Form 1-A - Form Of Application For Commutation Of A Fraction Of Superannuation Pension Without Medical Examination

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FORM 1-A
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
[see Rules 5(2), 12,13(30,14(i) and 15(3)
(To be submitted in duplicate at least three months before the date of retirement)
PART I
The
(Here indicate the designation and full address of the Head of Office)
Subject: - Commutation of pension without medical examination.
Sir,
I desire to commute a fraction of my pension in accordance with the provisions of the Central Civil
Services (Commutation of Pension) Rules, 1981. The necessary particulars are furnished below -
1.
Name (in Block letters)
2.
Father's name (and also husband's name in the
case of a female Government servant)
3.
Designation
4.
Name of Office/Department/Ministry in which
employed
5.
Date of Birth (by Christian era)
6.
Date of retirement on superannuation or on the
expiry of extension in service granted under FR
56 (d)
7.
Fraction of superannuation pension proposed to
be commuted (The applicant should indicate the
fraction of the amount of monthly pension subject
to be maximum of forty percent thereof which he/
she desires to commute and not the amount in
Rupees)
8.
Disbursing authority from which pension is to
be drawn after retirement (score out which is
not applicable) -

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