ICNo

Name
REOUIRED,!N TRIPLICATE
:
:
Tele No: Mobile No
:
Address:
Appendix-I phot,ographs of the pensioner and his spouse
Passport size
To
Addl Dte Gen of Manpower (Policy & Planning)/tutP 5(B) Adjutant General's Branch
Integrated HQ of MoD (Army) Wing No 3, Ground Floor, Room No 21, West Block-III
, R K Puram t New Delhi- 1 10066
duly attested
SUB: ENDORSEMENT OF FAMILY PENSION ENTITLEMENT IN THE PENSION PAYMENT ORDER OF L
IVING ARMED FORCES PENSIONERS
The requisite particulars are given below :Name of Pensioner
With reference to Deptt of pension and pensioners Welfare OM No 1/1U85-p&pW date
d 28.10.87 and Ministry of defence oM No 6(4)/87/r369/B/D(pen/sers) dated 30.6.8
8. I hereby apply for endorsement of entitlement of family pension in the ppo.
(ii) (iii) (iv)
Regt No/IC No Rank last held Date of retirement/discharge
(v) Name of record Office in case of personnel blow officer rank.
Original PC/PPO No & year (in case of pension circular quote pension circular No
, part apd Qiscriptive Sl No)
(vi)
(vii) Particulars of Pension Discharge Authority :Treasury IDPDO/IAO/ Bank/Post
Office (c) Bank branch with full address and SB A/C No
(a) (b)
Station
(viii) Particulars of pay last drawn at the time of retirement.
...2/
2
(ix)
Family pension from other sourr:es : (a) Whether a family pensiorr is already sa
nctioned by any other pensiott sanctioning authority and if so, the name ol the
pension sanctioning authority, PPO No itnd the particulars of the pension disbur
sing Authority.
Whether Family is eligible fgr family pension from any other source and if so, t
he authority who will sanction the pension.
(b)
(c) In case the family is sanctic ned pension or is eligible for family pension
from anrt other source, an option to receive family pension fo'the spell of serv
ice for which the pension has been sanctioned vide PPO/PC No quoted above, foreg
oing family pension admissible from any other sources should be enclosed. (x) De
tails of family, in terms of pension rules, etigiUte for family pension.
SI
No
Name(s) and address of members of family
Relationship
with - the
oensioner
Date of marriage
Marital status (in case of dauqhters)
Date of birth
(xi)
Attested joint photographs of Smt ----is pasted above. (Attestation can be done
by any Gazetted Officer, pension Disbursing Officer, Head of office of retired o
fficial, village Sarpanch, Block Development Officer, MLA/MLC etc).
:
(xii) Signature of or thumb impression of
spouse.
(xiii) Marks of identification.
Signature of or left hand Thumb impression of the Pensioner (in case of Female R
ight Hand Thumb) Witness
1.
,t,.-
:
\
4
Name
I
Full adress
Siqnature
2.
II The pafticulars furnished above have been
verified
from th records available could be verfied at our end.
The particulars furnished above have been verified with reference to service per
records.
(S ig natu re R/O/Concerned Service Heaadqua rters.
:II
(Signature of the eonfeankers) With officer stamP I
';
{t
i
IV
PM sanctioned
Ordinary familypension @ Rs,
..,i,
vide PCDA (P) PPO NO
:
..;;,
ONLY ONE COPY REQUTREp E
PENSIONER (Tick Category) Telephone Mobile
Officer
[]
Spouse
lr ame F ddress
C
I
I
Family
Pensi'ner |-]
ity
:
Date
To
Addl Dte Gen of Manpower (Policy & PlanninSt)/MP 5(b) Adjutant General's Branch,
lntegrated HQ of lloD(Army) Wing No 3, Ground Floor,West Block-lll RK Puram, Ne
w Delhi-66
NOTIFICATION OF DATE OF BIRTH IN THE PPO FOR ADDITIONAL PENSION ON ATTAINING 80
YEARS OF AGE AND ABOVE BY OFFICER/SPOUSE/FAMILY PENSIONERS Dear Sir,
ln order to record Date of Birth in PPO for additional pension in terms of para
12 of GOl, MoD Revised Pension letter 17(4)12008/(1)/D(Pen/Policy) dated 11 Nov
2008. Data Sheet
designed by PCDA(P) for issue of corrigendum PPO is provided below :(a)
1.
Details of Officer.
(i) (ii)
(iii) (iv) (v) (b)
Rank Name Date of retirement Service No Original PPO No Latest Corrigendum PPO N
o Date of birth
(DD/MMATY)
Spouse
(i) (ii)
Name Date of Birth
(DD/MMiYY)
(c)
Familv Pensioner(Parents/UnmarriedAl/idowed/Divorced Daughter/ Handicapped Child
) (Only if applicable)
(i) (ii) (i)
(ii)
Name Date of Birth
(DD/MMATY)
(.q)
Bank Details (To be ascertained from the Bankersl. BSR Code of Link Branch
Link Branch & Address Pension Bank A/C No BSR Code of Pension Paying Bank Addres
s of Branch PayinE Pension Pension Paying Bank City
(iii) (iv) (v) (vi)
PIN Code No
Necessary Documents duly attested by Gazetted Officers are attached(Copy of any
one of PAN Card/Matriculation certificate/Passport/ECHS Card, Driving License as
proof of birth of Spouse/family pensioner alongwith copies of Original and Corr
igendum PPOs)
.l
I
{
Yours sincerely,
Enclosufeg lProof of birth. Copies of Original and Corr PPOs.
I