| 1. |
Name of the applicant in block
letters and full postal address. |
| 2. |
Type of pension admissible. |
| 3. |
Name of the Pensioner/ deceased
Government servant (Pensioner) in case of family pension. |
| 4. |
Date of retirement /death of the
Government employee. |
| 5. |
Date from which pension/family
pension is being drawn. |
| 6. |
Pension Payment Order (P.P.O) No. |
| 7. |
Office/ Department/Ministry in
which the pensioner/ deceased government servant (pensioner) served last and the post held
by him. |
| 8. |
The scale of pay of the post last
held and the last pay drawn. |
| 9. |
Consolidated final pension /
family pension admissible from 1.1.96. |
| 10. |
Name of the authority which issued
PPO. |
| 11. |
Name of the Pension Disbursing
Authority with SBA number, wherever applicable. |
| 12. |
If any documentary evidence is
being attached to facilitate settlement of the case, details thereof. |