Form of Application for Commutation of a Fration of Pension Without Medical Examination

FORM NO : 1

FORM OF APPLICATION FOR COMMUTATION OF A FRATION OF PENSION WITHOUT MEDICAL EXAMINATION.

(To be submitted in duplicate after retirement but within one year of the date of retirement)

THE SUPERINTENDING ENGINEER

PLANNING CIRCLE,PWD(R&B)

AGARTALA.

Subject: Commutation of pension without medical examination.

Sir,

I desire to commute a fraction of my pension as indicated below in accordance with the provisions of the Central Civil Service (Commutation of pension) Rules. 1981. The necessary particulars are furnished below.

01 / Name (in block letter) / :: / Sri Sudhanya Sinha
02 / Father’s name (also husband’s name in case of Female Govt. servant) / :: / Sri Laxman Sinha
03 / Designation at the time of retirement / :: / Executive Engineer
04 / Name of Office/Department/Ministry in which employed / :: / Office of the Superintending Engineer Planning Circle, PWD(R&B), New Secretariat Complex, Khajur Bagan Agartala Tripura
05 / Date of birth (by Christian era) / :: / 10th January/1954.
06 / Date of retirement / :: / 31st day of December/2012
07 / Class of pension on which retired / :: / Retired on Superannuation
08 / Amount of pension authorized (In case final amount of pensionhas not been authorized, indicatethe amount of provisional pension sanctioned under rule 64 of the Central Civil Services (Pension) rules, 1972). / :: / 40% of the Basic Pension i.e Rs.5890/- [Calculation on Basic Pension Rs.14,725/-]
09 / * Fraction of pension proposedto be commuted. / :: / Rs.[5890/- x 10.46 x 12]=Rs.7,39,313/-

Note : The payment of commuted value of pension shall be made through the disbursing authority from which pension is being drawn. It is not open to applicant to draw the commuted value of pension from a disbursing authority other than the disbursing authority from which pension is being drawn.

* The applicant showing indicate the fraction of the amount of monthly pension (subject to maximum of one-third thereof) which he desired to commuted and not the amount in rupees.

10. Designation of Accounts Officerwho authorized the pension and

the No. and date of the pension payment order if issued.:: A.G. Tripura

Pension,

a. / Treasury/Sub-Treasury (Name and complete Address of the Treasury/Sub-Treasury to be indicated). / TREASURY OFFICER, TREASURY NO.I, AGARTALA; TRIPURA
b / (i) Branch of the Nationalized Bankwith complete postal address. / State Bank of India, Kunjaban Branch, Kunjaban, Agartala, Tripura.
(ii) Bank Account No. to whichmonthly pension is being creditedeach month / S/B Account No:32108875555
c / Account office of the Ministry Department Office / A.G. Tripura.

Place:: Agartala

Dated :: Signature

Postal addressed :: Sri Sudhanya Sinha.

Mathchowmuhani, A.A.RoadBack side

of Bank Of Boroda, Jail Ashram Branch,

PO: Agartala : 799001, Tripura (West)

PART-II

ACKNOWLEDGEMENT

Received from Sri Sudhanya Sinha, Assistant Engineer of Office of the Superintending Engineer Planning Circle,PWD(R&B), Tripura Retired on 31st day of December/2012 application in part I of part II for the commutation of a fraction pension without medical examination.

Place :: AgartalaSignature Head of Office.

Dated…

Note : This acknowledgement is to be signed stumped and dated and is to be detached from the form and handed over to the applicant. If the form has received by the post, It has to be acknowledged on the same day the acknowledgement sent under registered cover.

PART-III

Forwarded to the Accounts Officer (A & E) Tripura, Agartala.

(Here indicate the address and designation)

The Accountant General,

Tripura.

With remarks that :

(i)The particulars furnished by the applicant in part I have been verified and are correct.

(ii)The applicant is eligible to get a fraction of his pension commutation without medical examination.

(iii)The commuted value of pension determined with reference to be table applicable at present comes to Rs.______.

(iv)The amount of residuary pension after commutation will be Rs.______

______.

(v)It is requested that further action to authorize the payment of the amount of commuted value of pension may be taken as in rule 15 of the central civil services (commutation of pension) rules, 1981.

2. The commuted value of pension is debatable to Head of Account ‘2071’pension.

Signature of Head of Office.

Death-cum-retirement gratuity::

PART-II

ACKNOWLEDGEMENT

Received from Sri Sudhanya Sinha, Assistant Engineer of Office of the Superintending Engineer Planning Circle,PWD(R&B), Tripura Application in part-I of Form-I for the commutation of a fraction of pension without Medical examination.

Signature of the D.D.Os

Dated : ______

Statement showing the calculation of Death cum-retirement Gratuity of

Sri Sudhanya Sinha, Assistant Engineer of Office of the Superintending Engineer Planning Circle, PWD (R&B), Tripura

01 / Last pay drawn / :: / Rs.29450.00
02 / Qualifying service / :: / 33 Years 04 Months 06 Days
03 / Eligible / :: / For Pension on Superannuation attaining at the age 58 Years
04 / Death cum-retirement gratuity / :: / Rs.4,00,000/-

Rs.4,00,000/- [ Rupess. four lakhs) only

T.A. to Superintending Engineer

Planning Circle, PWD(R & B)

Agartala

Statement showing the calculation of Death cum-retirement Gratuity of

Sri Sudhanya Sinha, Assistant Engineer of Office of the Superintending Engineer Planning Circle, PWD (R&B), Tripura

Rs.4,00,000/- [ Rupess. four lakhs) only

T.A. to Superintending Engineer

Planning Circle, PWD(R & B)

Agartala

Calculation of pension after commutation of Sri Sudhanya Sinha, Assistant Engineer of Office of the Superintending Engineer

Planning Circle, PWD (R&B), Tripura

01 / 50% of last pay drawn / :: / Rs.14,725.00
02 / 40% of the pension Basic / :: / Rs.5890.00
03 / Pension admissible / :: / Rs.14,725.00
04 / 40% commutated value / :: / Rs.5890.00
05 / 40% of the commuted amount / :: / Rs.7,39,313/-

Signature of the Drawing & Disbursing Officer

Calculation of pension after commutation of Sri Sudhanya Sinha, Assistant Engineer of Office of the Superintending Engineer

Planning Circle, PWD (R&B), Tripura

Signature of the Drawing & Disbursing Officer

Calculation of commutation accounts in respect of Sri Sudhanya Sinha, Assistant Engineer of Office of the Superintending Engineer

Planning Circle, PWD(R&B), Tripura

01 / Last pay drawn / :: / Rs.29450/-
02 / Length of Service / :: / 33 Years 04 Months 06 Days
03 / Pension (Minimum) / :: / Rs.14725/-

T.A. to Superintending Engineer

Planning Circle, PWD(R & B)

Agartala

Calculation of commutation accounts in respect of Sri Sudhanya Sinha, Assistant Engineer of Office of the Superintending Engineer

Planning Circle, PWD(R&B), Tripura

01 / Last pay drawn / :: / Rs.29450/-
02 / Length of Service / :: / 33 Years 04 Months 06 Days
03 / Pension (Minimum) / :: / Rs.14725/-

T.A. to Superintending Engineer

Planning Circle, PWD(R & B)

Agartala