:: 01 :: (Form of obtaining Pension)

FORM – 3
See Rule 54 (12)
DETAILS OF FAMILY
01. Name of the Government Servant :

02. Designation :

03. Father’s/Husband’s Name :

04. Date of Birth :

05. Date of Appointment :

06. Religion :

07. Details of the members of my

family *as on ----- :

Sl.No. Name of the members of family* Date of Birth Relationship Initials of the Remarks
with the Head of Office
officer
01 02 03 04 05 06

01.

02.

03.

04.

05.

06.

07.

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

Place:__________________________
Signature of Government Servant
Dated the ______________________

*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.
 :: 02 ::
FORM – 5
See Rules 59 (1) (c) and 61

Particulars to be obtained by the Head of Office from the retiring Government

servant eight months before the date of his retirement
01. Name :

02. (a) Date of birth :

(b) Date of retirement :

03. 1Two specimen signatures (to be furnished in a separate sheet) duly attested by a Gazetted
Government servant.

04. 2 Three copies of passport size joint 3 photograph with wife or husband (To be attested by the
Head of Office).

05. Two slips showing the particulars of height and 4 personal identification marks duly attested by a
Gazetted Government servant.

06. Present address :

07. 5 Address after retirement :

08. Name of the Treasury or the Branch of

Public Sector Bank or the Pay and
Accounts Office through which the
pension is to be drawn.

09. 6 Details of the family in Form-3.

10. Indicate whether you have taken any

type of advances i.e. HBA/Motor Car/
Moroe Cycle/TA/LTC, etc. :

11. Indicate whether you have allotted

Govt. accommodation or not.
Contd…page-3
 :: 3 ::
12. Indicate whether family pension is
admissible from any other source –
Military or State Government and/or a
Public Sector Undertaking/Autonomous
Body/Local Fund under the Central or a
State Government.

Place:__________________________

Signature:_________________________
Dated the ______________________
Designation:_____________________

Ministry/Deptt./Office:__________________

1. Two slips each bearing the left hand thumb and finger impressions duly attested may be
furnishede by a person who is not literate to sign his name. If such a Government servant
on account of physical disability is unable to give left hand thumb and finger impressions, he
may give thumb and finger impressions of the right hand. Where a Government servant has
lost both the hands, he may give his toe impressions. Impressions should be duly attested
by a Gazetted Government servant.

2. Two copies of the passport size photograph of self only need be furnished:
(i) if the Government servant is governed by Rule 54 of the Central Civil Services (Pension)
Rules,1972 and is unmarried or a widower or widow;
(ii) if the Government servant is governed by Rule 55 of the Central Civil Services (Pension)
Rules,1972.

3. Where it is not possible for a Government servant to submit a photograph with his wife or
her husband, he or she may submit separate photographs. The photographs shall be
attested by the Head of Office.

4. Specify a few conspicuous marks, not less than two, if possible.

5. Any subsequent change of address should be notified to the Head of Office.

6. Applicable only where Rule 54 of the Central Civil Services (Pension) Rules, 1972, applies to
the Government servant.
 :: 04 ::

Joint photographs (size 9 cm X 7 cm) to Shri/Smt/Miss/Dr.________________

___________________________________________________________________

Name of Wife/Husband________________________________________________

in the Indian Council of Agricultural Research, Krishi Bhavan, New Delhi – 110 001.

Attested by:
(Two Gazetted Officers)

01. 02.
 :: 05 ::

Left hand thumb and finger impression of incase of Male.

Right hand thumb and finger impression in case of Female.

Thumb

Pointer Finger

Middle Finger

Ring Finger

Little Finger

Signature:

ATTESTED

Signature/Designation with official seal.

(01) (02)
 :: 06 ::

Specimen signatures of Shri/Smt/Miss/Dr.__________________________

____________________________________________________________________

in the Indian Council of Agricultural Research, Krishi Bhavan, New Delhi – 110 001.

01.

02.

03.

