Application for Pension

CS-63

APPLICATION FOR PENSION

From

Shri/Smt/Kum______

Kendriya Vidyalaya, ______

______

______

To

The Deputy Commissioner,

Kendriya Vidyalaya Sangathan,

BENGALURU.

THROUGH PROPER CHANNEL

Sir,

1.  I beg to say that I am retiring on Superannuation from service with effect from the ______[afternoon] my date of birth being ______. I, therefore, request that steps may kindly be taken with a view to the pension and gratuity admissible to me being sanctioned by the date of my retirement.

2.  I hereby declare that I have neither applied nor received, any pension or gratuity in respect of any portion of the service qualifying for this pension and in respect of which pension/and/or gratuity is claimed herein nor shall I submit any application hereafter without quoting a reference to this application and the orders which may be passed thereon.

3.  I enclose herewith:-

i) Three slips bearing in each three specimen signatures of mine, duly attested;

ii) Three copies of joint passport size photograph of mine with spouse also duly

attested;

iii) Three slips each showing particulars of height and identification marks;

iv) Three slips each bearing my left-hand thumb & fingers impressions;

v) Details of family in Form CS-63a

4.  The particulars for the drawal of pension through an authorized branch of the State Bank of India are as under:-

i) Name of place: ______

ii) Name of Branch: ______

iii) The Particulars of SB/Current A/c No.

to which pension is to be credited: ______

My present address is ______

______

5.  And my address after retirement will be ______

______

Place: ______Signature: ______

Dated: ______Designation: ______

CS-63[a]

DETAILS OF FAMILY

Name of the Sangathan Employee : ______

Designation : ______

Date of Birth : ______

Date of appointment : ______

Details of the members of my family as on : ______

Sl.
No. / Name of the members of family* / Date of Birth / Relationship with the Employee / Initials of the Head of Office / Remarks
1 / 2 / 3 / 4 / 5 / 6
1
2
3
4
5
6

I hereby undertake to keep the above particulars up-to-date by notifying to the Head Office any addition or alteration.

Place: ______ ______

Signature of the Sangathan Employee

Dated: ______

*Family for this purpose means family as defined in Clause (b) of Sub-Rule (14) of Rule 54 of the CCS (Pension) Rules, 1972.

NOTE: Wife and husband shall include respectively judicially separated wife and husband.

CS-64

KENDRIYA VIDYALAYA ______

______

F.______/ Date: ______

To

The Deputy Commissioner,

KENDRIYA VIDYALAYA SANGATHAN,

BENGALURU.

Subject: Pension Papers of Shri/Smt/Kum.______, for authorization

of Pension.

Sir,

I am directed to forward herewith the Pension Papers of Shri/Smt/Kum. ______, of this Vidyalaya for further necessary action.

2. The details of KVS dues which will remain outstanding on the date of retirement of the KVS employee and which need to be recovered out of the amount of Death-Cum-Retirement Gratuity are indicated below:

S.No. / Nature of Recovery / Amount [Rs.]
[a] / Balance of the House Building or Conveyance Advance
[b] / Overpayment of Pay and Allowances including leave salary
[c] / Income Tax deductible at source under IT Act, 1961 [43 of 1961]
[d] / Arrears of Licence Fee for occupation of Govt./KVS accommodation
[e] / The amount of Licence Fee for the retention of Govt./KVS accommodation for the permissible period of two months beyond the date of retirement
[f] / The amount of Gratuity to be withheld for adjustment of un-assessed dues if any
GRAND TOTAL

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 Vidyalaya informed that necessary instructions for the disbursement of pension have been issued to the disbursing authority concerned.

5. The Death-cum-Retirement Gratuity will be disbursed by this Vidyalaya on receipt of authority from you. The outstanding Govt. dues as mentioned in Para 2 above will also be recovered out the Death-cum-Retirement Gratuity before making payments.

Yours faithfully,

Signature of the Employee

CS-64[a]

FORM FOR ASSESSING PENSION AND GRATUITY

1. / Name of the Applicant
2. / Father’s Name [and also Husband’s Name in case of Female Employees]
3. / Date of Birth
4. / Date of Birth [by Christian Era]
5. / Religion
6. / Permanent residential address showing Village, Town, District and State
7. / Present or Last appointment including name of establishment:
[i] Substantive
[ii] Officiating if any
8. / Date of beginning of qualifying service in KVS
9. / Date of ending of service in KVS
10. / [i] Particulars of service if any under Central Govt. etc., before joining KVS
[ii] Details of Pro-rata retirement benefits already received for that service:
[a] Pension
[b] Gratuity
[c] Management Share of CPF
[iii] Details of Pro-rata retirement benefits already transferred for counting that service in the KVS:
[a] Pension
[b] Gratuity
[c] Management Share of CPF
11. / Class of Pension applicable

