“Annex-A”

APPLICATION /CERTIFICATES TO BE GIVEN BY THE PENSIONER FOR PENSION/

GRATUITY/ COMMUTATION

[To be given by retiring government servant for grant of pension in case of superannuation retiring/
invalid/ compensation / compulsory retirement].

The ---------------------------
--------------------------------

Sir/ Madam,
It is submitted that I-------------------------------------- Father / husband Name-------------------------------
Designation / post held ---------------------------------- BPS.----------------------On ---------------------(Please
indicate kind of appointment i-e Regular/ Officiating or Acting charge / Current charge w.e.f. --------)
CNIC No. (Copy enclosed)--------------------------------- Nationality--------------------------------Personal No.
---------------------------- Cell No.(i) ---------------------------------- (ii)------------------------Gmail: -------------
------------------------Postal Address-------------------------------------------------------------------------------------
--------------------------------------------------------------------------------- that I have retired/ have been
permitted to retire from the Government service/ I’m due to retire/ has been retired compulsorily on -------
-------------------. My pension/ commutation/ gratuity may be transferred/ credited by the Accounts office
in the bank / Post office / Treasury office ------------------------------Branch -------------------- Account No. -
----------------------- DCS form, (where applicable) and list of my family members is enclosed).

UNDERTAKINGS:-

1. I herby declared that I am not in receipt of any other pension, military or otherwise except
PPO No. -------------------- dated -------------- amount ----------------- Department---------------retired on-----
-------------------------------

2. Under 351 (B) of CSR: I do hereby undertake that government may, within one year from the issue of
Pension Payment Order, recover any of its dues from the pension granted to me.

3. Article 351 (2) of CSR: I hereby declare that I shall not take part in any election or engage myself in
political activities of any kind within two year from the date of retirement.

4. In pursuance of Article 911 of CSR: I do hereby declare that I have neither applied for nor received
any pension/ commutation / gratuity in respect of any portion of the service included in this application
and in respect of which pension /gratuity is claimed herein, nor shall I submit any application hereafter
without quoting a reference to this application and to the order which may be passed thereon.

5. Under Article 920 (1) of CSR: I hereby undertake to refund if the amount of pension granted to me
afterwards found to be in excess of that to which I am entitled under the regulation.

6. Under Article 922(a) of CSR: I do hereby declare that I have not received any pension or gratuity in
respect of any portion of the service included in this application.

7. I hereby opt for commutation @. ---------(subject to maximum of Rs. 35%) of my gross pension.

Name Signature
of retiring Government Servant (Pensioner)
Dated------------

Note: Application to be verified by Pension Sanction Authority /DDO

 Specimen of Form 25 (Revised, 2016)
PENSION FORM TO BE USED IN CASE OF SUPERANNUATION /RETIRING/INVALID/
COMPENSATION AND COMPULSORY RETIREMENT.

To be issued by the Appointing Authority 90 days before superannuation/ retirement of the retiring
Government servant.
Subject:- SANCTION OF PENSION ON SUPERANNUATION/ RETIRING/INVALID/
COMPENSATION AND COMPULSORY RETIREMENT.

On attaining the age of superannuation/having applied for retiring/invalid/ compensatory

pension vide application No. ---------------------------dated -------------------OR has been retired
compulsorily vide Notification No. --------------------dated -----------------issued by-----------------------------
---Mr. Mrs./Ms.--------------------------------------S/O W/O D/O ------------------------------------ Designation-
---------------------------------------drawing pay / emoluments Rs. --------------------- (reckonable towards
pension), in BS-----------on --------- basis (Please indicate nature of appointment i.e Regular/Officiating or
Acting charge /Current charge w.e.f. ------------) Personal No. ---------------------------CNIC No. ------------
---presently posted at (Office)-------------------------------(place of posting) ------------------- has retired /has
been permitted to retire/ is due to be retired/ has been retired compulsorily from the Government service
(ticked whichever is applicable) on ---------------date, after availing LPR for ---------------------- days /
Leave encashment in lieu of LPR Rs.-----------------------
Pension Calculation

Gross Pension Rs.------------------------

Commutation Rs.------------------------
Net Pension Rs.------------------------

Other Benefits:-

i)------------------- Rs.------------------------
ii)------------------- Rs.------------------------
iii)------------------- Rs.------------------------

Gratuity(in case where qualifying service is 5 years or more but less than 10 years) Rs.-----------------------

(1) His /her date of birth is ---------------Date of 1st entry in to government service is -------------------- and
EOL availed is ------------ days. Total length of qualifying service for pension is ------------ years------------
month--------- days.

(2) Certified that no inquiry is pending against him /her.

(3) Certified that no recovery is outstanding against him /her

(4) Certified that:-

i) Advances drawn (if any) stand fuly repaid, along with interest.
ii) An amount of Rs.------------------------ on account of --------------- (HBA, MCA/etc)
principal amount alongwith interest is outstanding which may be recovered from the pension.

