FORM - 7 PART - I FORM FOR ASSESSING PENSION AND GRATUITY

Transcription

1 FORM - 7 PART - I FORM FOR ASSESSING PENSION AND GRATUITY 1. Name of the Government Servant : 2. Father's Name ( and also husband's : Name in the case of Female Govt. Servant) 3. Date of Birth (by Christian era) : 4. Religion and Nationality : 5. Permanent Residential Address showing Village/Town/District and State : 6. Present or last appointment including Name of establishment : (i) Substantive (ii) Officiating if any : 7. Date of beginning of service : 8. Date of ending of service : 9. i) Total period of Military service for which Pension/Gratuity was sanctioned: ii) Amount and nature of any Pension/ Gratuity received for the Military service : 10. Amount and nature of any pension/ Gratuity received for previous/civil service 11. The date of which action initiated to : i) Obtain the "No demand Certificate" from the Department in charge of building as provided in Rule 52 : ii) Assess the service and emoluments qualifying for pension as provided in rule 57 & 61 :

2 iii) Assess the Government dues other than the dues relating to the allotment of Government accommodation : 12. Details of commission, imperfection or deficiencies in the service book which has been ignored : 13. Length of qualifying service : 14. Periods of non-qualifying service : i) Interruption(s) : ii) Extraordinary leave not qualifying for pension : iii) Period of suspension not treated as qualifying : iv) Any other service not treated as qualifying : Total : 15. Emoluments reckoning for Gratuity : 16. Average Emoluments (Emoluments drawn during the last ten months of service) Last Pay Drawn : 17. Date on which Government Servant applied for Pension in Form-5 : 18. Proposed Pension : 19. Proposed Death-cum Retirement Gratuity : 20. Date from which pension is to commence: 21. Proposed amount of provisional pension if departmental or judicial proceedings is instituted against the Government servant before retirement : 22. Details of Government dues referred to in rule 70 recoverable out of gratuity : 23. Whether nomination made for :

3 i) Death-Cum-Retirement Gratuity : -- ii) Non contributory family pension if applicable : Whether contributory family pension applies to Government Servant and if so: -- i) Emoluments reckoning for : - family pension ii)the amount of the family pension becoming payable to the wife/husband of the Govt. servant in the event of his/ - her death after retirement : iii) Complete and up-to-date details of family as given in Form-3 : Serial Names of Members Date of Birth Relationship with Government Servant 25. Height : 26. Identification marks : 1) 2) 27. Place of payment of Pension : Payment of Gratuity (Head of Office) : 28. Head of Account to which pension and gratuity are debitable : Place : Chennai.6 Date: SIGNATURE AND DESIGNATION /Counter signed/

4 FORM 7 - PART II Emoluments drawn during the last 10 months of service Post held From To Pay Details of Pay and Allowances Drawn as on by Pay Rs. DA HRA CCA DEPUTY DIRECTOR OF COLLEGIATE EDUCATION (ADMN) (I/C)

5 FORM 5 TAMIL NADU PENSION RULES 1978 Application for Commutation of Pension 1. Name : 2. a) Date of birth : b) Date of retirement : c) Designation at the time of retirement : 3. Two specimen signature duly attested (to be furnished in a separate sheet) : 4. Three copies of the Passport size joint Photography with wife or husband( to be attested by the Head of Office) : 5. Two slips showing the particulars of height and personal identification marks duly attested : 6. Present address : 7. Address after retirement : 8. Name of the Treasury : 9. Details of the Family members : 10. Class of Pension : 11. Amount of Pension authorised : 12. Whether pension is proposed to be : commuted 13. If so, fraction of Pension to be commuted: Place: Date: ATTESTED SIGNATURE DESIGNATION DEPUTY DIRECTOR OF COLLEGIATE EDUCATION (ADMN)(I/C)

6 CALCULATION SHEET 1. Name of the individual : 2. Designation : 3. Date of Birth : 4. Date of entry in the Government : 5. Date of retirement : 6. Length of qualifying service reckoned for pension/.gratuity : 7. Pay last drawn : 8. 1) Emoluments for pension : ii) Pension admissible : 9. i) Emoluments for Gratuity : ii) Retirement Gratuity : 10. i) Emoluments for Family Pension : ii) Family Pension admissible : a) Ordinary Family Pension : b) Enhanced Family Pension Family Pension equal to 50% of the pay Last drawn or at ordinary rate as at (a) above x 2 subject to prescribed : to minimum and maximum as per Rule The Designation and address of the : departmental officer to whom gratuity : authorisation is to be addressed 12. The name of the P.A.O concerned to which the bill should be presented :

7 PASSPORT SIZE PHOTOGRAPH OF WITH SPOUSE SIGNATURE AND DESIGNATION ATTESTED DEPUTY DIRECTOR OF COLLEGIATE EDUCATION (ADMN)(I/C)

8 SLIP SHOWING OTHE HEIGHT AND IDENDIFICATION MARKS OF 1) Height: 2) Marks of Identification: /ATTESTED/ DEPUTY DIRECTOR OF COLLEGIATE EDUCATION (ADMN)(I/C)

9 SPECIMEN SIGNATURE OF 1) 2) 3) //ATTESTED// DEPUTY DIRECTOR OF COLLEGIATE EDUCATION (ADMN)(I/C)

10 COMPLETE AND OUP-TO-DATE DETAILS OF FAMILY OF Serial Name of the family Age Date of Birth Relationship with member Government servant //Attested// DEPUTY DIRECTOR OF COLLEGIATE EDUCATION (ADMN)(I/C)

11 DECLARATION I do hereby declare to refund the Pension or Gratuity authorised by the Accountant General, Chennai, if it afterwards found to be in excess of the amount to which I am entitled under the rules. Signature: Name: Designation:

12 WORK SHEET WORK SHEET ARRIVING AT THE QUANTUM OF PENSIONERY BENEFITS ADMISSIBLE TO D M Y NET QUALIFYING SERVICE Date of Birth ADD: Date of Superannuation Date of Retirement Date of entry into service Gross qualifying service Less Non Qualifying service Net Qualifying Service PENSION: EMOLUMENT Rs. 20,900/- Net Qualifying Service D M Y Amount of Pension admissible for Half Years ( Half years ) AMOUNT OF D..C.R.G. Net Qualifying Service D M Y Pay last drawn ( Pay + 64 % DA) Amount of D.C.R.G. FAMILY PENSION: Pay last drawn Amount of Family Pension Rs. Rs. = Rs. Deputy Director of Collegiate Education (Admn) (i/c)

13 From To Sir, Sub: Tamil Nadu Ministerial Service / Tamil Nadu Collegiate Educational / Tamil Nadu General Sub-ordinate Service / Tamil Nadu Basic Service - Thiru/ Tmt/Selvi. Pension Proposals submitted for onward transmission to the Accountant General, Chennai.18 Regarding I submit that I am due to retire on superannuation on the after noon of Hence, I submit herewith my pension proposals in triplicate for onward transmission to the Accountant General, Chennai.18 1) Form.7 2) Form.5 3) Calculation Sheet 4) Joint Photo duly attested 5) Height and Identification marks duly attested 6) Specimen signature duly attested 7) Details of Family Members duly attested. 8) Declaration 9) Work Sheet I request you to kindly countersign the pension proposal and forward to the Accountant General Chennai.18 for admitting the pensionary benefits. Yours faithfully, Encl: Pension proposal in triplicate