FORM- 1 –A

FORM OF APPLICATION FOR COMMUTATION OF A FRACTION OF SUPERANNUATION PENSION WITHOUT MEDICAL EXAMINATION WHEN APPLICANT DESIRES THAT THE PAYMENT OF THE COMMUTED VALUE OF PENSION SHOULD BE AUTHORIZED THROUGH THE PENSION PAYMENT ORDER.

 

[ See Rules 5(2), 12, 13 (3), 14(1) and 15(3)]

 

(To be submitted in duplicate at least three months before the date of retirement.)

PART 1

 

The………………………………………………………………………………………………………………………………………………………………………………………… (Here indicate the designation and full address of the Head of Office)

 

Subject: - Commutation of Pension without medical examination.

 

Sir,

     I desire to commute a fraction of my pension in accordance with the provisions of Central Civil Services (Commutation of Pension) Rules, 1981. The necessary particulars are furnished below.

  1. Name
  2. Father’s name (and also husband’s name

In the case of a female Govt. servant)

  1. Designation
  2. Name of office / Department/ Ministry in

Which employed.

  1. Date of Birth
  2. Date of retirement on Superannuation or

On the expiry of extension in service granted

Under FR 56 (d)

  1. Fraction of Superannuation pension proposed to

Be commuted.

  1. Disbursing authority from which pension is to be

Drawn after retirement.

(a)   Treasury / sub treasury (Give name and

Complete address)

(b) 1. Branch of nominated nationalized bank

     with complete postal address.

      2. Bank account no. to which monthly

      pension is to be credited each month.

(b)  Accounts office of the Miny./Dept./Office

 

Signature

Present Postal address ……………………………….

Postal address after retirement……………………….

 

Place.

Date.

PART – II

(ACKNOWLEDGEMENT)

 

Received from Shri/Smt/ Kumari …………………(name)………………(designation) application in Part –I of Form – 1-A for commutation of a fraction of pension without medical examination.

 

Place                                                                                           Signature of Head of Office

Date:

 

 

PART – III

Forwarded to the Accounts Officer.

(here indicate the address and designation)………………………………………………… with the remarks that ----

(1)   The particulars furnished by the applicant in Para 1 have been verified and are correct.

(2)   The applicant is eligible to get a fraction of his pension commuted without medical examination;

(3)   The commuted value of Pension determined with reference to the Table applicable at present comes to Rs……………………………………………….; and

(4)   The amount of residuary pension after commutation will be Rs……………………..

 

2. The pension papers of the applicant completed in all respects were forwarded under this Ministry / Department / Office letter no…………………………………, Dated……... It is requested that the payment of commuted value of pension may be authorized through the Pension Payment Order which may be issued one month before the retirement of the applicant.

3. The receipt of Part – I of this form has been acknowledged in Part – II which has been forwarded separately to the applicant on …………………………………………

4. The commuted value of pension to Head of Account ………………………..

 

Place                                                                                           

Signature of Head of Office

Date: