APPLICATION FOR PREMATURE RETIREMENT / RESIGNATION

(NOTE : Strike out portions not applicable, state `Yes’, `No’, `Nil’ or `NA’
where required and do not use dot or dashes)

SECTION-I

PARTICULARS OF THE OFFICER

1. Personal No. :

2. CDA (O) Account No. :

3. Rank (a) Substantive :

(b) Acting

4. Name as per Army List :

5. Date of (a) Birth :

(b) Commission :
(c) Seniority :
(d) Relegation in seniority
if any

6. Arms / Services :

7. Decoration :

8. Qualification :

9. Present unit / formation with date of :

assumption of duty and whether under
orders of posting

10. Previous units / formations and duration :

of posting

11. Service in ranks, if any (Give details of :

service as JCO/OR separately)

12. Former civil service reckonable for :

pension (mention separately class
I/II/III appt held with periods)

13. Courses attended in India indicating :

dates & service liability where applicable

14. Courses attended abroad with dates

and service liability
 -2-

15. Details of service on deputation :

in India

16. Details of service on deputation abroad :

and service liability, if any

17. Details of study leave, availed with :

dates and service liability if any

18. Present medical category (if in temp/ :

perm low medical category, authentic
copy of the latest medical board procee-
dings duly approved by higher medical
authorities should be attached)

19. Details of statutory / non statutory :

complaints pending

20. Details of disciplinary judicial or quasi :

judicial proceedings if any pending
(Application for premature retirement /
resignation in such cases can be considered
only after such proceedings are finalized.

21. Details of previous applications (s) for :

premature retirement / resignation

22. Whether belongs to Adm Cadre or Spl :

Cadre, If specialist, Name of speciality

23. Home state of the officer :

24. Posting profile of the officer since :

commissioning indicating locations

25. Whether the officer is an AFMC graduate:

or done PG from the Dept channel and
period thereof.
 SECTION –III

(To be filled by officers seeking premature retirement only)

(Delete certificate not applicable)

1. MR No. _____________ Rank _________ Name

____________________

(a) I have read Integrated HQ of MoD (Army/Navy/Air) letter No.

_____________________________ dated ______________ and
understand the implications and obligations / entitlement of proceeding on
premature retirement.

(b) I have submitted this application after consideration of all the

factors involved and will not here-in-after withdraw my request.

(c) I have not attended any course involving obligatory period of

service during the last five years.

Or
I have attended __________ Course from ___________ to
___________ and the obligatory period will expire on ______________.

(d) In the event of my request being accepted, I will refund the

proportionate cost of training for the un-served period to the Govt. I will
credit the said amount into the treasury payable to the concerned CDA
(Army/Navy/AF) in one lump sum, before I am relieved of my duties / the
said amount may be adjusted against my entitlement or gratuity as
confirmed by concerned CDA (Army/Navy/AF) vide their letter No.
_______________________________________ dt _________.

(e) I have not availed study leave during the last three years,

Or

I have availed study leave for _________ years/months from

_____________ to ___________ and the obligatory period will expire on
_______________. In the event of my request being accepted, I will
refund the total cost of study leave expenditure including pay and
allowance etc for the period of study leave to the Govt in one lump sum
before I am relieved of my duties, I also understand that in such an event,
the total period of study leave will not count towards pensionable service.

(f) My conduct is not presently under investigation by any authority, no

inquiry is either pending or envisaged against me. I am not personally
involved in a disciplinary case / administrative action or any other penal
action including penal recoveries due from me.

(g) I am aware of the provisions of para 22 of pension regulations for

the Army 1961 (Part-I). I am prepared to accept Death-cum-Retirement
gratuity / service gratuity as applicable at the rates to be decided by the
President of India.
 -4-

(h) I have/ have not drawn any advance for purchase of motor
conveyance/house or for house building.

(j) If the amount outstanding to the Govt. on account of advance for

house building / outright purchase of house / purchase of motor
conveyance / proportionate cost of training of course is in excess of the
gratuity admissible to me, I hereby undertake to refund to the Govt from
my own resources the amount in excess of entitlement of gratuity before I
am relieved of my duties.

Or

No amount is outstanding from me to the Govt. on account of

advance for house building / purchase of motor conveyance etc.

Or

I owe to the Govt. the following amount which I undertake to credit

into the treasury before I am relieved of my duties / may be adjusted
against my entitlement of gratuity as confirmed by the concerned CDA
(Army/Navy/AF) vide their letter No.
_______________________________ dt ___________ (copy enclosed)

Sr. Particulars Advance Interest Total

No.
i) Advance for house building /
out-right purchase of house
ii) Advance for purchase of
motor conveyance
iii) Any other advance
iv) Proportionate cost of training

Total
(k) I have not preferred any statutory / non statutory / legal
proceedings prior to the date of application. Should I prefer any such
complaint / proceedings before my request for premature retirement /
resignation is finalized. I will inform Army /Navy / Air HQ immediately. In
such an eventuality I understand that my request for premature retirement
/ resignation is liable to be closed or pended till my complaint /
proceedings are finalized.

---------------------------------------
Signature of the officer
Station :
Date :
 -5-

SECTION-IV

(To be filled in by the officer seeking permission to resign their

commission only )
(Delete portion not applicable)

1. Personal No. ____________ Rank __________ Name _______________

(a) I have read Army HQ /Naval HQ/Air HQ letter No. ____________

_____________________________ dated ______________ and
understand the implications of and obligations / entitlement on seeking
permission to resign my commission.

(b) I have submitted this application after consideration of all the

factors involved and will not here-in-after withdraw my request.

(c) I have not attended any course involving obligatory period of

service during the last five years.

Or
I have attended __________ Course from ___________ to
___________ and the obligatory period will expire on ______________.

(d) In the event of my request being accepted, I will refund the

proportionate cost of training for the un-served period to the Govt. I will
credit the said amount into the treasury payable to the concerned CDA
(Army/Navy/AF) in one lump sum, before I am relieved of my duties.

(e) I have not availed study leave during the last three years,

Or

(f) My conduct is not presently under investigation by any authority, no

inquiry is either pending or envisaged against me.

(g) I have/ have not drawn any advance for purchase of motor
conveyance/house or for house building.

Or

No amount is outstanding from me to the Govt. on account of

advance for house building / purchase of motor conveyance etc.

Or
 -6-

I owe to the Govt. that any loan from AGI / the following amount
which I undertake to credit into the treasury before I am relieved of my
duties / may be adjusted against my entitlement of gratuity as confirmed
by the concerned CDA (Army/Navy/AF) vide their letter No.
_______________________________ dt ___________ (copy enclosed)

Sr. Particulars Advance Interest Total

No.
i) Advance for house building /
out-right purchase of house
from AGI etc.
ii) Advance for purchase of
motor conveyance
iii) Any other advance
iv) Proportionate cost of training

---------------------------------------
Signature of the officer
Station :

Date :
 -7-
SECTION-V

CERTIFICATE FOR REGULAR RESERVE OF OFFICER CLASS (X) LIABILITY

TO BE FILLED BY OFFICERS UPTO THE RANK OF LT COL WHO APPLY
FOR PREMATURE RETIREMENT

(A) I understand that I will be in Regular Reserve of officers Class (X) upto a
period of five years from the date of SOS or upto the age of superannuation in
my present rank whichever is earlier.

(B) If I so desire during the period of Reserve Liability to visit a foreign country
or acquire foreign citizenship, I will obtain prior permission of the Govt. as
required vide para 32 of SAO 10/S/63 as amended.

(C) I will report on duty to the earmarked HQ / Establishment on mobilization

within 72 hours after receiving order on TV / Radio / by letter, whichever is
earlier.

(D) My permanent residential address is as under :-

i) House No. :
ii) Road/Street/Locality :
iii) Post office with Pin Code :
iv) District :
v) State

(E) I will inform DGMS (Army)/Navy/Air of any change in my permanent

residential address as given above immediately on occurrence alongwith
appropriate amendment to Para (D) upto liability period.

(F) The following five Military HQ / Establishments are located nearest to my

home at approximate distance shown against each :-

HQ/Establishment Distance (in Km.)

i)
ii)
iii)
iv)
v)
(Give names of HQ/establishment such as Headquarters/Corps/Area/ Div/Sub
Area/ Bde, Category `A’ Establishment Training Centres, Embarkation HQ / NSC
Group HQ, NCC, Industrial Security unit, Ordance Depots, Army/Static
Workshop)

------------------------------------
-
Signature of the officer
Station :
Date :
COUNTERSIGNED
(By immediate superior officer / officiating incumbent with rank Name and
designation)
 -8-
SECTION –VI

RECOMMENDATIONS OF THE COMMANDING OFFICER /

COMMANDANT / OFFICIATING INCUMBENT ALONGWITH
COMMENTS

Station :

Date :

SECTION –VII

RECOMMENDATIONS OF MEDICAL AUTHORITY AT FORMATION /

STATION LEVEL / OFFICIATING INCUMBENT ALONGWITH
COMMENTS

Station :

Date :
SECTION –VIII

RECOMMENDATIONS OF MG (MED) / CMO / PMO / OFFICIATING

INCUMBENT ALONGWITH COMMENTS

Station :

Date :

SECTION –IX

RECOMMENDATIONS OF THE HEAD OF THE BRANCH/ DTE/

ORGANIZATION INCLUDING COMMENTS

Station :

Date :
 -9-
Appendix `B’

CERTIFICATE

1. It is certified that I have not been allotted a PPO No. by CDA (P) and have
not drawn any amount on account of pensionary awards, including pension,
DCRG, commuted value of pension etc to date.

Or

Certified that I have been allotted PPO No. ______________ and have
drawn an amount of Rs. ___________ on account of pensionary awards,
including pension, DCRG, commuted value of pension etc from CDA (P).

2. In the event of cancellation of premature retirement orders, I undertake to

refund the above amount to CDA (P) immediately, through MRO.

Signature :
MR No. :
Rank :
Name :
Unit :

COUNTERSIGNED BY COMMANDING OFFICER

Signature :
MR No. :
Rank :
Name :
Unit :