Professional Documents
Culture Documents
SJSHSGSVSVSV
SJSHSGSVSVSV
2. I hereby declare that I have neither applied for, nor received any pension
or gratuity in respect of any portion of the service qualifying for this pension
and gratuity as claimed herein, nor shall i submit an application, hereafter
without quoting a reference of this application and the order which may be
passed thereon.
3. I am governed by the Family Pension Scheme 1964 and that the complete
and up-to-date details of my family are as under:
SrNo Name Age Relation Date of Birth Remarks
1 Hansi 43 DAUGHTER 06/09/1980
2 BHOLLA DUTT BHATT 41 SON 10/10/1982
3 Bimla 38 DAUGHTER 04/06/1985
4 Pushpa Rani 34 DAUGHTER 16/09/1989
4. I enclose herewith :
Statement of the savings affected and the reasons why employment could
3.
not be found elsewhere (it claim is for compensatin, pension or gratuity).
AND
(ii)If the government employee is governed by rule 6.17 of the Punjab Civil
service Rule Volume II.
FORM PEN. 15-A
See Rule 9.6(I)
Sir,
2. The detail of government dues which will remain outstanding on the date
of retirement of the government employee and which need to be recovered
out of the amount of death-cum-retirement gratuity are indicated below:
A) Balance of the house building or conveyance advance Rs.0
B) Over payment of pay and allowances including leave salary Rs.0
Income tax deductible at source under the income Tax Act-1961,(43
C) Rs.0
of 1961)
Arrears of license fee for the retention of government
D) Rs.0
accomodation.
E) The ammount of license fee for the retention of government . Rs.0
F) Accommodation for the permissible period of two month beyond
Rs.0
the date of retirement
G) Any other assessed dues and the nature there of Rs.0
Any amount of gratuity to be withheld for adjustment assessed due
H) Rs.0
if any
Total 0
3. Your attention is invited to the list of enclosures which is forwarded
herewith.
4. The receipt of this letter may be acknowledged and this Department
informed that necessary instructions for the disbursement of pension have
been issued to disbursing authority concerned.
5. The death-cum-retirement-gratuity will be drawn and disbursed by this
Department on receipt of the authority from you. The outstanding
government dues as mentioned in para 2 above will be recovered out of the
death-cum-retirement-gratuity before making payment.
Yours Faithfully
Superintending Engineer
Patiala Drainage Circle Patiala
Irrigation
FORM PEN.I
Amount (In
Description
Rs.)
Balance of the house building or conveyance advance 0
Over payment of pay and allowances including leave
0
salary
Income tax deductible at source under the income Tax
0
Act-1961,(43 of 1961)
Arrears of license fee for the retention of government
0
accomodation.
The ammount of license fee for the retention of
0
government .
Accommodation for the permissible period of two month
0
beyond the date of retirement
Any other assessed dues and the nature there of 0
Any amount of gratuity to be withheld for adjustment of
0
un- assessed dues, if any.
Total 0
i) In case where the last ten months include some period not to be reckoned
for calculating average emoluments an equal period backward has to be
taken for calculating average emoluments.
ii) The calculation average emoluments should be based on actual number
of days contained in each month.
19) Date on which Form Pen 15 has been 26/06/2023
obtained from the government
employment (to be obtained eight months
before the date of retirement of Govt.
employee.)
20) I) Proposed Pension. I) 23050
II) Proposed Graded relief. II)Nill
21) Proposed Death-Cum-Retirement Gratuity 942054
22) Date from which pension is to be 01/10/2023
commence.
23) Proposed amount of Provisional pension,-
If departmental or Judicial proceeding is
instituted against the government
employee before retirement.
24) Detail of Government dues recoverable
out of Gratuity: i) 0
i) Licence fee for the Allotment of ii)
Government accomodation
[see sub-rule(2),(3) and (4) of rules 9.17].
ii) Dues referred to in rule 9.18.
25) Whether nomination made for-
i) Death cum retirement Gratuity. I) Yes
ii) Family pension 1950, If applicable. II) Yes
26) Whether Family Pension 1964 Applies to Yes
the Government employee and if so i)
i) Emoluments reckoning for family
pension.
ii) The amount of Family Pension
becoming payable to the family of the
Government employee and if death taking
place after retirement.
