ALIGARH MUSLIM UNIVERSITY, ALIGARH

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1 01 ALIGARH MUSLIM UNIVERSITY, ALIGARH (FORMAL APPLICATION FOR PENSION AND GRATUITY) To, JR / DR / AR (Service Book & Pension Section) Aligarh Muslim University, Aligarh SUBJECT: Application for sanction of Pension & Gratuity. Sir, I have been retired/retiring from the University service on superannuation with effect from..as my date of birth is I, therefore, request you kindly to process my case for sanction of the Pension and Gratuity admissible to me. 2. I hereby declare that I have neither applied nor received any Pension or Gratuity in respect of any portion of the service included in this application and the Pension/Gratuity is being claimed now. 3. I undertake the following: i) Should the amount of Pension & Gratuity afterwards found to be in excess of that to which I am entitled, the same will be refunded by me and on my failing to do so such excess payment may be adjusted by deduction from my pension in future in one or more instalments, as the authority may order. ii) Demands outstanding against me on account of University dues may be adjusted from the Gratuity due to me in lump sum. P.T.O.

2 02 4. I enclose herewith the following documents duly attested by the Head of the deptt./office concerned 1. Two slips of Specimen Signatures of mine. 2. Two copies of authentic proof of date of birth / High School Certificate with Marksheet. 3. Four copies of passport size joint photographs of husband and wife. 4. Two slips each bearing my left hand / Right hand thumb and finger impression. (In case of female employee Right hand thumb & finger impression are required). 5. Two copies of latest pay slips before superannuation / retirement. 6. Two slips of Permanent Address for future correspondence. 7. Copy of order of 1 st continuous appointment in the university alongwith joining report. 8. Copy of confirmation order on each post. 9. Present Address :.. Address after retirement : 10. Contact No. (Mobile) (1).(2) (if any)..... Signature of the applicant Name of the Applicant... Designation... ID No... Department/Office... Forwarded Chairman of the Department/Head of the Office with Seal Date Note: In case, the employee concerned is working as regular Dean/Chairperson/Principal of College at the time of submission of pension papers, he/she may indicate clearly this position in bracket against designation in the designation columns provided in the papers, these papers should be signed / attested by his/her leave sanctioning authority.

3 03 SERVICE RECORD Department/Office :... Certified that Dr./Mr./Mrs./Miss :... S/o / D/o / M/O :... was/is a Permanent/temporary (Designation):... in the Department/Office :... The fact about his/her service are as under: 1. Date of first continuous appointment in the university : Name of the present post held : Temporary from : Permanent w.e.f. : Period of leave without pay or unauthorized absence, if any, during the entire service with dates :... Leave A/C No The date and reason of his leaving the post promotion/transfer/resignation/death/ Termination/Retirement : Whether he was ever placed under suspension, if yes... (i) Period (s) of suspension from... (ii) Date (s) of Reinstatement:... (iii) Whether the period of suspension was on reinstatement treated as duty, if not how was it treated : Date of birth indicating the source from which verified : Whether there was/is any break in the service if so period of such break with period and dates : Whether the employee/deceased was in employment elsewhere prior to join this University, if so the amount of pensionary benefits which the employee/deceased was getting may also be mentioned :...

4 Whether the nomination for Gratuity had been filed during service if so the number and date may be mentioned (copy enclosed): Was he/she a member of University regular establishment : Remarks regarding his/her, Character and past conduct : Whether the claim for pension and gratuity is established and should be admitted.... I declare that the entries made in the above columns are based on relevant records such as Attendance Register, Leave Accounts etc. and are true to the best of my knowledge. Signature Chairman/Head of the Deptt./Office (Seal) NOTE: In case the individual joined the department on transfer from another department of the University a copy of this proforma may be sent to that department for completion and admittance to the Registrar s Office.

5 05 FORM II (Page 1) APPLICATION FOR PENSION OR GRATUITY AND DEATH-CUM-RETIREMENT GRATUITY 1. Name of Applicant (in Capital letters) : Father s name (and also husband s name in case of married Women employee) S/o... W/o Religion and Nationality : Permanent Residential Address showing village/town, District and State : Present or Last appointment including name of establishment : Date of beginning of service : Date of ending of service : Length of service with details Yrs Months Days of interruption and non-qualifying period, if any (a) Qualifying service :... (b) Interruption of non-qualifying service : Class of Pension or Gratuity applied for and cause of application : Average emoluments : Proposed Pension : Proposed Gratuity : Proposed Death-cum-Retirement Gratuity : Whether nomination made for Death-cum-Retirement Gratuity (copy of the nomination enclosed) : Date of Applicant s birth by Christian Era : Height : Identification marks : Date from which Pension is to be commenced :...

6 19. * Thumb and fingers impression : 06 (Page 2) THUMB FORE FINGER MIDDLE FINGER RING FINGER LITTLE FINGER Signature Chairman/Head of the Deptt./Office (Seal) 20. Date on which the applicant applied for pension :... REGISTRAR A.M.U. * In case of male, Left Hand and for female Right Hand impressions required.

