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Moni

This document is an application form for commuting pension without a medical examination. It provides details such as the applicant's name, date of birth, date of superannuation, designation held, amount of pension sanctioned, class of pension, treasury or bank account details, designation of the accounts officer, amount of basic pension, and portion of pension proposed to be commuted. No previous application for commutation was made and no medical examination was required.

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48 views

Moni

This document is an application form for commuting pension without a medical examination. It provides details such as the applicant's name, date of birth, date of superannuation, designation held, amount of pension sanctioned, class of pension, treasury or bank account details, designation of the accounts officer, amount of basic pension, and portion of pension proposed to be commuted. No previous application for commutation was made and no medical examination was required.

Uploaded by

Apurb
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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FORM-C

[To be submitted in duplicate]

PART-I

[Rule 14(1)(a)]

FORM OF APPLICATION FOR COMMUTATION OF PENSION

WITHOUT MEDICAL EXAMINATION

1. Name (in Block Letters) : SRI Monimohan De, ASI

2. Date of Birth : 25.01.1957

3. Date of superannuation of attaining

the age of 60 years : 31.01.2017 (AN)

4. Designation of the post held at the Assistant Sub-Inspector of Police, Anti Corruption
time of superannuation and the Branch under P & A. R. Deptt., 9th Floor, Block‘A’,
name of the Deptt./Office : N.S.Buildings, 1, K.S.Roy Road, Kolkata-700001.
5. Amount of pension sanctioned : Rs. 9930/- P.M., Final

and whether it is provisional or

final.

6. Class pension as defined in the : Superannuation Pension

West Bengal Services (Death-cum

-Retirement Benefit) Rules ’71.

7. Name of Treasury or Bank and


Account Number from which
Pension is being drawn:

8. Name of Treasury or Bank through : Kolkata Pay and Accounts Office-1, through Deputy

which the commuted value is desired Superintendent of Police (HQ) & D.D.O, Anti

to be paid, if payment is not desired Corruption Branch, West Bengal.

through the Accounts Officers who


authorized the pension.

9. Designation of the Accounts Officer : The Principal Accountant General (A&E), W.B.

and the number and date of pension P.P.O. will be issued in due course.

payment order, is issued.

10.Amount (in whole rupees) of pension : Basic Pension- Rs. 9,930/- p.m. and
and Portion of Pension proposed to be Proposed C.V.P. Rs. 3972/- i.e. 40% of Rs.9,930/-
commuted.

11.Particulars of any application for

commutation of pension made

previously and whether appears before : NIL

any Medical Authority or not.

Date: Signature

Full Address:

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