Form Pen - 16

(See rule 91)

OFFICE OF THE PRINCIPAL ACCOUNTANT GENERAL (A&E),HARYANA
REVISED(PENSION PAYMENT ORDER)
File ID :- 2051476469 PEN-R1/1
PPP/Family ID :- NA Date of Authorisation :- 02/01/2024
For Pensioner/Pension Disbursing Authority
1. Pension Payment Order No.(PPO NO.) 1114108694108694
Gratuity Payment Order No. (GPO) NO. 1224452559452559

2. Name of the Pensioner KASHMIRI LAL

3. Gender MALE

4. Father's Name RONKI RAM

5. Case No./Application No. 1523554739

Haryana Civil Services(Pension) Rules 2016
6. Rules Applicable :
Debitable to Government Haryana Government 2071-Pension
7.
Classification of Pension/Family 2071-01-101-51-000051-27-V (Pension)
8.
pension(Head of Account) See Footnote 1
9. Aadhaar Card Number N/A
10. Unique Payee Code N/A

11. Place of Payment of Pension (Treasury, Sub- JAGADHARI

Treasury or Branch of Public Sector Bank)
12. Bank Account No. N/A

13. SHIVPURI- BP.NO.- 344 YAMUNA NAGAR HARYANA

Full address along with mobile phone number

13.1 Mobile no N/A

13.2 Email N/A
14. Date of birth of pensioner 12/12/1954
15. Date of appointment in Government service 25/04/1986
16. Date of retirement 31/12/2012
17. Post held at the time of retirement ASSISTANT
18. (Level/Pay scale)last held N/A
19. Group of the post last held GROUP - C
PU267-DISTRICT SOCIAL WELFARE OFFICER PANCHKULA
20. Office from where retired

Superannuation (Rule 143 of HCS (General) Rules 2016)

21. Class of pension

22. Net Qualifying Service 26Y- 3M- 21D

23. Last pay drawn 16220/-
24. Emoluments for Pension/Family Pension 16220/-

1.Column No. 8 reflects the Classification for pension only.Classification For DCRG and Commuted value of Pension may be
determined at the level of treasury officer.
25. Emoluments for DCRG 30274/-
26. Amount of Pension 9238/-
27. Whether Regular or Provisional Pension Regular

28. Pension Withheld,if any NA

29. Commuted Portion of pension 0/-
30. Date of restoration of commuted portion of
*Please see instruction No. 6.
pension
31. Net pension payable 9238/-
32. Amount of Normal Family pension Rs. 0/- *Please see instruction No. 5.

33. Amount of Enhanced Family pension Rs. 0/- *Please see instruction No. 5.

34. Commuted Value of pension 0/- Zero only

35. DCRG Sanctioned. 444856/-

35.1 DCRG Recovery 0/-
35.2 DCRG Withheld 0/-
444856/- Four Lakhs Forty Four Thousand Eight Hundred Fifty Six
35.3 DCRG Payable only

Details of Family members eligible for family pension

Sr Name Relationship Date of birth/age Wheather disabled Aadhaar card

no. (attached proof) no.
1 N/A N/A N/A N/A N/A

(A) UNTIL FURTHER NOTICE,on the expiry of every month,please pay to sh./smt./km. KASHMIRI LAL S/W/o RONKI
RAM the above said Pension/family Pension plus the amount of dearness relief as admissible thereon from time to time
after due identification of the pensioner.

(B) The payment of pension shall commence from 01/01/2013 (Not to be issued before Date of Retirement)
In the event of death of sh./smt./km. KASHMIRI LAL above said enhanced family pension shall be paid to smt./sh.
(C) N/A from the day following the date of death till the expiry of seven years from the date of retirement or on the
completion of 65 years age had the retiree survived.
whichever is earlier and thereafter above said Normal Family Pension shall be paid as per conditions mentioned in
Haryana Civil Services(Pension) Rules,2016.

(D) Income Tax, as per rules, shall be deducted at source.

36. Medical Allowance Open

36.1 Date of option for Medical Allowance N/A

36.2 Medical Allowance if opted for fixed Medical

0/-
Allowance

37. Remarks if any If any please see instruction 7.

ANITA Digitally signed by ANITA RANI TALWAR

cn=ANITA RANI TALWAR, ou= INDIAN

Speciman Signature RANI AUDIT and ACCOUNTS DEPARTMENT,

o= INDIAN AUDIT & ACCOUNTS
DEPARTMENT, st= HARYANA, c= IN
Date: 2024.01.02 16:45:34 IST

TALWAR
Signature and Designation

Seal of pension payment

issuing authority
To
The Treasury Officer,
JAGADHARI

Copy forwarded for information record and further action to :

PU267-DISTRICT SOCIAL WELFARE OFFICER PANCHKULA

Copy to :
KASHMIRI LAL S/W/o RONKI RAM,SHIVPURI- BP.NO.- 344 YAMUNA NAGAR HARYANA

Important Instructions
Family Pension in case of death of pensioner:

1. In case of widow/widower: From the date following the date of death of pensioner upto
the date of remarriage or death whichever is earlier.However, the childless widow shall
be eligible after remarriage provided her income from all sources should be less than or
equal to minimum family pension plus dearnesss relief thereon.
In case of dependent unmarried son/daughter: From the date following the date of ineligibility of mother/father till the
date of marriage , on attaning the age of 25 years or earning livelihood,
which is the earliest.