A)Family pension a) 13830
iii) Complete and uptodate details of
family as given (in form3)
Name of the member Relationship with the
Sr.No Date of Birth
of the Family Government employee
1. Hansi 06/09/1980 DAUGHTER
2. BHOLLA DUTT BHATT 10/10/1982 SON
3. Bimla 04/06/1985 DAUGHTER
4. Pushpa Rani 16/09/1989 DAUGHTER
PART II
SECTION I
ACCOUNT ENFACEMENT:
1) Total period of qualifying service which has Years: 30 Months: 5 Days: 4
been accepted for the grant of
superannuation or retiring or invalid or
compensation or compulsory retirement
pension and gratuity, with reason for
disallowance, if any (other than disallowance
indicated in part I of this form)
2) Amount of superannuation or retiring or 23050
invalid or compensation or compulsory 942054
retirement Pension and Gratuity that has
been admitted.
3) The date from which superannuation or 01/10/2023
retiring or invalid compensation or
compulsory retirement pesion or gratuity is
admissible.
4) Head of account to which superannuation or 2071-Pension & Other
retiring or invalid compensation or Retirement Benefits 01-
compulsory retirement pension or gratuity isCivil
chargeable. 101-Supernnuation and
Tetirement Allowances
105-Family Pension
104-Gratuites
102-Commuted Value of
Pension
5) The amount of family pension 1964 becoming 13830
payable to the entitled member of family in 23050
event of death or the govt employee after
retirement.
SECTION II
PART A- PARTICULARS
Employee Code: (221885) Husband Name:Nitia Nand
Employee Name: KALAWATTI
Designation: PEON Pay In Pay
Office: PATIALA DRAINAGE CIRCLE (BasicPay+DA+IR+GP+NPA):
PATIALA 46100+15674+0+0+0
PART B- QUALIFYING SERVICE
1. Date of entry into Govt. Service 26/04/1993
2. Date Of Retirement 30/09/2023
Total Period of Service From 26/04/1993 Years Months Days
3.
To 30/09/2023 30 05 04
4. Non Qualifying service 00 00 00
5. Weightage in Service 00 00 00
6. Pre-Joining Qualifying Service 00 00 00
7. Net Qualifying Service for Pension 30 5 4
PART C-PENSION(Average Emolunments For Last Ten Months)
Sr.No Month/Year Pay(BasicPay+GradePay+DA+IR+NPA) Total
1. DEC/2022 44800+0+15232+0+0 60032
2. JAN/2023 44800+0+15232+0+0 60032
3. FEB/2023 44800+0+15232+0+0 60032
4. MAR/2023 44800+0+15232+0+0 60032
5. APR/2023 46100+0+15674+0+0 61774
6. MAY/2023 46100+0+15674+0+0 61774
7. JUN/2023 46100+0+15674+0+0 61774
8. JUL/2023 46100+0+15674+0+0 61774
9. AUG/2023 46100+0+15674+0+0 61774
10. SEP/2023 46100+0+15674+0+0 61774
Average Emolunments Pay in Pay Band____ 61077
Pension for the Maximum Service(50% of AE/Last
23050
Emolunments)
Family Pension @ 30% 13830
Total Death-cum-Retirement Gratuity 942054
Percentage/Amount Of Monthly Pension Commuted 9220
Amount of commuted value of Pension Authorised 906584
Remarks(if Any)
Signature of Head of Office
Superintending Engineer
Patiala Drainage Circle Patiala
Irrigation
HISTORY OF SERVICE
Dated: 26/06/2023
1. __________________________________________
2. _________________________________________
3. _________________________________________
Attested
FORM Pen 1-C
NOMINATION FOR DEATH - CUM - RETIREMENT GRATUITY.
(when the officer has family and wishes to nominate member thereof)
............................................................................
Employee Name- KALAWATTI (221885 ) c/o Nitia Nand, Peon, Patiala
Drainage Circle Patiala, Irrigation. I hereby nominate the person mentioned
below who is a member of my Family and confer on his/her right to receive
any gratuity and may be sanctioned by the Government in the event of my
death.
Name & address and
Name & Contingencies in the
relationship of the person if
relationship happening of which the
Age any, to whom the right
Address with nomination shall
conferred the nominee
officer. become invalid.
redeceasing the officer
Hansi
43
DAUGHTER
BHOLLA DUTT
41
BHATT SON
Bimla
38
DAUGHTER
Pushpa Rani
34
DAUGHTER
Dated this 26/06/2023 day of ________________________
At___________________________
Signature of the employee.
