Retirement Benefits

Application forms for pensioners/family pensioners.

As referred to in Para 4 of OM No.45/86/97-P&PW(A)-Part-Iv dated: 8th May, 1998.

FORM OF APPLICATION

To,

____________________________________

(PENSION SANCTIONING AUTHORITY)

i.e. Head of Deptt./Office.

Subject: Revision of family pension in terms of Department of Pension and Pensioners' Welfare Office

Memorandum No. 45/86/97-P&PW(A)-Part-IV

Dated 8th May, 1998.

Sir,

Kindly revise my family pension entitlement shown in my PPO(Photo copy enclosed) in terms of the Department of Pension and Pensioners' Welfare Office Memorandum No. 45/86/97-P&PW(A) Part-IV dated the 8th May, 1998. The requisite particulars are given below :-

1.	Name of the Applicant in Block letters and Full Postal Address :
2.	*Name of the deceased Govt. servant/pensioner :**
3.	Date of retirement/death of the Govt. employee :
4.	Date from which family pension is being drawn:
5.	Pension payment Order (PPO) No.:
6.	Office/Department/Ministry in which the pensioner/deceased government servant (pensioner) served last and the post held by him :
7.	The scale of pay of the post last held and the last pay drawn :
8.	Name of the authority which issued PPO :
9.	Name of the Pension Disbursing Authority ( with Saving Bank Accounts Number, whereever applicable) :
	*Applicable only in cases where the applicant is a family pensioner.
	DATE:
	(SIGNATURE OF PENSIONER/FAMILY PENSIONER)

Department of Personnel and Training
Department of Administrative Reforms & Public Grievances.

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