Ex-Servicemen Contributory Health Scheme (Echs) Application Form For Membership (Rev 2015) Page 15
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177
DPDO/BANKER’S CERTIFICATE
Certified the following:
Ser. No ….….……………. Rank …….………………….. Name………………………………………………………
Pension Account No ………………………………………………………. of this Bank is drawing Pension as follows:
(a)
Uncommuted Basic Pension
Rs. ………………………………………..
(b)
Dearness Pension
Rs. ……………………………………….
(50% of Basic Pension)
(c)
DA
Rs. ………………………………………
Rs. ……………………………………...
His Pension Payment Order No .is……………………………….………………………………………………
Fixed Medical Allowance has been stopped w.e.f. (date) …………………………………………………….
(Authority for discontinuation of FMA. CGDA New Delhi Circular No. 5601/AT-P/Paytt dated 17 Jun 05 and GOI, MOD
letter No. 2 (a) / 01/ US(WE)/D (Res) dated 30 Dec 2002)
Date ________________________
PDA/Bank manger/i/c DPDO
(With Official Stamp)
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