ATTESTED BY

(1) (2)
 :: 07 ::

INDIAN COUNCIL OF AGRICULTURAL RESEARCH

KRISHI BHAVAN : NEW DELHI – 110 001

Descriptive roll of Dr./Shri/Smt./Miss.___________________________________

in the Indian Council of Agricultural Research, Krishi Bhavan, New Delhi – 110 001.

01. Date of Birth:

02. Height :

03. Personal marks on hand or on face as identification:-

(i)

(ii)

04. Signature:
(i)

(ii)

(iii)

Attested by (Two Gazetted Officers)

(1) (2)
 :: 08 ::

INDIAN COUNCIL OF AGRICULTURAL RESEARCH

KRISHI BHAVAN : NEW DELHI – 110 001

I hereby agree to the recovery of Rs.____________________________ on

account of over drawal of pay and allowances and of Rs._____________________

on account of arrears of rent and other miscellaneous recoveries being made for

my pension and/or Retirement Gratuity/Death-cum-Retirement Gratuity.

Signature: ___________________________

Designation:_________________________

Address(Office/Residence):_________________________________

_________________________________

________________________________

Two Witnesses:

01.

02.
 FORM – I

FORM OF APPLICATION FOR COMMUTATION OF A FRACTION OF PENSION

WITHOUT MEDICAL EXAMINATION

See Rules 5 (2), 6 (1), 12, 13 (1) and (2), 14 (1) and (2), 15 (1) and (2) and 16 (1) and (2)

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

P A R T – I
To
The Under Secretary(Cash)/H.O.O.,
Indian Council of Agricultural Research,
Krishi Bhavan,
New Delhi-110 001.

Sub: 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 Services (Commutation of Pension) Rules, 1981. The necessary particulars
are furnished below :---

01. Name (in Block Letters):

02. Father’s Name (also Husband’s Name in

the case of a female Government
servant):
03. Designation at the time of retirement:

04. Name of Office/Department/Ministry in

which employed:
05. Date of birth (by Christian era):

06. Date of retirement on

superannuation/voluntarily or on the
expiry of extension in service granted
under FR 56(d):
07. Class of pension on which retired: SUPERANNUATION OR VOLUNTARILY

08. Amount of pension authorized (in case

final amount of pension has not been
authorized, indicate the amount of YET TO BE SANCTIONED.
provisional pension sanctioned under Rule
64 of the Central Civil Services (Pension)
Rules, 1972):
Contd…page--2
 :: 02 ::

09. Fraction of pension proposed to be Fraction of the amount of monthly pension

commuted: (subject to a maximum of 40%)

10. Designation of the Accounts Officer who

authorized the pension and the Number SENIOR F&AO(PENSION),ICAR HQRS.
and date of the Pension Payment Order
(PPO), if issued:
11. Name of Treasury or Bank and Account
Number from which pension is being I. C. A. R. HEADQUARTERS
drawn:

12. Name of the Treasury or Bank through

which the commuted value is desired to
be paid, if payment is not desired through I. C. A. R. HEADQUARTERS
the Accounts Officer who authorized the
pension:
13. Particulars of any application for
commutation of pension made previously -----------------
and whether appeared before and
Medical Authority or not:

Signature:____________________________________________

Full Name (in block letter):______________________________

Designation(at the time of retirement):______________________________

Full Postal Address:______________________________

______________________________

_________________________________

Place:_______________________

Dated:______________________
 :: 03 ::

P A R T – II

Forwarded to the Senior Finance & Accounts Officer(Pension), I.C.A.R., Krishi

Bhavan, New Delhi-110 001, for authorizing the payment of the amount of commuted
value of pension under Rule 15 of the Central Civil Services (Commutation of Pension)
Rules, 1981.

UNDER SECRETARY(CASH)/H.O.O.
I.C.A.R., KRISHI BHAVAN,
NEW DELHI-110 001

Place:________________________

Dated:_______________________

___________________________________________________________________

P A R T – III

ACKNOWLEDGEMENT

Received from Dr./Shri/Smt./Miss._______________________________

,
Ex-____________________ application in Part-I of Form-1 for the commutation

of a fraction of pension without medical examination.

Signature, Name & Address of

the Head of the Office
(with stamp)

Place:______________________
Dated:_____________________