Employee Information duly signed by Retiring employee

(To be kept in personal file of retiring employee)

To
The Manager/Trustee
PNB Employees Pension Fund Trust
HO: PF & Pension Fund Department JOINT PASSPORT SIZE PHOTOGRAPH
Dwarka, New Delhi TO BE ATTESTED BY BRANCH MANAGER

Subject: Pension Payment Proposal,

PF No. ______________________________ Sign- of employee:

Name ______________________________________
LTI/RTI:
Design ______________________________________

With reference to my retirement / cessation of

service from the bank on .................................. ,
I submit as under:
# Contact Details after retirement:

Address: _______________________________________________________________________

______________________________________ _________________________________________

Pin code: ___________________ Mobile No. _________________________________________

Email : __________________________________ Landline No ____________________________

Aadhar Card No of Retiree (Pl attach a copy) : _____________________________________________

# If opted for VRS, date of notice ____________________________________________

Dependent Details (Person eligible for family pension) ( Attach Aaadhar Card & PAN Card)
Name Date of Birth Relation

Aadhar No of Spouse / eligible family pensioner PAN No of Spouse/eligible family pensioner

R R R R R R R R R R R R R R R R R R R R R R

Reason, if spouse is not mentioned above (attach document proof) :

________________________________________________________________________________________

If Spouse employed with PNB, PF number of spouse: ___________________________________

Incase of Ex-Servicemen, please furnish the following details:

PPO Number: _________________________________ PPO Date: ________________Rank _____________

Regimental Number : _________________________ Address of PPO Issuing Office : _________________

 - 2 -
PENSION PAYMENT LOCATION DETAILS

Name of Branch where pension payment is requested: ___________________________________

D No. Of branch: ___________________ Circle Office: _________________________________

Pensioner's Account no *: _________________________________________________________

(*Joint Account with spouse at the Pension Paying Branch)
# NOMINATION DETAILS (MUST BE WITNESSED)

I, Name.................................................... PF No…………………………….. hereby nominate the person

named below under Regulation 51 of PNB (Employees) Pension Regulations,1995:
Name & address of the Relationship Date of Birth Name & Address/phone no. of person who may
receive the said pension during the nominee's
nominee with Pensioner of nominee
minority(if nominee is minor)*

Aadhar No of the Nominee PAN No of the Nominee

0 0 0 0 0 0 0 0 0 0 0 0

Witnesses Name Signature Address

Witness1

Witness 2

# Having regard to the wage revision settlements, I request you to compute my Pension Provisionally on
the basis of Pay as defined in settlement/ joint note relevant to me. Further, I hereby undertake and
authorize you and/or the Bank to make suitable adjustments or effect recovery, if any, from the
Pensioner/family pension payable to me / my family in future, if necessitated due to amendment(s) in
PNB (Employees) Pension Regulation, 1995.

# Please commute 1/3rd of my pension as per bank rules on my cessation of service / attaining
superannuation / on completion of 3 months notice period (in case of VRS), as I am a pension optee.

# I undertake to present myself at the pension paying branch between 1- 30 November every year for
signing and submitting my life certificate failing which the release of pension to me may be stopped until
it is submitted.

# I shall submit Investment Declaration to the Pension Paying Branch every year by 20th March if I wish
to avail rebate u/s 80C-U of Income Tax Act, 1961 failing which I shall not hold the bank responsible for
deduction of TDS from my pension.
Disclaimer: I have checked all the details mentioned above. I shall not hold the bank/Trust responsible
for any discrepancy on the above.

Place

Date Signature of the employee

COUNTER SIGNATURE BY BRANCH MANAGER

Date: Signature with stamp and PF No.

 PF NO : _____________
IDENTIFICATION FORM
1. NAME IN FULL

PF NO

DESIGNATION

2. SEX (MALE / FEMALE)

3. COMPLETE POSTAL ADDRESS

WITH PIN CODE

TELEPHONE NO

EMAIL ID

4. PHOTOGRAPH

(JOINT WITH SPOUSE, IF ALIVE)

(Photograph should bear the AFFIX

signature & seal of the Branch
Manager) PHOTO

If spouse not alive, Attach Death HERE

Certificate (duly attested)

5. SPECIMEN SIGNATURE

LEFT/RIGHT HAND THUMB

6.
IMPRESSION OF THE EMPLOYEE

7. DATE

FOR OFFICE USE ONLY

Signature & Seal of the Branch Manager with GBPA No &

PF No in token of having attested the above.
 BO: _________________

Dated: __________
The Chief Manager
HRD Department
Circle Office-South Delhi
Rajindra Bhavan, Rajindra Place
New Delhi – 110 008

Reg: Settlement of terminal dues – Confirmation in respect of employee retiring in

the month of ________________

Shri/Ms. _____________________________
PF No. ______________________________
Designation ______________________________
B/O ______________________________

In respect of the above employee, we confirm:

 That the employee remained on LWP for ______days as per our record and it
is confirmed that the same relates to the entire period of service of the retiree.
 That the employee did not avail sabbatical leave.
 That there is nothing due in any shape or form.
 All types of leaves availed by the employee has been marked in HRMS.
 We have got confirmation from his/her previous branches, where he has
worked during the last 5 years, that there is nothing due in any shape or form.
 Pension Account is opened at the proposed pension paying branch with spouse
name as per dependent details in HRMS.
 The details mentioned in hard copies formats are in commensurate with HRMS
details and there is no discrepancy in this regard.
 While submitting the pension proposal in HRMS, the following default details
has been got checked from the concerned employee: -
 Residential Address
 Mobile No.
 Aadhar Number
 PAN No.
 Spouse Name spelling and his/her DOB in “Nominee details” and
“Eligible Family Pension details”

