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    Death or Insanity: Form A

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    chinna raja
    SWADESH RAO N, a staff car driver, has nominated his wife MS. RATHANAM NARADA to receive 100% of any arrears of pension and commuted pension value payable upon his death. He provides her name, date of birth, address, and relationship. Should she predecease him, the alternate nominee is R SEKHAR REDDY of Visakhapatnam, Andhra Pradesh. The nomination was received by the Head of Office of the India Meteorological Department in Visakhapatnam on July 6, 2017.

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    Death or Insanity: Form A

    Uploaded by

    chinna raja
    24 views2 pages
    SWADESH RAO N, a staff car driver, has nominated his wife MS. RATHANAM NARADA to receive 100% of any arrears of pension and commuted pension value payable upon his death. He provides her name, date of birth, address, and relationship. Should she predecease him, the alternate nominee is R SEKHAR REDDY of Visakhapatnam, Andhra Pradesh. The nomination was received by the Head of Office of the India Meteorological Department in Visakhapatnam on July 6, 2017.

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    SWADESH RAO N, a staff car driver, has nominated his wife MS. RATHANAM NARADA to receive 100% of any arrears of pension and commuted pension value payable upon his death. He provides her name, date of birth, address, and relationship. Should she predecease him, the alternate nominee is R SEKHAR REDDY of Visakhapatnam, Andhra Pradesh. The nomination was received by the Head of Office of the India Meteorological Department in Visakhapatnam on July 6, 2017.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    24 views2 pages

    Death or Insanity: Form A

    Uploaded by

    chinna raja
    SWADESH RAO N, a staff car driver, has nominated his wife MS. RATHANAM NARADA to receive 100% of any arrears of pension and commuted pension value payable upon his death. He provides her name, date of birth, address, and relationship. Should she predecease him, the alternate nominee is R SEKHAR REDDY of Visakhapatnam, Andhra Pradesh. The nomination was received by the Head of Office of the India Meteorological Department in Visakhapatnam on July 6, 2017.

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    © All Rights Reserved
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    You are on page 1of 2

    https://bhavishya.nic.in/RetireeOtherDetails.aspx?PageId=JOZGTSL...

    Report Date :07/07/2017 4:07 PM


    Form A
    (Common Nomination Form for Arrears of Pension and Commutation of Pension)
    [See Rule 5 of Payment of Arrears of Pension (Nomination) Rules, 1983 and Rule 7 of Central Civil Services (Commutation of Pension)
    Rules, 1981]

    Head of Office,
    India Meteorological Department
    Asstt. Met (C & A), RMC India Meteorological Department, 50 College Road CHENNAI

    I, SWADESH RAO N, STAFF CAR DRIVER-I , hereby nominate the person/persons mentioned below and confer on him/her/them
    the right to receive in the event of my death, to the extent specified below, amount on account of the following:-
    i. Arrears of Pension
    ii. Commuted Value of Pension payable under Central Civil Services (Commutation of Pension) Rules, 1981

    Name, date of birth Relationship Share to If nominee is Name, DOB and Relationship Name, DOB and Contingency
    (DOB) and address of with be paid minor,name, address of alternate with address of person who on
    the nominee employee/ to each DOB and nominee in case the employee/ may receive the amount happening
    pensioner address of nominee under Column pensioner if alternate nominee in of which
    person who (1) predeceases the Column (5) is a minor nomination
    may receive the employee/ pensioner shall
    amount on become
    behalf of minor invalid
    1 2 3 4 5 6 7 8
    MS. RATHANAM 100%
    NARADA Death or
    12/06/1966 Insanity
    C/O R SEKHAR
    REDDY,
    D.NO.63-1-189,
    Wife
    ASHOK NAGAR,
    SRIHARIPURAM ,
    VISAKHAPATNAM ,
    VISAKHAPATNAM ,
    ANDHRA PRADESH ,
    530011

    These nominations supersede any nominations made by me earlier.

    Place : Visakhapatnam
    Date : 06/07/2017

    Signature of Government servant/Pensioner


    Telephone No./Mobile No. 9618505019
    Note 1:- Completely strike out the benefit for which nomination is not intended to be made. Separate copies of this nomination Form may
    be used for nominating different persons for benefits (i) and (ii) above.
    Note 2:- The Government servant shall draw lines across the blank space below the last entry to prevent the insertion of any name after
    he/she has signed. The nominee(s)/alternate nominee(s)' shares together should cover the whole amount.

    1 of 2 7/7/17, 4:08 PM
    https://bhavishya.nic.in/RetireeOtherDetails.aspx?PageId=JOZGTSL...

    (To be filled by the Head of Office/ authorised Gazetted Officer)

    Received the nominations, dated ., under the following Rules:-


    1. Payment of Arrears of Pension (Nomination) Rules, 1983
    2. Central Civil Services (Commutation of Pension) Rules, 1981

    made by : MR. SWADESH RAO N


    Designation : STAFF CAR DRIVER-I
    Office : India Meteorological Department
    Asstt. Met (C & A), RMC India Meteorological Department, 50 College Road CHENNAI
    (Strike out which nomination is not received)
    Entry of receipt of nomination(s) has been made in page Volume.of Service Book.

    Name
    Signature
    Designation of Head of Office
    authorised Gazetted Officer with seal
    Date of receipt

    The receiving Officer will fill the above information and return a duly signed copy of the complete Form to the Government servant who
    should keep it in safe custody so that it may come into the possession of the beneficiaries in the event of his/her death.
    The receiving officer shall put his/her dated signature on both pages of this Form.

    2 of 2 7/7/17, 4:08 PM

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