FORM –D

 

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 PEMSION SHOULD BE AUTHORISED THROUGH THE PENSION PAYMENTS ORDER

  

(To be submitted in duplicate 3 months before the date of retirement)

 

PART –1

 

To,

        The Chief Secretary to the Government of U.P.

        ………………………………………………………….

      …………………………………………………………..

 

Subject :- COMMUTATION OF PENSION WITHOUT MEDICAL EXAMINATION

           

Sir,

            I desire to commute a fraction of my pension in accordance with the provision of the AIS (Commutation of Pension) Regulations 1959.

 

 

1.        Name in block  letters:…………………………………………………………………………………………………………

2.        Father's name (and husband's name in the case of female member of the service) ……………………………………………………………………………………………………

3.        Designation:………………………………………………………………………………………………

4.        Name of Office/Department/ministry in which posted …………………………………………………………………

……………………………………………………………………………………………………………

……………………………………………………………………………………………………………

5.        Date of Birth (by Christian era)………………………………………………………………………

6.        Date of retirement on superannuation or on the expiry of

extension in service…………………………………………………………………………….

7.     Fraction of superannuation person proposed to be

commuted (Maximum amount of pension on that

can be commuted is one third)…………………………………………………………………………

8.     Disbursing authority from which pension is to be drawn

after retirement……………………………………………………………………………………….….

………………………………………………………………………………………………………………

(a)     Treasury/Sub Treasury (Name and complete address of

the Treasury/Sub-Treasury Office indicated)………………………………………………………………………………

………………………………………………………………………………………….

(i)   Branch of the nationalized bank with complete postal address………………………………………………………………

        ………………………………………………………………………………………………

(ii)   Bank account No. to which monthly S.B.A./No. …………………………………………………………………………...

        Pension is to be credited each month………………………………………………………………………………………

(C)   Designation and address of the Account officer.

         (Applicable in a case where the pension is proposed to

         be drawn through an Account Officer other than the A.O.

         issuing the P.P.O.)……………………………………………………………………………………….

         …………………………………………………………………………………………………………

 

                                                                                                                  Signature

                                                                                                                  Present  Postal address…………………………………………………………….…………………………………………

     ……………………………………………………………………….…………………………………...      

 

Postal address after retirement

…………………………………………………………………………………………………………...

               

Place:…………………….

Date:…………………….

 

NOTE:  The payment of commuted value of pension shall be made through the disbursing authority from which  pension is to be drawn after retirement.  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 to be drawn.