7 07 FORM II (Page 3) REMARKS BY THE HEAD OF THE DEPARTMENT/OFFICE/REGISTRAR 1. As to character and past conduct of applicant : Dr./Mr./Mrs./Miss Explanation of any suspension degradation : 3. Regarding any Gratuity of pension already received by applicant. 4. Any other Remarks : 5. Specific opinion of the Head of the Department/Office/Registrar, whether the claim is established and should be admitted or not (See Clause 17 (ii) Statute 61, Ordinance and Regulations.). Countersigned Signature Chairman/Head of thedeptt./office (Seal) REGISTRAR A.M.U.

8 A U D I T 08 (Page 4) E NF A C E M E N T 1. Total period of qualifying service which has been accepted for the grant of pension/ Death-cum-Retirement Gratuity with reasons for disallowances if any other then disallowances, if any of service the reasons for which are recorded by the Finance Officer in the second page. NOTE: Service for the period commencing from and up to the date of retirement has not been verified this should be done before the pension, payment order is issued. 2. Amount of Pension/Death-cum-Retirement Gratuity that may be admitted. 3. The date from which the Pension/Death-cum-Retirement Gratuity is admissible. 4. In the event of death of the widow/widower shall be entitled to a family pension of Rs..per month from the date following the date of death of the pensioner till her/his date of remarriage or death, whichever is earlier.

9 ID No. 09 DETAILS OF FAMILY Mob:... Name of the University Servant... Department/Office Designation... Date of Birth of the employee.. Date of first continuous appointment... Details of the members of family as on S. No Name of the members of family Date of Birth Relationship with the employee Remarks 1. Verified that the above declaration is true to the best of my personal knowledge and belief, that nothing material has been concealed therein and that no part of this declaration is false. 2. I hereby undertake to keep the above particular upto date by notifying to the Joint Registrar Service Book and Pension Section, Registrar Office. Place. Signature of the University Servant Date Forwarded to the Joint Registrar (Service Book & Pension Section), Registrar s Office, Aligarh Muslim University, Aligarh. Dated Counter Signed Signature of the Head of the Department/Office Dated Registrar Aligarh Muslim University ALIGARH

10 09 DETAILS OF FAMILY (To be submitted in duplicate with details of marital status of family members as on date) ID No. Mob: Name of the University Servant... Department/Office Designation... Date of Birth of the employee.. Date of first continuous appointment... Details of the members of family as on S. No Name of the members of family Date of Birth Relationship with the employee Remarks 3. Verified that the above declaration is true to the best of my personal knowledge and belief, that nothing material has been concealed therein and that no part of this declaration is false. 4. I hereby undertake to keep the above particular upto date by notifying to the Joint Registrar Service Book and Pension Section, Registrar Office. Place. Signature of the University Servant Date Forwarded to the Joint Registrar (Service Book & Pension Section), Registrar s Office, Aligarh Muslim University, Aligarh. Dated Counter Signed Registrar Aligarh Muslim University ALIGARH Signature of the Head of the Department/Office Dated

11 10 FORM B FORM OF APPLICATION FOR COMMUTATION OF PENSION WITHOUT MEDICAL EXAMINATION (UNDER MINISTRY OF FINANCE, OFFICE MEMORANDUM No. 14 (5) (A) DV Dated 26 th December, 1977 PHOTO duly attested by the Head of the Deptt./Office To, The Vice-Chancellor Aligarh Muslim University, ALIGARH SUBJECT: Commutation of pension without Medical examination Sir, I furnish below the relevant particulars and request that I may be permitted to commute a part of my pension as indicated below: (An attested copy of my photograph is pasted on this application and unattested copy is enclosed) 1. Name in block letters Date of Birth Date of superannuation on attaining the age of 60/62/65 years Designation of the post held at the time of superannuation and the name of the Department/Office Amount of pension sanctioned and whether it is provisional or final Class of pension as defined in Chapter V or the CCS (Pension) Rules, Name of the Bank and Account No. from which pension is being drawn Name of the Bank through which the Commuted value is desired to be paid if payment is not desired through the Finance Office....

12 11 9. Designation of the Accounts Officer and the number and date of the PPO, if issued Amount (in whole rupees) or percentage of pension proposed to be commuted Particulars of any application for commutation of pension made previously and whether appeared before any Medical Authority or not... Signature of applicant... FULL POSTAL ADDRESS : Note: The photographs are required to be submitted if the pension is desired otherwise than through the Accounts Officer of the University / Deptt. / Offices from which University employees retired. Signature... Name and Address of the Head of Office/Deptt. ASSISTANT FINANCE OFFICER (PENSION) INTERNAL AUDIT OFFICER VICE CHANCELLOR

13 12 TO WHOM IT MAY CONCERN This is to certify that Dr./Mr./Mrs./Miss... Designation... has worked in the Office/Deptt... As per office records the Service particulars of Dr./Mr./Mrs./Miss are as follows : 1. Whether he/ she was a re-employed pensioner Date of First continuous appointment in A.M.U Date of Confirmation There is no break in his/her Service from date of First continuous appointment till death/retirement, if any break in service please mention the same Extra Ordinary Leave / Leave without pay availed, if any Leave Account No I.D. No Contact No. (Mobile)... Signature Chairman/Head of the Deptt./Office (Seal)

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