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APPLICATION FOR PAYMENT OF FAREWELL GRANT TO RETIREMENT.

PART-I
PART-I. PERSONAL DETAIL.
1. a) Name of the incapacitated/ deceased employee. -

b) CNIC No. c) d) e) Father/Husband Name. Date of birth. Date of death.

PART-II. SERVICE DETAIL.


2. f) g) Name of Department/Division/ Ministry. Last appointment held Alongwith BPS (Gazetted/NonGazetted) Station/Place of last posting. Date of entry into service. Date of removal from service on account of a) Incapacitation b) Superannuation/Qualifying service. c) Dismissal from service. Pay per month. a) Basic Pay b) Special Pay c) Technical Pay d) Personal Pay e) Qualification Pay Total Audit Office.

h) i) j)

k)

l)

m) Audit Office Personal No. n) o) Bank Account alongwith Bank Branch Name. Period of EOL or period for which contributions to Benevolent and Group Insurance Funds were not paid. Present address of the employee

p)

(SIGNATURE OF THE EMPLOYEE)

PART II CERTIFICATE BY THE HEAD OF OFFICE

1. Certified the information contained in Part-I of the Application Form is correct and according to our record. 2. Certified the above named employee was neither a contingent paid/work charged employee nor a deputationist from a Provincial Government/Autonomous body. 3. Certified that the above named employee is covered under the provisions of FEBF & GI Act, 1969 and had been contributing to the Benevolent & Group Insurance Funds for last 25 years or above. In case of any variation the department will be responsible to pay back the amount of Farewell Grant. Certified the Farewell Grant claim has been preferred for the first time. 4. Following documents are submitted with claim: i) ii) An attested copy of initial Appointment Letter of the employee. An attested copy of last pay certificate issued by the Head of the office/Authorized officer. A copy of retirement orders of the employee. An attested copy of Pension Payment Order book (where Pension is not applicable, a certificate of service record by Head of the department/Authorized officer. An attested copy of CNIC of the employee. (Annex-I)

(Annex-II) (Annex-III)

iii) iv)

(Annex-IV) (Annex-V)

v) vi)

An attested copy of last month schedule of recovery of Benevolent & Group Insurance Funds made from the pay bill of the retired employee/ AGPR Pay Slip. (Annex-VI)

Seal and Signature Authorized officer not below BS-20

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