List of Forms/documents required for applying for grant of family

pension in respect of unmarried/widowed/divorced daughters of

an Armed Forces personnel

(a) Personal application addressed to Director, PP&R, Air HQ, West

Block– VI, RK Puram, New Delhi-110106
(b) MPB-501. (Blank form enclosed)
(c) MPC-60. (Blank form enclosed)
(d) Particulars of NOK. (Blank form enclosed)
(e) Income certificate/Income declaration duly countersigned by
Tehsildar.
(f) Non Marriage/re-marriage certificate.
(g) Certificate to be furnished by the bank. (Format enclosed)
(h) Three recent passport size photographs duly attested by a
commissioned officer or a gazetted officer on the reverse side.
(i) An Affidavit stating that Ms ___________is unmarried and
unemployed and her income from all sources is less than minimum
pension i.e. Rs. 3500/- plus dearness relief.
(j) Date of birth certificate from school/college/ Municipal Corporation/
Gram Panchayat.
(k) Copy of death certificate of father.
(l) Copy of death certificate of mother.
 (To be submitted in triplicate)
PARTICULARS OF WIFE/NOK OF

LATE

1. Name of Wife/NOK -
2. Relation with deceased officer -
3. Specimen Signatures - (a)
(b)
(c)
4. Right/left hand thumb and fingers impressions :

(Right in case of female applicant/left in case of male applicant)

_________ __________ __________ _________ ________

Thumb Index finger Middle Finger Ring finger Small
finger

5. Personal marks of identification :

(preferably two identification marks)

ATTESTED

(Seal) (Signature)
Name :
Designation:
Date: Address:
Place: Mobile No.
Telephone:
Email ID :

Note: Attestation should be done by any serving Gazetted/Commissioned

Officer (not below the rank of Captain and equivalent)/Magistrate.
 MPC-60

STATEMENT OF TOTAL MEANS OF SUPPORT FROM ALL SOURCES

OF AN APPLICANT FOR A PARENT’S PENSION/ALLOWANCES IN
RESPECT OF THE DEATH/MISSING OFFICERS (GIVE RANKS NAME
AND UNIT/REGT/CORPS/SHIP/ESTABLISHMENT

1. Applicant’s Name (IN BLOCK LETTERS)………………………………………………………

Yourself Your wife/husband

Rs. P Rs. P
2. State present yearly income from :
(a) Salary or wages including overtime
Bonus, Commission etc. ………… ……….. ………… ………

(b) Business on own account

(Estimated profit) ………… ……….. ………… ………

(c) Old age or widow pension State

Pension number here ………… ……….. ………… ………

(d) Any other pension (including the

Portion commuted if any) or grant
Give particulars here ………… ……….. ………… ………

Total income yearly ………… ……….. ………… ………

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Where there are two parents the reply to question 3,4,5 and 7 should cover both father and
mother.

3. If you sublet or tame in lodgers or boarders state the total amount received from this
source.
4. If you own a house in which you are living, attach annual assessment certificate from
Municipal authority and state.

(a) The net annual value as assessed for income tax ……………………………………………….
(b) The amount of any mortgage still outstanding …………………………………………………..
(c) The rate of mortgage interest ……………………………………………………..
(d) Ground rent, if any ……………………………………………………….

5. Amount of rent being paid for the accommodation, if lying in the rented house …………………
6. Give particulars of any other benefits in kind (for example, free board)………………………………
……………………………………………………………………………………………………………………………………………………………
7. Have your any money invested or unvested e.g. in the bank, post office? If so, give
particulars………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………

Note: Certificate from the bank of post office/firm etc, regarding the date(s) of sum and annual
interest/dividend thereon, to be attached.

8. Amount of DOP fund to the credit of the deceased.

9. Amount of insurance of deceased, if any.
P.T.O.
10. Disposal of the amount stated against 8 & 9 above. If since can release.

11. Give particulars of all your surviving children including step children and adopted children.

S.No. Sex DOB Married, Occupation Total Whether Whether Rate of monthly income
Single or income living at depend made by each member of
Widower p.m. home upon family (including amount
with you you & if paid for board at lodging
so what at living at home

Note : If any son is apprentice, indicate the stipend/allowance he is receiving and the
date on which apprenticeship will be completed and the salary to be given on
accepting the assignment.