Signature of Employee Signature of Branch Head with GBPA Number

 DETAILS OF RETIRING EMPLOYEE OF PUNJAB NATIONAL BANK
FOR AVAILING THE BENEFITS UNDER
“PNB PARIVAR BHAVISHYA AROGYA YOJNA”

Please paste attested

recent passport size
photograph here

PARTICULARS OF RETIRING EMPLOYEE

NAME

EMP ID

DATE OF BIRTH

DATE OF RETIREMENT

OFFICE FROM WHERE

RETIRED
ADDRESS FOR
COMMUNICATION

TELEPHONE NO

PERMANENT ADDRESS

Place _______________

Date _______________

SIGNATURE OF BANK OFFICIAL

WITH DESIGNATION & GBPA NO
 RETIREMENT CERTIFICATE FORMAT
(Please fill the format neatly in CAPITAL Letters)
(PROVIDE REQUIRED INFORMATION WITHIN TEN DAYS FOR ISSUANCE OF CERTIFICATE TO
EMPLOYEE AT THE TIME OF RETIREMENT)

PARTICULARS OF RETIRING EMPLOYEE

NAME OF THE EMPLOYEE (In English)

NAME OF THE EMPLOYEE (In Hindi)

PF NO.

DESIGNATION

DATE OF JOINING THE BANK

DATE OF RETIREMENT

PLACE OF POSTING

CIRCLE OFFICE SOUTH DELHI

PHOTO AT THE TIME OF PRESENT PHOTO

JOINING
 Important points to be noted prior to Processing of Pension Papers

1. It should be ensured that the concerned employee has opted for pension.

2. Date of appointment should be the date when the employee was permanently posted
in the bank. Appointment on temporary basis is not to be taken into account. In case of sub-
staff, more particularly in case of sweeper, it should be seen from the service records that
how much service has been rendered on 1/3 or ½ or ¾ or full scale wages.

3. In Date of cessation from service, please specify reasons i.e. Superannuation/VRS /

CRS/deemed retirement etc.

4. Extraordinary leave on loss of pay shall not count as qualifying service except when
the sanctioning authority has directed that such leave not exceeding twelve months during the
entire service, may count as service for all purposes including pension. Period of sabbatical
leave and period of suspension unless specified otherwise in the order of disciplinary
authority must be deducted from qualifying service. LWP mentioned in the proposal are total
LWP during total span of service.

5. No addition in qualifying service is allowed except in case of Voluntary Retirement

(pension regulation 29) .

6. Commutation of pension should not be recommended unless requested for by the

pensioner.

7. In case of compulsory retirement, invalid Pension and compassionate allowance, the

request for commutation has to be accompanied by a medical certificate of fitness by Bank's
approved Medical Officer.

8. Where family pensioner is son or daughter of the employee, certificate of date of birth
and declaration of non-employment/ date of marriage of son or daughter/remarriage of
spouse, if any, should be procured and kept in file.

9. If the employee has availed leave on loss of pay during the last ten months of service,
an equivalent period prior to ten months should be taken for calculation of average pay.
Incumbent will check all the details in the pension proposal invariably.

10. If in dependent details, retiree does not mention the name of spouse, reason may be
asked for in writing as - i) Deceased or ii) Divorced/judicial separation or iii) Retiree
unmarried with full details of death certificate/divorce petition and order of the court etc.

11. Incumbent will positively get the information signed from retiree/family pensioner as
per format available in link of Pensioner information/family pensioner information at
navigation( Manager Self Service > Terminal Benefits (submission)
>Add/Update/Recommend Pension> Pension Reports) and will keep them safe in personal
file. Nominee details in the draft will be signed by witness and the name of witness will be
recorded by the incumbent in pension proposal details.
12. Incumbent will be responsible for maintaining record of all documents procured
from the retiree/family pensioner in respect of Pension/Family Pension Proposal and will
make them available on demand to CO/HO/Auditors/any other authority, in case of need.

13. The family pension payable to disabled children beyond the age limit specified in
Pension Regulation shall be stopped if he or she starts earning his or her livelihood. In such
cases, it shall be the duty of the guardian or son or daughter to furnish a certificate to the
Bank every month that –

(i) he or she has not started earning his or her livelihood;

(ii) in case of daughter that she has not yet married;

(iii) In addition, he or she or guardian shall produce every three years a certificate
from a medical officer approved by the Bank to the effect that he or she continues to
suffer from disorder or disability of mind or continues to be physically crippled or
disabled.

14. The pension account has to be in the Joint Names of the retiree & spouse at the proposed
pension paying branch.

15. Kindly check the dependent details (viz Correctness of Name, Date of Birth &
Relation) of the retirees, through the following menu option in HRMS, and report any
anomalies to this office at the earliest with a copy of the proof of Name, Date of Birth & and
request letter for correction of data, duly recommended by the Branch Head, for necessary
amendment:-

Go to Main Menu → Employee Information System → Personal Information →

Personal Relationships → Dependent Information

16. For detailed guidelines & navigation details for issuance of Identity Card to Retired
Employees, please be guided by HRDD Circular No. 751 dated 10.01.2017

17. The retiree may be advised to go through the contents of PAD Circular No 201/2014
on PNB Hospitalisation Contributory Benefit Scheme for Retired Employees.

18. Please provide the PAN No & Aadhar No of retiree & spouse / person eligible for
family pension, at the space provided in the Pension Proposal.

19. In case of any query/clarification/assistance on Pension Papers / Online Pension Module,

please feel free to contact CO HRD DEPARTMENT AT _________________-