Download Proforma for Calculation of Pension & Gratuity for Retirees

Department of Soil & Water Conservation, Punjab FORM PENSION-1 (Referred to in Rules 9.3, 9.6(1), 9.6(3) and 9.10 (1) Form For Assessing Pension and Gratuity (To be Sent in duplicate if payment is desired in a different circle of account) PART-I 1 Name of the Government Employee 2 Father's Name (and also Husband's Name in the case of a female Government Employee) 3 Date of Birth (by Christian era) 4 Religion 5 Permanent Residential Address showing Village, Town, District and State 6 Present or last appointment including name of Establishment 7 i) Substantive ii) Officiating, if any 8 Date of beginning of Service 9 Date of ending of Service 10 i) Total period of military Service for which pension or Gratuity was sanctioned ii) Amount and nature of any pension/gratuity received for the military Service 11 Amount and nature of any pension/gratuity received for previous civil service 12 Government under which service has been rendered in order of employment. 13 Class of pension applicable 14 Date on which action initiated to:- i) Obtain the'No Demand Certificate ' from the Directorate of Estate as provided in rule 9.2 ii) Asses the service and emoluments qualifying for pension as provided in rule 9.4 and iii) Asses the Government dues other than the dues relating to the allotment of Govt. Accommodation as provided in rule 9.8 15 Details of omission, imperfections or deficiencies or deficiencies in the service book which have been ignored under rule 9.4(B) (II) 16 Total length of qualifying service (for the purpose of adding towards broken periods, a month is reckoned as of thirty days) 17 Period of non-qualifying service i) Interruption in service condoned under rule4.23 ii) Extraordinary leave not qualifying for pension iii) Period of suspension not treated as qualifying for pension iv) Any other service not treated as qualifying for pension 18 Emoluments reckoned for gratuity 19 Average emoluments Emoluments drawn during the last ten months of service i) In a 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 of average emoluments should be based on actual number of days contained in each month. 20 Date on which form 15 has been obtained from the government employee (to be obtained eight months before the date of retirement of government employee) 21 i) Proposed Pension ii) Proposed Graded Relief 22 Proposed Death-Cum-Retirement Gratuity 23 Date From which pension is to commence 24 Proposed Amount of Provisional pension If Department or judicial proceeding is instituted against the Government Employee before Retirement. 25 Detail of Government Dues Recoverable out of Gratuity i) Licence fee for the Allotment Government accommodation (see sub-rule (2)(3) and (4) of rules 9.17) Department of Soil & Water Conservation, Punjab ii) Dues referred to in rule 9.18 26 Whether nomination made for:- i) Death-Cum-Retirement Gratuity ii) Family Pension 1950 (if applicable) 27 Whether Family Pension 1964 applies to the Government employee and if so:- i) Emoluments reckoning for the Family Pension ii) The amount of the family pension becoming payable to the family of the Government Employee, if death takes place after retirement A) Before attaining the age of 68Years of B) After attaining the age of 68 Years Rs 28 iii) Complete and up-to-date details of family as given (in form-3) Sr. No Name of the Member of the family Date of Birth Relationship with the Government Employee 1 2 3 4 5 6 7 8 9 10 29 Height 30 Identification Marks 31 Place of Payment of Pension (Treasury sub-Treasury of branch of public sector bank or the Pay and Accounts Office) 32 Head of account to which pension and gratuity are debitable Department of Soil & Water Conservation, Punjab PEN:1 (Part-II) FORM PEN-15-A (See Rule 9.6 (i) Form of letter to the Accountant General Punjab, forwarding the Pension papers of a Government Employee No- Government of Punjab Department/Office Dated the: To The Accountant General, Punjab, Chandigarh. Subject:- Pension Papers of Sh. ________________________, Superannuation Retirement for authorization of Pension. Sir, I am directed to forward herewith the pension papers of Sh.________________________ Office of _______________________ of this department/ office for further necessary action. 2 The details 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 death-cum- retirement gratuity are indicated below:- A) Balance of the house building or conveyance advance Rs.____________ B) Over payment of pay and allowances including leave salary Rs.____________ C) Income tax deductible at source under the Income Tax Act-1961, (43 of 1961) Rs.____________ D) Arrears of license fee for occupation of government accommodation. Rs.____________ E) The amount of license fee for the retention of government accommodation for the permissible period of two months beyond the date of retirement. Rs.____________ F) Any other assessed dues and the nature thereof Rs.-Nil- Rs.