Page 1 of 3

12. / The date on which action initiated to:
[a] Obtain ‘NO DEMAND CERTIFICATE’ from the Authority Controlling allotment of residential accommodation as provided in Rule 57.
[b] Assess the service and emoluments qualifying for pension as provided in Rule 59; and
[c] Assess the Sangathan dues other than the dues relating to the allotment of accommodation as provided in Rule 73[1].
13. / Details of omissions, imperfections or deficiencies in the service book which have been ignored under Rule 59 [1] b[ii]
14. / Total length of qualifying service [for the purpose of adding towards broken periods, a month is reckoned as 30 days]
15. / Period of Non-qualifying service:
[i] Interruption in service condoned under Rule / From / To
[ii] Extra Ordinary Leave not qualifying for Pension
[iii]Period of suspension not treated as qualifying service
[iv] Any other service not treated as qualifying
Total
16. / Emoluments reckoning for gratuity
17. / Average Emoluments:
* Emoluments drawn during the last ten months of service.
Post Held / From / To / Pay [in Rs.]
[B.Pay + D.Pay] / Personal Pay
Or
Special Pay / Average Emoluments
18. / Date on which Form 63 has been obtained from the applicant. [To be obtained eight months before the date of retirement of Sangathan Employee.]
19. / Date from which pension is to commence
20. / Have any departmental or judicial proceedings been instituted/contemplated against the applicant before retirement ?
21. / Details of Sangathan dues recoverable out of gratuity:
[a] Licence Fee for the allotment of office accommodation etc.
22. / [b] House Building Advance
23. / Other Dues if any
24. / Weight

Page 2 of 3

25. / Identification marks
26. / Place of payment of Pension through SBI
27. / Name of Branch and Account Number

[ Signature of the Head of Office ]

*[i] In case where the last ten months include some period not 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.

Page 3 of 3

Annexure-I

KENDRIYA VIDYALAYA ______

APPLICATION FOR DRAWAL OF PENSION THROUGH STATE BANK OF INDIA

To,

The Deputy Commissioner,

Kendriya Vidyalaya Sangathan,

BENGALURU.

Sir,

I opt to draw my pension through State Bank of India (Place and Branch given below). Necessary particulars to enable you to make arrangements in this regard are as under:-

1. Particulars of Pensioner:

b) Name : ______

c) Pension payment letter No. : ______

d) Present Address : ______

______

______

2. Particulars of authorized branch of S.B.I: ______

a) Name (Place)

b) Branch where payment desired : ______

c) Branch Code Number : ______

3. *Pensioner’s SB/Pension A/c Number: ______

at the Branch to which pension is to be

credited

Yours faithfully,

PENSIONER

Place: ______

Dated: ______ ______

Pensioner’s Specimen Signature

FOR USE IN SANGATHAN’S OFFICE

Shri/Smt/Kum.______ has been paid pension for the period up to the month of ______.

Amount of pension relief and adhoc relief, if any payable, is clearly indicated.

Annexure-B

KENDRIYA VIDYALAYA, ______

Specimen signature of Shri/Smt./Kum.______

______

______

English Hindi

1. ………………………………………. …………………………………….

2. ………………………………………. …………………………………….

3. ………………………………………. …………………………………….

ATTESTED BY:

______

PRINCIPAL

Dated:______

Annexure-B

KENDRIYA VIDYALAYA, ______

PARTICULARS OF HEIGHT & IDENTIFICATION MARKS

of Shri/Smt/Kum.______

1. Height :

2. Identification Marks : i]

ii]

ATTESTED BY:

______

PRINCIPAL

Dated: ______

Annexure-B

KENDRIYA VIDYALAYA, ______

LEFT HAND THUMB & FINGERS IMPRESSION

of Shri/Smt./Kum.______

1.  THUMB IMPRESSION:

2.  LEFT HAND FINGERS IMPRESSION:

FORE FINGER / MIDDLE FINGER / RING FINGER / LITTLE FINGER

ATTESTED BY:

______

PRINCIPAL

Dated: ______

Annexure-B

KENDRIYA VIDYALAYA, ______

Joint photographs of Shri/Smt/Kum______with his/her spouse Shri/Smt/Kum______ are hereby attested.

ATTESTED BY:

______

PRINCIPAL

Dated: ______

KENDRIYA VIDYALAYA,______

ADDRESS OF PENSIONER AFTER RETIREMENT

The Address of the Pensioner, Shri/Smt/Kum.______after his/her Retirement on Superannuation [i.e., on the afternoon of ______] is given here below.

ATTESTED BY:

______

PRINCIPAL

Dated: ______

KENDRIYA VIDYALAYA, ______

NO DUE/DEMAND CERTIFICATE

Certified that there is nothing due or outstanding in respect of Shri/Smt/Kum______(Desig) who is RETIRING ON SUPERANNUATION on the afternoon of ______.

.