(5) Anticipatory pension upto ( %) of full pension is sanctioned as admissible to him/ her under
section 19 (2) of Civil Servant Act. 1973 (in case of anticipatory pension).
(6) Certified that deficiency / disciplinary/ criminal case pending against the aforementioned retired
government servant has been finalized. Therefore, final pension payment @ ( %) (Subject to a
maximum of 35% of gross pension), as determined by concerned Accounts office, may be paid.
 -2-
7) Undersigned is satisfied that the service of retiring employee has been satisfactory Administrative and
financial sanction for grant of pension/ commutation @ ---------------% upto maximum of 35% of gross
pension, if so opted by the retiring government servant, to be determined by the Accounts Office is
hereby accorded in favour of Mr. /Mrs./ Ms. ----------------------------------- through Bank / Post Office /
Treasury Account No. ------------------------------------------- (mentioned in DCS Form enclosed) as
admissible under the rules.
OR
(7-a) Undersigned is satisfied that the service Mr. /Mrs./ Ms. -----------------------------------has not been
satisfactory and it has been decided that the full pension/ gratuity found to the Audit/ Account
Officer to be admissible under the rules should be reduced by the specific amount or percentage
given below:-
i. Amount or percentage of reduction in pension-------------------------------------------
ii. Amount or percentage of reduction in gratuity-------------------------------------------
iii. Sanction is hereby accorded to the grant of pension/ gratuity as so reduced.

8) The payment of pension and/ or gratuity may commence w.e.f------------------------------------------

Following documents attached.

i. Pension application alongwith three attested photographs, as “Annex-A”

ii. Notification of retirement.
iii. Last Payment Certificate (LPC)
iv. Pension Contribution receipts/ Bank Challan/acceptance certificate (if required).
v. Original service book along with its attested copy/ service statement (in case of gazetted
government servant).
vi. N.D.C. from Estate Office in case of Government accommodation.

Official Seal

Signature (By Name) with stamp

Pension sanctioning Authority

1. The A.G.P.R / Accounts Office is requested to grant pension and endorse a copy of computerized
pension payment order (C.P.P.O) / Pension Payment order (P.P.O) to this department/ office. The original
service book after recording necessary entries regarding issuance of C.P.P.O. /P..P.O may also be
returned to this department / office.

2. Mr. / Mrs./ Ms.--------------------------------, your are hereby informed that your commutation
(if opted) and first monthly pension shall be transferred/ credited by the Accounts Office in the Bank /
Post Office/ Treasury Office ------------------ Branch --------------------Account No. ---------------------as
opted by you.

Important:- As per requirement every pensioner is bound to provide life certificate to his/ her bank on
or before 10th March and 10th September of each year (Annex-C)
 “Annex-C”
LIFE CERTIFICATE FORM

(This certificate is to be furnished on or before 10th March and 10th September of each
year to the concerned Bank/ Post office/ treasury (pension payment office) in person or
through representative or by post/ courier service).

This is to certify that Mr. /Mrs. /Ms. ---------------------------------------------------------------

W/o D/o ----------------------------------------------holder of PPO No. ---------------------------
CNIC No. -------------------------------------------- whose specimen signatures / thumb
impression an address are appended below is alive till date ------------------------

Date:

(Pensioner’s Signatures /Thumb Impression)

Phone No.
Address: --------------------------------------------
-------------------------------------------------------
-

(Signatures of attesting officer

with date& Name Stamp)
 “Annex-B”

APPLICATION FOR FAMILY PENSION

(To be filled in and signed by the application himself/herself)

The--------------------------

------------------------------

Dear Sir/Madam

It is submitted that my Husband/Wife/Son/Daughter--------------------------------------- has expired on (date) -----------

(Death Certificate attached)I, therefore, request that the family pension admissible under the rules may kindly be
sanctioned to me.
2. List of my family members is given below:-

Sr. No. Name Relationship with CNIC No. Age/date of Birth Marital Status
the deceased

3. It is hereby informed that my gratuity/ family pension may be transferred/ credited by the Accounts Office in the
Bank/Post Office/ Treasury office----------------------------Branch-------------------------- Account No.-------------(DCS
form, where applicable, is enclosed).
Undertakings

4. Under Article 351 (B) of CSR: I do hereby undertake that government may, within one year from the issue of
pension payment order, recover any of its dues from the pension granted to me.

5. In Pursuance of Article 911 of CSR: I do hereby declare that I have neither applied for nor received any family
pension or gratuity in respect of any portion of the service included in this application and in respect of which family
pension/gratuity is claimed herein, nor shall I submit any application hereafter without quoting a reference to this
application and to the order which may be passed thereon.

6. Under Article 920(1) of CSR: I hereby undertake to refund if the amount of family pension granted to me
afterwards found to be in excess of that to which I am entitled under the regulation.