____________ G) Any amount of gratuity to be withheld for adjustment of un-assessed dues, if any. Rs.____________ 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/office 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/office on receipt of the authority from you. the outstanding government dues as mentioned in para-2 above will also be recovered out of the death-cum-retirement gratuity making payment. Yours faithfully, Department of Soil & Water Conservation, Punjab PEN: 1(Part-II) Pen 15-A (27) ACCOUNT ENFACEMENT:- 1 Total period of qualifying service which has been accepted for the grant of superannuation or retiring or invalid or compensation or compulsory retirement pension and gratuity with reasons for disallowance, if any (other than disallowance indicated in part-I of this form) 2 Amount of superannuation or retiring or invalid or compensation or compulsory retirement pension or gratuity that has been admitted. 3 The date from which superannuation or retiring or invalid compensation or compulsory retirement pension or gratuity is admissible. 4 Head of account to which superannuation or retiring or invalid or compensation or compulsory retirement pension or gratuity is chargeable. 5 The amount of the family pension 1964 becoming payable to the entitled members of the family in the event of death of the government employee after retirement. SECTION-II 1 Name of the government employee 2 Class of pension or gratuity 3 Amount of pension authorized 4 Amount of gratuity authorized 5 Date of commencement of pension 6 Amount of family pension in the event of death after retirement:- i) If death takes places before 68 Years of age, or ii) If the death takes place after 68 Years of age 7 The amount of graded relief admissible on pension 8 The government dues recoverable out of gratuity before authorising its payment 9 The amount of case deposit or the amount of gratuity held over for adjustment of un-assessed government dues 10 Date on which the pension papers received by the "Accounts Officer" In the said rules, after Form PEN 15 the following form shall be inserted namely. LIST OF ENCLOSURES 1 Form PEN-1 and form PEN 15 duly completed 2 Medical Certificate of incapacity (if the claim is for invalid Pension) 3 Statement of savings effected and the reasons why employment could not be found etc. Where (if claim is for compensation pension or gratuity) 4 Service Book (date of retirement to be indicated in the service book) 5 A) Two specimen signatures, duly attested by a gazetted government employee or in the case of pensioner not literate enough to sign his name, two slips bearing the left hand thumb and finger impressions duly attested by gazetted government employee. B) Three copies of passport size photograph with wife or husband (Either jointly or separately) duly attested by the head of office. C) Two slips showing the particulars of height and identification marks duly attested by a gazetted government employee 6 A statement indicating the reasons for delay in case the pension papers are not forwarded before six months of the retirement of government employee 7 Written statement leading to reinstatement of the government employee in case the government employee has been reinstated after having been suspended, compulsorily retired, removed or dismissed from service. Note:- When initials or name of the government employee are/is incorrectly given in the various + records consulted this fact should be mentioned in the letter. 9 If a government employee is compulsorily retired form service and delay is anticipated in obtaining from PEN-I form the government employee, the head of office may forward the pension papers to the Accountant General, Punjab without Form PEN-I. The form may be sent as soon as it is obtained from the government employee. ** Only two copies of passport size photograph need be furnished. i) If the government employee is unmarried or a widower of widow: AND ii) If the government employee is governed by rule 6.17 of the Punjab Civil Service Rules, Volume-II. Department of Soil & Water Conservation, Punjab FORM PEN-15 Particulars to be obtained by the Head of office from the retiring Govt. employee eight months before the date of his retirement. ---------- 1 Name of the Govt. employee 2 Date of Birth/Retirement 3 Two specimen signatures of attested (to be furnished in a separate sheet) 4 Two slips each showing the particulars of height and present Identification mark. 5 Present Address 6 address after retirement 7 Name of Treasury/Public Sector Bank Branch through which the Govt. employee wants to draw his Pension 8 Detail of the family as defined in rule 8.17(c) of the Punjab Civil Services rules Volume-II Signature_____________________ (-----------------------) Office of ______________________ Department of Soil & Water Conservation, Punjab Undertaking by the retiree under rule 9.15 (I) of Punjab CSR-Volume-II ********* I hereby declare that I or my heirs will refund the amount of Pension/Adhoc increase, temporary increase/Adhoc relief or any other kind of