In case of dependent unmarried daughter/widowed or divorced daughter : From the date following the date of
ineligibility of mother and father/above said brother-sister(s) till the date of marriage/remarriage or earning
livelihood,whichever is earlier.

In case of dependent disabled child : From the date following the date of ineligibility of family pension
to the mother and father physically fit brother and sister(s) to the date of earning livelihood.
 In case of dependent parents upto the date of death:From the date following the date of ineligibility of spouse and
dependent children.
Note.- For detail see rule 8(10)(B) and chapter VIII of Haryana Civil Services (Pension) Rules, 2016.

2. No Pension shall be liable to seizure, attachment or sequestration by process of any court in india in the instance of
Creditor for any demand against the pensioner (Section 11, Act XXII of 1871).

3. (a) Pensioner shall have to submit his/her life certificate on line once in a year in the month of November by login
website www.jeevanpramaan.gov.in with Aadhar Biometric Authentication.In exceptional cases life certificate
signed by a competent medical authority shall also be accepted.

(b) In case of death of pensioner, it shall be the duty of the family to intimate the pension Disbursing Authority
immediately.

4. Dearness relief is payable with reference to the amount of original pension before commutation. Relief on pension/family
pension is payable at the rate prescribed by the government from time to time.

5. Condition for enhanced family pension is upto seven years from the date following date of death or upto 65 year
age(Related to age of original pensioner) whichever is earlier.

6. Commutation of pension is subjected to recovery from pension. Therefore, the recovery of the commuted portion of
pension shall be operative from the pension of the same month in which the commuted value of pension is credited in the
bank account of the pensioner.

7. Special remarks, if any, of Accounts Officer of the office of principal of Accountant General (A & E),Haryana :-
PROVISIONAL PENSION ISSUED MAY BE TREATED AS REGULAR PENSION

8. Reason For Revision

1 Change in DDO

2 Change in DDO
 Bank Details

1. Bank Name

2. Branch Name

3. Account Number N/A

4. IFSC Code

5. Branch Code

6. CPPC Code

7. Address

8. Pin Code

9. Phone Number

Part-I
(For Treasury Officer)
Medical Allowance
Date of Change of option Nature of Change Amount of Medical Allowance
Sr.
for Medical Allowance payable in case of change if
No.
applicable

1.
2.1
3.
4.
5.
6.
7.
8.
9.
10.
 Part-II
(For Pension Disbursing Authority)
Record of initial Pension and revision thereof

Authority Date of Amount of Reason for Rate of Remark Initials of

Letter No. effect Pension Revision Dearness designated
and date Fixed/Revised Relief officer
Rs. Rs.

Part-III

(For Pension Disbursing Authority)

Record of transfer of ppo from one Pension Disbursing Authority to another, if

Full Particulars of PDA at

Sr. which pension was Date upto which Full particulars of PDA Date and signature of
No. being drawn before pension has been to which PPO is authorized officer of
transfer paid transferred transferring PDA

1.
2.1
3.
4.
5.
6.
7.
8.
9.
10.
 Part-IV
(For Pension Disbursing Authority)
Record of periodical jeevan praman patra(Life Certificate)
To be authenticated once in a year i.e. in the month of March

Sr. Acknowledgement No. Initial of Remarks Sr. Acknowledgement No. Initial of Remarks
No. and dates of jeevan designated No. and dates of jeevan designated
praman patra officer praman patra officer

1. 26.

2. 27.
3. 28.
4. 29.
5. 30.
6. 31.
7. 32.
8. 33.
9. 34.
10. 35.
11. 36.
12. 37.
13. 38.
14. 39.
15. 40.
16. 41.
17. 42.
18. 43.
19. 44.
20. 45.
21. 46.
22. 47.
23. 48.
24. 49.
25. 50.
 The Information recorded reflects the data as present in System Automation Initiative (SAI) for Pension of the O/o The Pr. AG
Haryana (This is only for asistance).
File Id :- 2051476469

Authority Revision Benefit Enhance Family Pension Family Pension

Type Number No. Date Amount From Amount From To Date Amount From
PPO 1114108694108694 29/08/2014 8579.00 01/01/2013 8579.00 See Instruction no. 5 5652.00 See Instruction 5

* Only for use of Treasury officer

Annexure reference to changing following rows as per SAI(System Automation Initiative)