Before signing the Declaration you should make sure that all questions on the
form have been answered correctly. This will avoid correspondence and delay.

This application is an official document and any person male-fig as statement

which he or she knows to be false is committing a legal offence.
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DECLARATION BY APPLICANT

I declare that the answers to the questions on this form are true and complete to
the best of my knowledge and belief and that I have disclosed all me/our mean of
support.

Signature of Applicant……………………….… Witness of

Signature………………………………
(Any Commissioned Officer of the Defence
Address of applicant…………………………… Services not below the rank of Capt. or
……………………………………………………………… equivalent Or Magistrate or Serving Civilian
…………………………………………………………….. Gazetted Officer under his office
Seal/Stamp
Dated : Address
………………………………………………………….
………………………………………………………….
………………………………………………………….
Dated …………………………………

To be countersigned by Zila Sainik Kalyan Board.

 MPB-501 (REVISED)
APPLICATION FOR FAMILY PENSION AND CHILDREN ALLOWANCE
IN RESPECT OF DECEASED, AF OFFICERS

Please Note:-

A. The issue of this form does not imply that you will be found eligible for
pension.
B. When completed, this form should be sent with all available birth and marriage
certificates to Air Headquarters, Dte of PP&R, West Block VI, RK Puram, New
Delhi-110066. The decision on your claim will be communicated to you as
soon as possible and the certificates (if in original) returned.
C. Before signing the declaration, please make sure that the questions have been
answered correctly (dashes or ticks are not sufficient answers). This will save
correspondence and delay. Person making a statement which she knows to be
false is committing an legal offence.
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PART-I: PARTICULARS RELATING TO DECEASED OFFICER

1. Name (IN CAPITAL)……………………………………………………………………………………………….

2. (a) Personal Number…………………………… (b) Rank…………………………………….

(c) Unit/Regt/Corps/Ship/Establishment……………………………………………………………
(d) Date of Birth………………………………………………………………………………..

3. (To be answered only if death occurred after termination/release/retirement from

Service).

(a) Date of Death……………………………… (b) Place of Death…………………………

(Death certificate to be attached)
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PART-II:PARTICULARS OF APPLICANT

4. Name (IN CAPITAL)…………………………………………………………………………………………………..

5. Address in full………………………………………………………………………………………………………………
6. (a) Date of birth…………………………… (b) Date & Place of
Marriage…………………………. (Birth & marriage certificates are to be attached if available)

7. Where you living apart from your husband at the time of his death for any reason
other than this employment with the Forces? If yes, attach a statement of the
circumstances
………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………
PART-III: PARTICULARS OF CHILDREN

8. (a) Particulars of children of the deceased officer under 25 years of age (see
note below) in respect of whom allowance are claimed. (Birth certificate to be attached,
if available).

Full Name of each child Sex Date of Birth Present address(if difference from your
own also state reasons

(b) Are all the children maintained by you?................................

NOTE: When pecuniary circumstances require it, an allowance may also be granted
under certain conditions after the age of 18 for a child who is :-

(a) An apprentice (or in an analogous position) receiving not more than

nominal wages or
(b) Being educated at the university, a technical or secondary school, or
(c) Is capable of self-support by reasons of mental of physical infirmity which
arose before i.e. attained the age of 18 years.

Claim for any such allowance should be submitted on Form No. MPB-501
(Revised) which may be obtained from Dy CDA(AF), Pension Cell, Subroto Park,
New Delhi-110010 or CCDA (Pensions), G1 Mil Gp (Gp IV), Draupadi Ghat,
Allahabad-211014 on request.

9. (a) Are you or any of your children in receipt of any pension or allowance
…………………………. (if so, state the particulars thereof under Part-IV below, i.e. on
page 3).

(b) Nationality……………………………

(c) Have you applied for any pension or allowance (apart from the present
application or do you intend doing so?.............................................................