increase in excess of that due to me. Signature_______________________ (-------------------) Office of __________________________ Specimen signatures of ____________________, ____________ office of Chief Conservator of Soils, Punjab, Chandigarh. ********* 1_______________________ 2________________________ 3_______________________ above given specimen signatures of Sh. _______________________ office of_________________________________________________ Department of Soil & Water Conservation, Punjab FORM PEN-I I hereby nominate the person mentioned below, who are members of my family to receive the family Pension which may be granted by Govt. in the event of my death after completion of 10 Years qualifying service. Sr. No Name & Address of the Nominee Relationship with Official Age Whether married or unmarried 1 2 3 The official should draw lines across blank space below the last entry to present the impression of any name after he has signed. Dated: (___________________) office of ______________________ Witnesses Signatures: 1________________________ 2________________________ History sheet of ___________________, _____________, office of Chief Conservator of Soils, Punjab, Chandigarh. _______ Chief Conservator of Soils, Punjab, Chandigarh. Total Service as Total Extra-ordinary Leave 34 Years 2 Months 3 days Total= (days Extra-ordinary Leave ) Department of Soil & Water Conservation, Punjab Application of Proposed Pension in respect of ____________________ ,_____________________, Office of Chief Conservator of Soils, Punjab, Chandigarh. ---------- 1 Date of Birth 2 Date of Retirement 3 Date of Beginning of Service 4 Gross Service 5 Non Qualifying Service for Pension 6 Total Half Yearly Period 7 Average Emoluments for last 10 Months from 1-1-2005 to 31-10-2005 Period Pay Total Emoluments _________ to ________ _____________ D.P. = _________= ____________ _________ to ________ _____________ D.P. = _________= ____________ _______________________ Total = _________ Average Emoluments: ------ = Rs. ___________ ------ Say Rs. ____________ (Say Rs. _____________________________________________) Proposed Pension: ---------------- =--------------- Say Rs. ------------- ----- Chief Conservator of Soils, Punjab, Chandigarh Statement showing Average Emoluments of Sh. ________________________________ Office of ___ ____________________________ Period From _________ to __________ ( ____ Months) B. P. ______/- + ______/- D.P. = _____ x _____ = _______/- _________ to __________ ( ____ Months) B. P. ______/- + ______/- D.P. = _____ x _____ = _______/- ________________________ Total = -------------/- Average Emoluments: --------- = Rs. __________/- ---- Say Rs._________/- (Say Rs. _____________________________________ only) Chief Conservator of Soils, Punjab, Chandigarh Department of Soil & Water Conservation, Punjab Calculation of Proposed Death Cum Retirement Gratuity in respect of Sh. _____________________ office of __________________________________ --- 1 Total qualifying Service _____ Years _____ Months ______ days ____ Years ( _____Half Yearly is to be counted as qualifying service for Pension) 2 Total Half Yearly ____ Half Yearly Average Emoluments Last Basic Pay Rs ____________________________/- Dearness Pay Rs ____________________________/- D.A.@ as on 4/2005 Rs ____________________________/- Total Amount Rs ____________________________/- ( _______________________________________) Proposed Gratuity Rs. ----- x --- x -- = Rs. ______________/- (Rupees____________________________________ only) Chief Conservator of Soils, Punjab, Chandigarh Department of Soil & Water Conservation, Punjab FORM 'A' NOMINATION FOR DEATH-CUM-RETIREMENT GRATUITY (When the Officer has a family and wishes to nominate a member thereof) ----------- I hereby nominate the person mentioned below who is a member of my family and confer on him/her right to receive any gratuity that may be sanctioned by the Government in the event of my death. Name & Address Relationshi p with Officer Age Contingencies in the happening of which the nomination shall become invalid. Name and address of and relationship of the person, if any to whom the right conferred on the nominee predeceasing the Officer Signature_______________________ (-------------------) Office of __________________________ Place------------ Dated: ----------- Witness 1. _____________________ _____________________ 2._____________________ _____________________ Chief Conservator of Soils, Punjab, Chandigarh. Department of Soil & Water Conservation, Punjab DECLARATION OF REFUND OR EXCESS AMOUNT OF PENSION AMOUNT/ D.C.R.G. ********** I hereby declare that in case of the amount of Pension/D.C.R.G. sanctioned/ paid to me is subsequently found to be in excess of the amount to which I am entitled under the rules I undertake to refund the excess amount paid to me if any. Signature_______________________ (-------------------) Office of __________________________ Department of Soil & Water Conservation, Punjab DECLARATION FOR THE NON RECEIPT OF PENSION /D.C.R.G. ******** I hereby declare that I have neither applied for nor receipt any Pension or Gratuity in respect of any portion of the service included in the application and in respect of which Pension or Gratuity is claimed herein no shall I submit my application here-in-after without quoting reference to this application and the orders which may be passed thereon. Signature_______________________ (-------------------) Office of __________________________ Slip showing particulars of Personal Identification Mark of _________________, ___________________ Office of Chief Conservator of Soils, Punjab, Chandigarh *********** Height : -------------- Identification: : --------------- Signature_______________________ (-------------------) Office of __________________________ Department of Soil & Water Conservation, Punjab DECLARATION FOR RECOVERY OF GOVERNMENT DUES. ******* I hereby authorise Punjab Govt. to recover any Govt. dues such as Excess on account of pay allowances, Leave salary or admitted any obvious dues such as House Rent, Postal Life Insurance Premium, Outstanding Motor Car/House Building/Traveling allowance or other advance or any other amount or any description found recoverable from me at any stage from my Pension/D.C.R.G. Signature_______________________ (-------------------) Office of __________________________ LIST OF FAMILY MEMBER OF SH. ---------------------------------------- OFFICE OF ---------------------------------- -------------- ********** Sr. No Name of Family Member Age Relationship Remarks 1 2 3 4 Chief Conservator of Soils, Punjab, Chandigarh. Department of Soil & Water Conservation, Punjab NO DUE CERTIFICATE Certified that nothing is against Sh. ____________________________ Office of _________ _____________________________, who is going to retire superannuation on dated ______________ Chief Conservator of Soils, Punjab, Chandigarh. Department of Soil & Water Conservation, Punjab CERTIFICATE REGARDING DEPARTMENTAL/VIGILANCE INQUIRY ********* Certified that No Departmental/Vigilance Inquiry is pending against the Official. Chief Conservator of Soils, Punjab, Chandigarh. Department of Soil & Water Conservation, Punjab Calculation of Proposed Family Pension in respect of Sh. ___________________________________, Office of _______________________________. ************* 1 Basic Pay in the Scale as on _______________ Rs. ________ + _________ = Rs. ____________/- 2 Family Pension @ 40% of Rs. -------+----/-D.P. upto the age of 65 Years Rs. -----x---- = Rs.____________/- ---- 3 But eligible minimum family @ 30% of the pay Rs. -----x---- = Rs.____________/- ---- 4 Proposed family Pension upto the age of 65 Years Rs.____________/ 5 Thereafter normal Pension Rs.____________/ Chief Conservator of Soils, Punjab, Chandigarh Department of Soil & Water Conservation, Punjab Office of ________________________________________ Pension Case (Establishment Branch) To Accountant General, Punjab, Chandigarh. Memo No /, Dated, Chandigarh: Subject:- Pension Case of Sh. _____________________________________, ________________, Office of _____________________________ MEMORANDUM Sh. ___________________________, Office of ___________________________________ is retiring on superannuation with effect from ______________________ A.N. His Pension papers are sent herewith as per details given below for necessary action and reporting on his title to pension:- 1 Form Pen-I duly completed is enclosed in duplicate. 2 Form Pen-15-A duly completed is enclosed in duplicate. 3 Form Pen-15 duly filed is enclosed in duplicate. 4 Undertaking under rule 9.15(i) of Punjab CSR Vol-Ii is enclosed. 5 Two specimen signatures duly attested are enclosed. 6 Form Pen-I duly completed is enclosed in duplicate. 7 History sheet of service of the official is attached. 8 Details of earned leave/half pay leave and commuted leave taken by the official during the entire service is attached. 9 Statement showing average emoluments of the official is attached. 10 Statement showing proposed pension of Sh _________________________ is attached. 11 Statement showing proposed Gratuity admissible to Sh. ________________________ is attached. 12 Form Pen-I (Nomination for DCRG is attached) 13 Undertaking for the refund of excess amount of Pension/DCRG is attached. 14 Declaration for the non receipt of Pension/DCRG is attached. 15 Slip showing height and personal identification mark of Sh. _______________________ is enclosed. 16 Undertaking for effecting recovery if any to Govt. is attached. 17 Calculation of Proposed family Pension. 18 Nomination for family pension. 19 An envelope containing duly attested passport size joint photograph of Sh. __________ _____________________, Office of _______________________________ and his wife is enclosed in triplicate. 20 No due certificate 21 Certificate of No Pending Departmental/Vigilance enquiry . 22 Service Book of Sh. ________________________________ ENCL: Pension Case complete with full documents Service Book Chief Conservator of Soils, Punjab Chandigarh.