ATTESTED BY:

______

PRINCIPAL

Dated: ______

KENDRIYA VIDYALAYA SANGATHAN

BENGALURU REGION

KENDRIYA VIDYALAYA: ______

PROFORMA FOR GRANT OF VIGILANCE CLEARANCE IN RESPECT OF OFFICIALS OF AUTONOMOUS INSTITUTIONS/ ORGANIZATIONS UNDER THE ADMINISTRATIVE CONTROL OF MINSTRY OF HUMAN RESOURCE DEVELOPMENT

1 / Name
2 / Designation
3 / Institution
4 / Organization
5 / Whether IPR for previous year submitted by 31st January of the following year
6(a) / Whether the officer has been placed on the Agreed List of Officers of doubtful integrity.
6(b) / If yes, details to be given
7(a) / Whether any allegation of misconduct involving vigilance angle was examined against the officer during the last 10 years
7(b) / If Yes, its result
8 / Details of minor penalty imposed during the last 10 years, if any.
9 / Details of major penalty imposed during the last 10 years, if any
10 / Is any disciplinary/ criminal proceeding or charge sheet pending against the officer, as on date?
11 / Details of Prosecution sanction granted, if any.
12 / Whether debarred from assigning important assignment under the Government
13 / Positions held during the last ten preceding years (in the following format)
S. No / Organization
(Full Name) / Desig. / Place of Posting / From / To
1
2
3
4
5

Signature of the Principal

Annexure-B

KENDRIYA VIDYALAYA, ______

UNDERTAKING

I, ______ hereby undertake to refund the amount of DCRG, Pension including Adhoc Relief as sanctioned and if afterwards found in excess of the entitlement.

Signature: ______

Designation: ______

Address: ______

______

______

ATTESTED BY:

______

PRINCIPAL

Dated: ______

Annexure-B

FORM - D

Form of application for commutation of a fraction of superannuation pension without medical examination when applicant desires that the payment of the commuted value of pension should be authorized through the pension payment order.

(To be submitted in duplicate 3 months before the date of retirement)

PART - I

To,

The Deputy Commissioner,

Kendriya Vidyalaya Sangathan,

BENGALURU.

Subject: Commutation of Pension without medical examination.

Sir,

I desire to commute a fraction of my pension in accordance with the provisions of the AIS (Commutation of Pension) Regulations, 1959. The necessary particulars are furnished below:-

1.  Name in block letters : ______

2.  Father’s name : ______ (and also husband’s name :

in case of female employee)

3.  Designation : ______

4.  Name of KV/RO/KVS(HQ) : ______

Where posted

5.  Date of Birth : ______

(in Christian era)

6.  Date of retirement on Superannuation or : ______[AFTERNOON]

on the expiry of extension in service. [RETIREMENT ON SUPERANNUATION]

7.  Fraction of Superannuation/Retirement : ______

Pension proposed to be commuted

(Maximum amount of pension that can be

commuted is one third).

Page 1 of 2

8.  Disbursing authority from which pension is

to be drawn after retirement.

i) Branch of the State Bank of India with : ______

complete postal address. ______

______

______

______

ii) Bank Account Number to which : ______

monthly pension is to be credited

each month.

Signature: ______

Present Postal Address:

______

______

______

______

Postal address after retirement:

______

______

______

______

Place: ______

Dated: ______

NOTE: The Payment of commuted value of pension shall be made through the disbursing authority from which pension is to drawn after retirement. It is not open to an applicant to draw the commuted value of pension from a disbursing authority other than the disbursing authority from which pension is to be drawn.

Page 2 of 2

FORM – A

FORM OF APPLICATION FOR FINAL PAYMENT OF BALANCE IN

THE GENERAL/CONTRIBUTORY PROVIDENT FUND ACCOUNT.

To,

The Finance Officer,

Kendriya Vidyalaya Sangathan,

Regional Office

Bengaluru.

THROUGH PROPER CHANNEL

Sir,

I am retiring on Superannuation from Sangathan service with effect from ______A/N. I joined service in KVS on ______F/N.

2. I request that the entire amount at my credit with interest due under the rules may be transferred to my ______

3. My GPF/CPF Account No. is ______

4. I desire to receive payment direct to my Pension Account as stated above.

5. My specimen signatures in duplicate, duly attested by the Principal, Kendriya Vidyalaya,

______are enclosed.

Yours faithfully,

PENSIONER

Place: ______

Dated: ______

(For use by Head of Office)

Forwarded to the Finance Officer, Kendriya Vidyalaya Sangathan, Bengaluru, for necessary action.

2. The GPF/CPF No. ______of Sri/Smt/kum______as verified from the statements furnished to him/her from year to year) is ______

3.  He/She will be retiring on Superannuation from Sangathan service on ______A/N. He/She joined service in Sangathan on ______F/N.

4.  The last fund deduction was made from his/her pay in this office Pay Bill No ______dated ______for Rs. ______(Rupees ______only) and stands included in Demand Draft No. NIL dated NIL. The own share Rs. ______Rupees ______only) and recovery on account of deductions of advance is Rs. ______