If so, state to whom you have applied or intend to

apply………………………………………….………………………………………………………………………………
PART –IV : PARTICULARS OF ANY PENSION RECEIVED BY THE DECEASE OR THE
APPLICANT OR THEIR CHILDREN

Name of Nature of Rate of amount By whom paid Reference

Pension pension or per month or number/Authority
allowance annum

PART-V : NAME OF TREASURY AND NATIONALISED BANK

10. At which treasury and through which nationalized bank do you desire pension, if
granted to be payable :-

(a) Name of Treasury/DPDO/Bank :……………………………………………………………………..

(b) Saving Bank A/c No. ……………………………………………………………………………………….
(c) Postal Address of Bank …………………………………………………………………………………..
……………………………………………………………………………………

DECLARATION

I hereby declare that to the best of my knowledge and belief, the answer to the
questions on this form are true and complete and I claim pension on the basis of the
facts set forth. I undertake to furnish any further particulars that may be required.

…………………………………….
(Signature of applicant)
…………………………………………….
 Witness Signature

 (Any Commissioned officer of the Defence Services on effective list not below the
rank of Captain or equivalent rank or Magistrate under his Court Seal, or any
serving Civilian Gazetted Officer under his official Seal/Stamp)

Address of Witness ………………………….……………………………………………….……………………………..

Date………………
 INCOME CERTIFICATE/INCOME DECLARATION
(As per para (ii) of GOI, MOD letter No. 1(3)/99/D(Pen/Sers) dated 24.11.1999)

I…………………………………………………………………………………………………………(Name of the
applicant)
…………………………………………………..………………(wife/husband/son/daughter/father/mother) of
No. ……………………………..
Name…………………………………………….…………………………………………………… Rank……………………,
resident of ………………………………………………………………………………………………… do hereby
solemnly affirm and declare as under:-

Source of Annual Income for the year 20….. -…………

(a) Income from Immovable Property Rs. ……………………………………

(b) Income from Movable Property Rs. ……………………………………
(c) Income from Employment (Pvt./Govt.) Rs. ……………………………………
(d) Income from Pension Rs. ……………………………………
(e) Income from Self employment/business Rs. ……………………………………
(f) Income from other sources Rs. ……………………………………
Total Rs. ……………………………

Signature/Thumb Impression of the

applicant

Attestation
(By Village Officer/Municipal Councillor)

Countersigned
(By Tehsildar/Revenue Magistrate)

Place: Office Seal

Date :
 CERTIFICATE OF NON-MARRIAGE/RE-MARRIAGE

I, hereby declare that I am not married/have not been married during the past six
months.

OR

I, hereby declare that I have not been re-married and I undertake to report of such an
event to PDA.

Place :
Signature………………………….

(Name of Pensioner)
Date:

I certify to the best of my knowledge and belief that the above declaration is correct.

Signature of a Responsible Officer or

a well-known person.

Place : Name

Date : Designation

COUNTERSIGNED BY

Zila Sainik Kalyan Board/Zila Sainik Welfare Officer.

 CERTIFICATE TO BE FURNISHED BY BANK

1. It is certified that this bank has participation in the Pension Disbursement Scheme
of the Nationalised Banks for Defence Service Pensions. The full postal address is as
under :-

(a) Pension disbursing branch (in which pensioner hold account)

…………………………………………..……………………………………………… State………………………….
Pin Code……………………….. .

Code…………………..
BSR CODE ………………………………………………………………………
RTGS/NEFT/IFSC…………………………………………………………………………………

(b) Full postal address of Link Branch* or CPPC is as under :-

………………………………………………………………………………………………………………………………......
.................................State……………………………………….Pin
Code…………….………………… BSR CODE……………………………………………………………….

2. Shri/Smt…………………………………………………………………………………..…………….. resident of
………………………… ……………………………………………………………………………………………………………….. is
holding a family pension account No. …………………………………. in her bank.

(Signature of Manager with Rubber Stamp)

Date :

* Every Bank may have many branches in a district. Out of these, one branch is
designated as the Nodal Branch or the Main Branch for that district and known as Link
Branch in the pension parlance. The Pension Payment Order (PPO) which is issued by
the Pension Sanctioning Authority (PSA) i.e. Dy CDA (AF) is addressed to the Link
Branch which forwards it further to the Paying Branch for payment of pensionary
benefits.