FORM 7 [ See rule 57, 58(6), 61(1), 63, 64(2) and (3), 68(1) and (7)] FORM FOR ASSESSING PENSION AND GRATUITY (To be sent in duplicate if payment is desired in a different circle of Audit) PART - I 1. Name of the Government Servant : 2. Father's name (and also husband's : Name in the case of female Government servant) 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 the establishment (i) Substantive (ii) Officiating, if any 7. Date of beginning of service : 8. Date of ending of service : 9. (i) Total period of military service for : which pension or gratuity was sanctioned (ii) Amount and nature of military pension gratuity received from the military services 10. Amount of and nature of any pension / : gratuity received for previous civil services. 11. Government under which services has : been rendered in order of employment 12. Class of pension applicable. : 13. The date on which action initiated to : (i) obtain the 'No demand Certificate from the Department in charge of building as provided in rule 52* (ii) assess the service and emoluments qualifying for pension as provided in rules 57 and 61* (iii) assess the Government dues other than the dues relating to allotment of Government accommodation. 14. Details of omissions, imperfections or : deficiencies in the service book which have been ignored. 15. Total length of qualifying service (for : purpose of adding towards broken periods, a month is reckoned as thirty days). 16. Period of non-qualifying service: (i) Interruption in service condoned under Rule 25* (ii) Extraordinary leave not qualifying for pension (iii) Period of suspension not treated as qualifying. (iv) Any Other service not treated as qualifying : 17. Emoluments reckoning for Gratuity From To 18. Average emoluments " emoluments drawn during the last ten months of service: 19. Date on which Form 5 has been obtained from the Government servant (to be obtained on year before the date of retirement of Government servant) 20. Proposed pension 21. Proposed death-cum-retirement Gratuity 22. Date from which pension is to Commence 23. Proposed amount of provisional Pension if department or judicial proceeding is instituted against the Government Servant before retirement. 24. Details of Government dues referred to in rule 70 recoverable out of gratuity 25. Whether nomination made for (i) Death-Cum-Retirement gratuity (ii) Non-contributory family pension, if applicable 26. Whether Contributory family pension applies to the Government servant 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 servant, if death takes place after retirement Post held From To Pay Personal or Special pay @ (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 calculation average emoluments. (ii) The calculation of average emoluments should be based on actual number of days in each month. (*Tamil Nadu Pension Rules 1978) (iii) Complete and up to date details of the family as given in form 3 : : : : : : : Serial number (1) Name of the family members (2) Date of birth (3) Relationship with the Government Servant (4) 1. 2. 3. 4. 27. Height : 28. Identification marks : 29. Place of payment of pension : (Treasury, Sub-Treasury or Pay and Accounts Office) 30. Head of Account to which : pension and gratuity are debitable Signature of the Head of Office
