 Documents required from applicant of Family Pension:

1. Request Letter for family pension

2. Application Form for Family Pension (in Duplicate)
3. Affidavit duly stamped and attested by Executive Magistrate/Competent Authority
4. Original Death Certificate
5. ID Proof showing D.O.B. and Spouse Name
6. Three (3) Passport Size Photographs
7. Pension Payment Order (PPO) Copy
8. Bank Account Copy (SBI or PSB)
 FORM OF APPLICATION
(Family Pension Scheme of Punjab Govt. Employees, 1964)

Application for family pension for the family of late Sh./Smt. _________________________
Designation_________________________ in the office/department of _________________________.

1. Name of the applicant :

2. Relationship to the deceased :
3. Date of retirement, if the deceased :
was a pensioner

4. Date of death of Govt. :

employee/pensioner
5. Name and ages of surviving :
kindred of the deceased
Name Date of birth

Sons :
Unmarried Daughters :

6. Name of treasury/ sub-treasury :

PSB or SBI Branch along with Account No.
at which payment is desired
7. Signature or left hand thumb impression :
8. Descriptive roll of _____________________________________ widow/widower/
guardian of the minor children of late ______________________________________.
i) Date of birth :
ii) Height :
iii) Personal marks of identification, if :
any on hand or face.
iv) Left hand thumb and finger :
impression
Small finger Ring finger Middle finger Index finger Thumb

Attested by: Witnesses:-

1. ___________________ 1. ____________________

2. ___________________ 2. ____________________
 hlPIAw ibAwn

mYN xxxxxxxxxxxx (Name of Applicant) pqI/pqnI SRI/SRImqI xxxxxxxxxxxxx (Name of

Deceased Pensioner), pqw: xxxxxxxxxxxx (Permanent Residential Address) dw/dI vwsI
hW Aqy hyT iliKAw hlPIAw ibAwn krdI hW:-

1. ieh ik mYN aukq pqy dI/dw p`kI/p`kw vsnIk hW[

2. ieh ik myry pqI/pqnI xxxxxxxx (Deceased) spu`qr/spu`qrI xxxxxxxx (Father's Name), jo
ik gurU nwnk dyv XUnIvristI, AMimRqsr qoN bqOr xxxxxxxx (Designation) imqI nUM syvw-
mukq hoey sn, ijnHW dI mOq imqI xxxxxxxx (Date of Death of Pensioner) nUM ho cu`kI hY[
3. ieh ik myry pqI/pqnI jo ik xxxxxxxx (Name of the Bank where Deceased was getting
pensions) pwsoN Kwqw nM: xxxxxxxx (Deceased Pensioner's Account No.) ADIn pYnSn
pRwpq kr rhy sn[
4. ieh ik mYN PYimlI pYnSn pRwpq krn leI AplweI kr rhI/irhw hW[
5. ieh ik mYN Awpxy pqI/pqnI dI mOq qoN bwAd dUjI SwdI nhIN krvweI Aqy nw hI kdy
krvwvWgI/krvwvWgw[ jykr mYN dUjI SwdI krvwvWgI/gw, qW ies sbMDI dPqr nUM sUicq krnw
myrI izMmydwrI hovygI[
6. ieh ik mYN iksy srkwrI jW gYr-srkwrI mihkmy iv`c nOkrI nhIN krdI/dw hW Aqy nw hI mYN
pihlW pMjwb/kyNdr srkwr pwsoN iksy iksm dI koeI pYnSn pRwpq kr rhI/irhw hW[
7. ieh ik myry xx p`uqr Aqy xx p`uqrI/AW hn[ (No. of Children)
8. ieh ik myry pws iksy hor dyS dI nwgirkqw nhIN hY[
9. ieh ik mYnUM PYimlI pYnSn lgweI jwvy Aqy hor jo vI bxdy bkwey hn, id`qy jwx[ mYN ies
sbMDI mihkmy dIAW SrqW dI smyN smyN isr pwbMd rhWgI/gw[
10. ieh ik mYN aukq ibAwn dI Kud ijMmyvwr hovWgI/gw[
ibAwn krqw

myrw au`pr drz ibAwn myry igAwn Aqy ivSvws qoN iblkul shI vw durusq hY Aqy kuJ
lukwieAw nhIN hY[
ibAwn krqw