FORM OF APPLICATION FOR COMMUTATION OF A FRACTION OF PENSION WITHOUT MEDICAL EXAMINATION
(To be submitted in duplicate after retirement but within one year of the date of retirement)
The Chief Secretary to the
Government of .
Subject: Commutation of pension without medical examination.
I desire to commute a fraction of my pension as indicated below in accordance with the provision of the All India Services (Commutation of Pension) Regulations 1959. The necessary particulars are furnished below:-
1. Name (in Block letters)
2. Fathers name (also husbands
name in the case of a female
member of the Service)
3. Designation of the post held at the
time of retirement
4. Name of the Office/Department/Ministry
in which posted .
5. Date of Birth (by Christian era) .
6. Date of retirement
7. Class of pension on which retired
(i.e. superannuation pension, retiring pension etc.)
8. Amount of pension on authorised
(In case final amount of pension has
not been authorised, indicate the amount
of anticipatory pension sanctioned
under the rule 27 of AIS (DCRB) rules 1959)
9. Fraction of pension to be commuted
(Maximum amount of pension that can be
commuted is one third)
10. Designation of the Accounts Officer who
authorised the pension and the No. and
date of pension payment order, if issued
11. Disbursing authority for payment of pension
(a) Treasury/Sub-treasury (Name and complete address
of the Treasury/Sub/treasury to be indicated
(b) (1) Branch of the Nationalised Bank with
complete postal address
(2) Bank Account No. to which monthly pension
is being credited each month .
(c) Designation and address of the Account Officer.
(Application in a case where pension is being
drawn through an Accounts Officer other than
than Account Officer who issued the P.P.O.) .
PLACE: .. Signature ...
DATE . Postal Address ..
The payment of commuted value of pension shall be made through the disbursing authority from which pension is being drawn. It is not open to an applicant to draw the commuted value of pension from a disbursing authority other than the disbursing authority from which pension is being drawn.
This deed of indemnity is made on the date of .200
Corresponding to Saka Samvat the day of .200 . ...
By Sri .S/o .Resident of (Bounden)
In Favour of the Governor of Uttar Pradesh (called The Governor .. Whereas:-
1. The bounden above name was/ is in the service of the Government of Uttar Pradesh (Called Government) as .
..(Designation) in ..(name of office).
2. The Bounden above named has retired/is due for retirement on ..
3. A No demand certificate is required to be issued in favour of the Bounden by before sanction of pension, gratuity etc. to the Bounden but the said certificate could not be issued so far and the scrutiny of records for that purpose is likely to take further time.
4. The Government is willing to sanction pension and gratuity etc. to this Bounden of condition that the Bounden shall execute a bond, being these presents, to indemnify and save harmless the Government from any loss which the the Government may incur by reason of any moneys found due against the Bounden within a period of two years from the date of retirement of the Bounden.
NOW THIS DEED WITNESSES-
1. In consideration of Government agreeing to sanction pension and gratuity etc. to the Bounden before issue of No demand Certificate in this favour, the Bounden here by covenants with the Governor that the bounden shall pay on demand to the Government all moneys which may be discovered; within a period of two years from the date of retirement of the Bounden; to be
2. Any amount due under this deed may; on the certificate of .which shall be final; conclusive and binding on the Bounden; be recovered from him as arrears of land revenue.
In witness to the above written bond and the conditions there of the Bounden has signed hereunder on the day and year
first above written.
The stamp duty on this instrument will be borne by the e Government.
Signed by Bounden Witness:-