HIMSELF/HERSELF)
To
The ……………………………………
…………………………………………
…………………………………………
Sir,
I have the honour to say that I have retired/have been permitted to retire from service/am due to retire on (dated) ………………………..
- I declare that I have neither applied for nor received any pension or gratuity for any portion of this service, nor shall I submit any application hereafter without quoting a reference to this application and to the orders which may be passed thereon.
- Should the amount of the pension and/or gratuity granted to me be afterwards found to be in excess of that to which I am entitled under the rules, I hereby undertake to refund any such excess.
- I wish to commute my pension to the extent of Rs…………………..
- I wish to draw my pension from the district accounts Office/Treasury/Sub treasury/National Bank of Pakistan Branch at…………………………………………………………………………………………
………………………………………………………………………………… (Place).
- The following documents, duly attested, are enclosed:-
(a) Three specimen signatures of mine-two sets of my thumb and finger impressions on the prescribed form.
(b) Three photographs of mine.
(c) List of family members.
Yours obediently,
Signatures: …………………………….
S/o ………………………………..
W/o ………………………………..
D/o ………………………………..
Post held on the date of Retirement …………………………………………
Dated:- …………………………
______________________________________________________________________________________
* Delete in applicable alternative
Not required in case of gazetted officer
PART-II
(To be completed by the Office/Department receiving the application for pension)
SECTION (1)
PARTICULARS OF APPLICANT
- Name of civil servant ………………………………………………………………………
- Father’s Name ……………………………………………………………………………….
- Nationality ……………………………………………………………………………………
- Postal address …………………………………………………………………………………
- Post held on the date of retirement/death ……………………………………………………..
- BPS …………………………………………
- Date of Birth ………………………………….
- Marks of identification …………………………………………………..
[ Commencement of service …………………………………………………
- Date of [ Retirement/death ……………………………………………………………
[ Application for pension ……………………………………………………..
- Length of services, including interruption, is …………………………………………………..
- Date of commencement an ending of each spell of military service, if any
Y M D
From to
From to
From to
__________________________
Total:
_______ ___________________
- Government under which service has been rendered, in chronological order;
Government of ………………….. from ………… to i.e………………………………….
Government of ………………….. from ………… to i.e………………………………….
Government of ………………….. from ………… to i.e………………………………….
——————————————-
Total:
——————————————
- Class of pension or Gratuity applied for …………………………………………………………
- Average Emoluments …………………………………………………………………………….
- Proposed ordinary pension …………………………………………………… ………………….
- Proposed special additional pension, if any ………………………………………………………
- Proposed gratuity …………………………………………………………………………………
- Place of payment (Government Treasury or Sub Treasury) ……………………………………..
Office
Signature of Head _______________
Department
____________________________________________________________________________________
*Not required in the case of gazetted officers.
If the application is for a compensation, pension or gratuity, the nature of the change of establishment which has been given rise to the claim should be fully stated.
Entries No.1,2,3,4 and 18 should be made in capital letters.
THIRD PAGE
SECTION (2) – CALCULATION OF QUALIFYING SERVICE
PERIOD
Y M D
Total length of service, including interruptions,
Non qualifying service
From To PERIOD
Y M D
(i) Service rendered below the age of 20 years
(ii) Extraordinary leave
(iii) Suspension not treated as duty or leave.
(iv) Periods of break in service.
(v) Service rendered before break, if break is not condoned.
(vi) Service forfeited by resignation.
(vii) Unauthorized absence.
_____________________
Total:
_____________________
Net qualifying service_____________________________
Add
From To PERIOD
Y M D
(i) Periods, if any, of Military service or
War service allowed to count for pension
(ii) Benefit of condonation of deficiency in
Service
(iii) Any other addition to qualifying service ______________________
Total:
______________________
Total qualifying service …………………………………..
Section (3) – Calculation of Ordinary Pension
Statement of emoluments during the last 36 months
STATEMENT OF EMOLUMENTS DURING THE LAST 36/12 MONTHS
| Period | Duration in
Months & Days |
Monthly rate of
Emoluments |
Amount Drawn | ||||
| From
|
To | M | D | ||||
The total Emoluments for Months are
Therefore average emoluments work out be R. ________________ x 1/36 = Rs.
As the length of qualifying service is _________________ years
the amount of gross ordinary pension will be = Rs.
Less 1/4th of the applicant comes under the Pension-cum-Gratuity Scheme)
Amount of net ordinary pension = Rs.
*Please see rule 44(2) Pakistan Civil Service Pension Rules
FOURTH PAGE
Section (4) – Calculation of Special Additional Pension
No. of completed years of effective service in Grade III __________________ Years (A)
No. of completed years of effective service in Grade II __________________ Years (B)
No. of completed years of effective service in Grade I ___________________ Years ©
Amount of special additional pension in Grade III (Ax25
subject to the maximum of Rs.125) Rs.________________ per month
Amount of special additional pension in Grade III (Ax25
subject to the maximum of rs.255) Rs.________________ per month
Amount of special additional pension in Grade III (Ax25
subject to the maximum of Rs.350) Rs.________________ per month
Total special additional pension admissible after applying
the maximum prescribed in note below Rs. ________________ per month
Less 1/4th (if the applicant comes under the Pension-cum-
Gratuity scheme) Rs. ____________________
Amount of net special additional pension Rs. ________________ per month
*For officer drawing pay above Rs.3,000 but not exceeding Rs.3,250 per month ( ) Rs.25 per month for every completed year of effective service.
*For officers drawing pay above Rs.3,250 but not exceeding Rs.3,500 per month (a) Rs.45 per month for every complete year of effective services.
*For officers drawing pay above 3,500 per month (a) Rs.70 per month for every completed year of effective service.
Note: The combined maximum of Special Additional Pension. Grade III and grade II shall be Rs.25 per month and the combined maximum of Special Additional Pensions of all the three grades shall be Rs.350 per month.
Total Net Pension
Amount of net Ordinary Pension Rs.__________________
Amount of net Special Additional Pension Rs.__________________
Amount of Total Pension Rs.__________________
Section (5) – Calculation of Gratuity
Amount of ordinary pension surrendered[see Section (3)] Rs.__________________
Amount of Special Additional Pension surrendered
[See Section (4)] Rs.__________________
Total Amount surrendered Rs.__________________
Length of qualifying service Years _____________________
Rate of gratuity of every rupees surrendered Rs.104/130/120 ___________________
Lumpsum gratuity admissible Rs.________________________
FIFTH PAGE
Section (6) – Remarks by Head of Office/Department
(To be completed only after receiving the pension application)
- Character and past conduct of the applicant.
- Remarks regarding any gratuity or pension received by the applicant (See Chapter IX of West Pakistan Civil Services Pension Rules)
- Specific remarks as to whether the service claimed is established and whether the service claimed is established and whether it should be admitted for pension or not (See Rule 5 – 3 (2), West Pakistan Civil Services Pension Rules)
- Remarks as to Special Additional Pension stating whether or not the service rendered a qualifying post in grade III and/or I satisfy the standard of work and conduct required I the special condition of the post or duty for the grant of full special additional pension.
- Any other remarks.
Signature of the
Head of the Deptt./Office
______________________________________________________________________________________
*Applicable only in the case of Officers who are eligible for special additional pension.
Section (7) – Order of the Sanctioning Authority
- The undersigned is satisfied that the service of Please cross out this paragraph with
Mr. _________________________________
has been wholly satisfactory. The grant of full pension
and/or gratuity which the Audit Officer may and to be
admissible under the rules is hereby sanctioned OR
The undersigned is satisfied that the service of
Mr. ________________________________________ Please cross out this paragraph with
Has been wholly satisfactory, and it has been decided initials, if full pension is granted.
that the full pension and/or gratuity found by the Audit
Officer admissible under the rules should be reduced by
the specific amount or percentage given below.
Amount or percentage of reduction in pension ______________
Amount or percentage of reduction in pension ______________
Sanction is hereby accorded to the grant of pension and/or
gratuity as so reduced.
- The following period, of service of the officer have been Please cross out this paragraph with
approved for the grant of special additional pension under initials, when not applicablethe rules
Grade III:
Period of service _________________________________
Post/Posts held ___________________________________
Grade II:
Period of service _________________________________
Post/Posts held ___________________________________
Grade II:
Period of service _________________________________
Post/Posts held ___________________________________
- The payment of pension and/or gratuity may commence from ______________________ Before issuing the pension payment order, the Audit Officer may kindly ascertain whether the Last Pay and No Demand Certificates have been received by him. In case “No Demand Certificate” has not been received, the Government Servant, as soon as he retires or his family in the even of his death before retirement , may be requested to give his/its consent in writing to any amount outstanding against him on the date of retirement/death being recovered from the pension and/or gratuity in Lumpsum or in monthly instalments as before retirement/death and recoveries made accordingly.
Signature __________________________
Designation ________________________
SIXTH PAGE
PART III
(For use in the Accountant General’s Office)
- The calculation contained in the preceding pages have been checked.
- Length of qualifying service accepted in Audit.
- Reasons for difference, if any between this and the length of
qualifying service worked out by the Department.
- Amount of pension.
- Reasons for discrepancy, if any, between this amount and that calculated by the Department.
- Length of effective service in the:
Grade III __________________________________ years
Grade II __________________________________ years
Grade I ___________________________________ years
- Amount of special additional pension Rs. ________________
- Reasons for discrepancy, if any, between this amount and that calculated by the Department.
- Amount of Lumpsum gratuity Rs. ________________________
- Reasons for discrepancy, if any, between this amount and that calculated by the Department.
- The pension will commence from _____________________
- Allocation of the Pension and Gratuity:
Pension Gratuity
Government of _________________________________
Government of _________________________________
Government of _________________________________
Defence Estimates ______________________________
__________________________
Total Rs.
__________________________
- Anticipatory pension of Rs. ______________ (Rupees )
Per month granted with effect from ____________________________ vide
P.P.O. No. ______________________________ to be adjusted in final P.P.O.
- Amount of original pension commuted. Rs._______________________
ASST ACCTT-GEN/ACCOUNTS OFFICER
Checked with L.P.C. and No Demand Certificate/written consent, vide para 3 of section (7), Part I.
P.P.O. issued vide No. _______________________ dated ___________________.
ASST ACCTT-GEN/ACCOUNTS OFFICER
INSTRUCTIONS
- The Head of the Department or Office responsible for initiating the case should state filling in section (2) (5) of Part II of the working copy of the form one year before the expected date of retirement.
- Six months before the date of retirement, the pensioner should be asked to fill in and asked to fill in and sign part I in a fresh copy of the form and submit it alongwith the required enclosures mentioned in last paragraph of the application for pension.
- Part I of the working copy will then be filled in by copying from Part I of the signed copy received back from the applicant. Similarly, section (3) to (5), Part II of the signed copy will be filled in by copying from Part III of the working copy Section (I) of Part II of both the forms should then be filled in.
- The signed copy should be forwarded to the sanctioning authority after filling in and signing section (6) while the working copy will be retained in the initiating office as an office copy. If any extra enclosures such as list of family members, Death Certificate, invalid certificate, etc. are required by the special nature of a case, these should be attached with the form sent to the Audit Office.
- The sanctioning authority should fill in section (7) of the form and send it to the Audit Office, alongwith forwarding letter.
- The Audit Officer after scrutinizing parts I and II and arriving at his own findings about the correct length of qualifying service and amounts of pension and gratuity admissible, copy of the gist of his findings from his working papers into Part III. The form will then be filled as a record of the Audit Office.
- Before filling in the form please read Chapter V of the Punjab Civil Services Pension Rules.
FORM 6 (PEN)
(Referred to in Rule 8.2)
PART I – Form of Application
I _____________________________________________ desire to commute Rs.______________ of Superannuation/Retiring/Invalid/Compensation pension of Rs. _________________ a month. I certify that I have answered correctly and each and all of the questions below:
Signature of Applicant _________________________________
Designation __________________________________________
Address _____________________________________________
Questions Answers
- What is the date of your birth? ________________________________________
- How much of your pension do you wish to commute? _______________________
- (a) Have you already commuted a portion of your pension, if so, give particulars
______________________________________
(b) Has any application from you for commutation of pension ever been rejected, or have you ever accepted or declined to accept on the basis of any addition of years to your actual age recommended by the medical authority? If so, give particulars:
____________________________________________________________________________
- From what treasury do you want to draw or propose to draw your pension and commutation money? ______________________________________________________________________
- If you are already drawing your pension quote the number of your Pension Payment Order _________________________________________________________.
- Without prejudice to the discretion of the sanctioning authority, from what date approximately do you wish the commutation to have effect? _______________________________.
- At what station (near the area in which you are ordinarily resident) would you prefer your medical examination to take place ________________________________________________________.
Place ______________________ Signature of Applicant ________________________
Date _______________________
Forwarded to the ________________________________________ for necessary action.
______________________________________________________________________________________
PART II
- Forwarded to ___________________________________________________________________
_______________________________(here enter the designation of the sanctioning authority and address)
- Subject to the medical authority’s recommending commutation the capitalized value of
Rs._______________ out of monthly pension of Rs. __________________ will be payable as stated
below:
Sum payable, if the commutation becomes absolute before the On the basis of applicant’s normal
Applicant’s next birthday, which falls on ________________ i.e. _______ year’s Rs._________
Sum payable, if the commutation becomes absolute after the On the basis of normal age
Applicant’s next birthday, but before his next birthday. i.e.________ year’s Rs. _____________.
- The sum payable will be debitable to ____________________
Central Revenues The Government o __________________ station ____________________
Date_________________ Signature & Designation
of Officer
PART III
Administrative sanction is accorded to the above commutation. A certified copy of paragraph 2 of Part III of the Form has been forwarded to the applicant I Form 8 (Pen).