Witness
1.___________________________
2.___________________________
1.________________________________
2.________________________________
________________________________________________________________________________
(To be filled in by the head of the office in the case of a non-Gazetted Officer)
Date 26/06/2023
CERTIFICATE
Date 26/06/2023
Undertaking under rule 9.15
Witnesses:
Witness
Sr.No. Address Occupation Signature
Name
H No 29, Bhan Colony,
Government
1 Sunita Rani Century Enclave
Employee
Phase-3, Patiala
H no 14, New Century
Mandeep Government
2 Enclave, Ablowal
Kumar Employee
Road, Patiala
Attested by
Superintending Engineer
Patiala Drainage Circle Patiala
Irrigation
Signature of employee
Name: KALAWATTI (221885 )
Designation:Peon
Husband Name Nitia Nand
Establishment Department:Irrigation
Government of PUNJAB
Irrigation
(Patiala Drainage Circle Patiala)
Superintending Engineer Patiala Drainage Circle Patiala Nabha Road Patiala
9. Details of P.L.I Policy where premium deduction is done from pay bill
10. The Details of the C.P.F./Income-Tax/Profession Tax deduction made
from him/her upto the date from the beginning of current financial
year are noted below.
11. He resided at Government Rented House at . House Rent recovered
upto 30/06/2023.
Bank Acc. No. IFSC Code Mobile No. PAN No.
2918001300003216 PUNB0291800 9855951359 AOXPK5311F
Date: 27-06-2023
Signature ___________________________________
Designation ____________________________________
(Details of Recoveries)
Total amount of
Name of advance advance Outstanding Rate of Current
involving sanctioned with amount instalments Month
recovery/adjustment date of drawal and recoverable Rs. Deduction
T.V. number
Signature of Employee
Employee Name: KALAWATTI
Employee Code: 221885
Nitia Nand
Designation : Peon
Patiala Drainage Circle
Posting Office :
Patiala
Date : 26/06/2023
Patiala Drainage Circle
Place :
Patiala
Witnesses:
Witness
Sr Address Occupation Signature
Name
H No 29, Bhan Colony,
Government
1 Sunita Rani Century Enclave
Employee
Phase-3, Patiala
H no 14, New Century
Mandeep Government
2 Enclave, Ablowal
Kumar Employee
Road, Patiala
Attested By:
Head of Office/ Pension Authority
(Superintending Engineer)
Patiala Drainage Circle Patiala
Irrigation
Specimen Signatures/Left Hand Thumb and Finger Impressions
Specimen Signature
1. 2.
Left hand Thumb Impression and Finger Impression (Relevant for
Illiterate Pensioner)
Note: If government servant is unable to give left thumb and finger print
impressions, he may give right hand thumb and finger print impressions.
Where an employee has lost his hands, he/she may give his/her toe
impression.
Little Finger Ring Finger Middle Finger
Certified that the above specimen signature and thumb & finger impressions was / were taken in my
presence.
(Superintending Engineer)
Patiala Drainage Circle Patiala
Irrigation
Certificate Regarding Military Service
Certified that I have not rendered any Military service nor have received any
pension or gratuity.
Signature of Employee
Employee Name:KALAWATTI
Employee Code:221885
Father:Nitia Nand
Designation:Peon
Parent Deptartment:Irrigation
Date:26/06/2023
Place:PATIALA
Attested By:
Signature of Employee
Employee Name: KALAWATTI
Employee Code: 221885
Designation:Peon
Posting Office:Patiala Drainage Circle Patiala
Parent Deptartment:Irrigation
Date:26/06/2023
Place: PATIALA
Attested By:
Name: KALAWATTI
(Peon)
Patiala Drainage Circle Patiala/Irrigation
Address: H No 140 Block B New Century Enclave Ablowal Road
Patiala
No.
Dated:26/06/2023
Forwarded in original to the Principal Accountant General, (A & E), Punjab,
(Pen-Section) for authorizing the commuted value of 40 % of total pension.
(KALAWATTI)
FORM PENSION 10
To,
1. The District Treasury Officer: District Treasury Office, Patiala
A copy of the above is forwarded to: .....................(Designation and
2.
Address of the PSA);
A copy forwarded to:........................ (Name of the Pensioner with the
3.
complete address)
(PART III)
Bank Details for Pension Payment
1. Joint Bank Account Number 2918001300003216
2. IFSC PUNB0291800
3. Bank Name PUNJAB NATIONAL BANK
PATIALA MODEL TOWN, DISTT.
4. Branch Name
PAT
5. Branch Code 291800
6. CPPC Code
7. Bank Address MODEL TOWN , PATIALA
8. PIN