FORM 7 FORM FOR ASSESSING PENSION / FAMILY PENSION AND GRATUITY (To be sent in duplicate if payment is desired in a different circle of accounting unit) (See Rules 58, 60, 61 (1) and (3) and 65 (1)) PART - I 1. Name of the retiring Government employee .................. 2. Father's/Husband name ................. 3. Height ................. 4. Marks of Identification ................. 5. Date of birth ................. 6. Service to which belongs (indicate name of organized service, if any, otherwise says, General Central Service) ................. 7. Particulars of post held at the time of retirement:a) Name of the office ................. b) Post held ................. c) Whether the appointment mentioned above was under Government of outside the Government on Foreign Service terms. ................. 8. Whether declared substantive in any post under the Central Government. ................. 9. Date of beginning of service. ................. 10. Date of ending of service. ................. 11. Cause of ending of service a) Voluntary retirement on being declared surplus (Rule 29) ................. b) Permanent absorption in Public Sector undertaking / autonomous body (Rule 37-A) ................. c) Due to abolition of post (Rule 59) d) Superannuation (Rule-35) ................. e) Invalid on medical ground (Rule 38) ................. f) Voluntary/Premature retirement at the Initiative of the Government servant (under Rule 48, 48-A and FR 56 (k)) ................. g) Premature retirement at the initiative of the Government (Rule 48 or FR 56 (J)) ................. h) Compulsory retirement (Rule 40) ................. i) Removal/dismissal from service (Rules 24 and 41) ................. j) Death ................. 12. In the case of compulsory retirement, the orders of the competent authority whether pension may be Allowed at full rates or at reduced rates and, in case of reduced rates, the percentage at which it is to be allowed. ................. 13. In case of removal/dismissal from service whether orders of competent authority have been obtained for grant of compassionate allowances and if so, at what rate ................. 14. Particulars relating to military service, if anya) Period of military service. ................. b) Terminal benefits drawn/being drawn for Military service. ................. c) Whether opted for counting of military Service towards civil pension. ................. d) If answer to (c) above is in the affirmative, whether the terminal benefits have been refunded. ................. e) In case of ex-servicemen who are eligible for family pension under the Armed Forces Rules, whether opted to retain family pension Under the armed forces rules or to draw family pension under the Civil Rules. ................. 15. Particulars relating to the service in autonomous body, if any: a) Particulars of service. Sl. Name of Organization Post Held Period No. From To b) Whether the above service is to be counted for pension. ................. c) Whether the autonomous organization has discharged its pensionery liability to the Central Government. ................. 16. Whether any departmental or judicial proceeding are pending against the retiring employees. ................. 17. Qualifying service:a)Details of omission, imperfection or deficiencies in the service book which have been ignored (under Rule 59(I) (b) (iii) ................. b) Period not counting as qualifying servicei) Boy service (2nd proviso to Rule 13 ) ................. ii) Extraordinary leave not counting as qualifying service (Rule 21) ................. iii) Periods of suspension not treated as qualifying service (Rule 23) ................. iv)Interruptions in service (Rule 27(I)(b) and Rule 28(c) ................. v) Periods of foreign service with United Nations bodies for which United Nations Pension has been availed. ................. vi) Any other period not treated as qualifying service (give details) ................. c) Additions to qualifying servicei) Military service (Rule 19) ................. ii) War service (Rule 20) ................. iii) Weightage on voluntary retirement on being declared surplus (Rule 29) ................. iv) Weightage under Rule 30 ................. v)Benefit of service in an autonomous body (Rule 37) ................. vi) Weightage under Rule 48-B d) Net qualifying service ................. e) Qualifying service expressed in terms of completed six monthly periods (period of three months and over is treated as completed six monthly period) ................. 18. Emolumentsa) Emoluments drawn during 10 months proceeding retirement- From To Rate of Pay Amount b) If the officer was on foreign service immediately preceding retirement, the notional emoluments which he would have drawn under Government but for being on foreign service. ................. c) Average emoluments reckoned for pension. ................. d) Emoluments reckoned for retirement gratuity/death gratuity. ................. e) Emoluments reckoned for family pension. ................. 19. Date on which the retiring employee submitted his application for pension in Form 5 ................. 20. Compete and up-to-ate details of the family as given in Form-3 21. Whether nomination made for death gratuity / retirement gratuity. ................. 22. The on which action initiated to - a) Obtain the 'No demand certificate' From the Directorate of Estates as provided in Rule-57 ................. b) Assess the service and emoluments qualifying for pension as provided in Rule 59 and ................. c) Assess the Government dues other than the dues relating to the allotment of Government accommodation as provided in Rule 73 (I) Sl. No. Name of the Member of the family Date of birth Relation with the Government Servant. ................. 23. Details of Government dues recoverable out of gratuitya) License fee for Government accommodation (see sub-rules (2)(3) and (4) of Rule 72) ................. b) Dues referred to in Rule 73. ................. 24. a) Proposed pension/service gratuity. ................. b) Proposed dearness relief on pension (as on the date of retirement) ................. c) Date from which pension is to commence.................. 25. Rate of family pensiona) Enhanced rate ................. b) Period for which family pension will be Payable at enhanced rate. ................. c) Ordinary rate. ................. d) Date from which ordinary rate of family pension will be payable. ................. 26. Amount of retirement gratuity / death gratuity. ................. 27. Commutation of pensiona) Whether simultaneously applied for commutation of pension with the pension application (applicable only in the case of those who retire on superannuation pension) ................. b) The portion of pension commuted. ................. c) Commuted value of pension. ................. d) Amount of residuary pension after deducting commuted portion. ................. e) Date from which reduced pension is payable. ................. 28. Name and address of Bank/Pension accounting office from where pension is to be drawn. ................. 29. Head of Account to which pension and gratuity are debitable. ................. 30. Post-retirement address of the retiree. ................. ................. ................. ................. SIGNATURE OF THE HEAD OF OFFICE.