Place ____________________ Date _________________ Signature and Designation of
The Sanctioning Authority.
______________________________________________________________________________________
Forwarded with one copy of Rom 8 (Pen) and an extra copy of Part III to the Secretary to the Government of Punjab Health Department, Lahore, in original on ________________________ with the request that he shall arrange for the Medical Examination of the applicant by the proper, Medical authority as early as possible within three months from the but not (here enter the date) earlier than the ______________ and inform the applicant direct in sufficient (here enter the date of retirement) time where and when he should appear for the examination.
The next birthday of the applicant fall on ________________________ and his medical examination may be arranged before that date if possible unless the applicant desires that it should be held after that ……. within the period prescribed in the sanctioning order.
Signature & Designation
of the Sanctioning Authority
APPLICATION FOR FAMILY PENSION
(TO BE FILLED IN AND SIGNED BY THE APPLICANT HIMSELF/HERSELF)
To
The ……………………………
……………………………………………
………………………………………..
Dear Sir,
I have the honour to say that my husband/wife/* …………………………………………..
Has expired on (date) ………………………………………. I, therefore, request that the family pension admissible under the rules may kindly be sanctioned to me.
- I declare that I have neither applied for nor received any family pension.
- Should the amount of the family pension granted to me be afterwards found to be the excess of that to which I am entitled under the rules, I hereby undertake to refund any such excess.
- I wish to draw my pension from the District Accounts Office/Government Treasury/Sub-Treasury/National Bank of Pakistan Br at (place) ……………………………………
- The following documents, duly attested, are enclosed:-
- Three specimen signatures of mine duly attested/two sets of my thumb and finger impressions o the prescribed form.
- Three photographs of mine.
- List and particulars of \family members
- Descriptive Roll.
- Death Certificate
- Non-remarriage and non separation certificates.
Yours faithfully,
Widow/Husband/entitled member of the family
Dated _______________________
To
- The Accountant General Punjab, Lahore.
- The District Accounts Officer ______________.
Subject: Grant of Family Pension to Mst. _______________________________________
W/o __________________________________ holder of P.P.O. No. ________________
Sir,
It is submitted that my husband Mr. ________________________________ s/o _______________________________________ has died on _____________________. He was an employee of ______________________________________________________.
- Now I am the only and lawful widow of the deceased. Hence I request to kindly issue me family pension payment order so that I may receive the familypension payment order so that I amy receive the family pension.
The following documents are enclosed with the application for necessary:
(i) Death Certificate
(ii) List of family members
(iii) Descriptive roll of widow
(iv) Non-remarriage certificate
(v) Certificate of lawful widow
(vi) Photocopy of old P.P.O.
Yours faithfully,
Dated: ________________ Mst. _______________________
W/o _______________________
Address _____________________
____________________________
LIST OF FAMILY MEMBERS OF ______________________________________
I solemnly declare and affirm that my family members are as under:-
| Sr.No. | Name of Member | Relationship | Age | Married/
Unmarried |
|
|
I further declare that there is no other family member except those mentioned above.
ATTESTED
APPENDIX II
Form of Descriptive Roll
Descriptive of Roll of Mst. ________________________________________________________________ widow/Son/Daughter/Wife of Mr.(Late) _____________________________________________________ _______________________________________________District ________________________________
- Name _________________________________________________________________________
- Race __________________________________________________________________________
3. Resident of _____________________________________________________________________ - Father’s Name __________________________________________________________________
- Height __________________________________ Feet __________________________________
- Age ___________________________________________________________________________
- Colour of hair ___________________________ Colour of Eyes ___________________________
- Personal Mark, if any, on head ______________________________________________________
Face etc. _______________________________________________________________________
- Place of Payment: Government Treasury or Sub Treasury ________________________________
- Signature of Right Hand or Thumb Impression and Finger Impression ______________________
Little Finger _____________________________ Ring Finger ____________________________________
Middle Finger ____________________________Fore Finger ____________________________________
Thumb Impression ______________________________________________________________________
ATTESTED
Note: Descriptive roll form and list of family members is to be filled in duplicate.
NON-REMARRIAGE CERTIFICATE
- I, Mst. ______________________________________________________________________________
Widow of late Mr. _______________________________________________________________________ serving as ___________________________________ in _____________________________ department
do hereby declare that I am the sole widow of late Mr. _______________________________________.
- I further declare that I have not been married after the death of my late husband and am residing as widow with my children.
Signature
We certify to the best of our knowledge and belief that the above declaration is correct and accept full responsibility for it.
- Signature with Designation ____________________________________________
- Signature with Designation ____________________________________________
Date: ___________________________