7.Under Article 922(a) of CSR: I do hereby declare that I have not received any family pension or gratuity in
respect of any portion of the service included in this application (In case of anticipatory pension only)

Signature: _________________
Thumb IMPRESSION: ____________________ Name: _________________
CNIC No: _________________

Note: Application to be verified by Pension Sanction Authority /DDO

Important: Every pensioner/family pensioner is bound to provide life certificate /Non-marriage

Certificate to his bank on or before 10th March and 10th September of each year (Annex-C)
 Specimen of Form 25 A (Revised, 2016)

FAMILY PENSION FORM

(To be issued by the Appointing Authority / Pension Sanctioning Authority in the event of in service
death of a government servant / death of pensioner)

Subject:- SANCTION OF FAMILY PENSION IN CASE OF IN- SERVICE DEATH OF

GOVERNMENT SERVANT / DEATH OF THE PENSIONER.

In service death

It is mentioned that Mr. / Mrs. / Ms. --------------------------------------------------------------S/o, W/o, D/o . --

-----------------------------Designation /post held ------------------------------ drawing pay / employments ------
------------- (reckonable toward pension) in BS------------------------------(Please indicate kind of
appointment i.e. Regular/ Officiating or Acting charge/ Current charge w.e.f. ------------------------)
Personal No. ---------------------- CNIC No.-----------------lastly posted at (office) ---------------------------
place of posting-------------------------- has expired on ----------------------- while in service.

Death of Pensioner

Mr. / Mrs. / Ms. -------------------------------------------------------S/o, W/o, D/o ------------------residing at ---

-------------------------designation at the time of retirement---------------------------drawing pension/family
pension vide PPO/ FPPO No. ----------------------CNIC No. --------------------------- drawing pension/family
pension Rs. --------------------------------per month, increase Rs. ------------------- Total pension Rs. ----------
----------- per month from Bank / Post office/ treasury ------------------ Branch --------------- account
No. ------------------- has expired on -----------------------. His /her date of birth is ----------------,date of
retirement from Government Service and date of sanction of family pension is----------------------------
A. Family Pension Calculation:- B. Family Pension Calculation:-
(in service death). (on death of pensioner).
Gross Pension Rs. --------------- Gross Pension Rs. ---------------
Family Pension @ 75 % of Rs.------------------ Family Pension @ 75 % of Rs.------------
(net of gross pension as the case may be)
Gratuity 1/4th (of Gross Pension) Rs.-------------
Other Benefits:-

i)-------------Rs. ---------------
ii)-------------Rs. ---------------
iii)-------------Rs. ---------------

(1) His/ her date of birth is ----------------- date of 1st entry in to government service is ---------EOL availed
during service is ------------- His/ her total length of qualifying service for pension comes to --------- years
---------- month---------- days.

(2) Certified that no inquiry is pending against deceased employee.

(3) Certified that no Demand / Recovery is outstanding against the deceased.
(4) Certified that Advances drawn by the deceased (if any) have been fully repaid or waived off.

(5) As per period record it is verified that Mr. / Mrs. / Ms. ------------------------------------------
CNIC No. --------------------------------------is bonafide family member entitled to family pension of Mr. /
Mrs. / Ms. (late) ------------------------- and his/ her gratuity/ family pension may be transferred/ credited in
Bank/ Post office /treasury----------------------------Branch -----------Account Number -------------------------
(as opted).

(6) Administrative and financial sanction for grant of family pension/ gratuity is hereby accorded.
Following documents attached

(i) Pension application alongwith three attested photographs, as “Annex-B”

(ii) Death Certificate and death Notification.
(iii) Original PPO/ FPPO of deceased pensioner.
(iv) Last Pay Certificate (LPC)/ Last Pension Payment Certificate.
(v) Pension Contributions receipts/ Bank Challan/ acceptance certificate (if required).
(vi) Original service book alongwith its attested copy/ service statement (in case gazetted
Government servant) (in service death)
(vii) N.D.C. from Estate office in case of Government accommodation.

Signature (By Name) with stamp

Pension sanctioning Authority

1. The A.G.P.R / Accounts office is requested to grant family pension/ gratuity and endorse a copy of
computerized family pension payment order (C.F.P.P.O)/ Pension payment order (P.P.O.) to this
department / office. The original service book after recording necessary entries regarding issuance of
FPPO may also be returned to this department /office.

2. Mr. /Mrs. /Ms. ------------------------------------ you are hereby informed that your gratuity / and first
monthly pension/ shall be transferred/ credited by the accounts office in the bank/ Post office/ treasury
office-------------------------------Branch -----------Account Number ----------------------as opted by
you.

Important: i. As per requirement every pensioner is bound to provide life certificate/ Non-
marriage certificate to his/ her bank on or before 10th March and 10th September of each year
(Annex-C)
 “Annex-C”

NO MARRIAGE CERTIFICATE

(This certificate is to be furnished on or before 10th March and 10th September of each year to the
concerned Bank / post office/ treasury (pension payment office) in person or through
representative or by post/ courier service).

I.-------------------------------Widow /Daughter of deceased Mr. / Mrs. / Ms. --------------------------

--------------------holder of Pension Payment Order No. -------------------------------hereby declare
that I have not been married during the last six months.

Date:

(Pensioner’s Signatures /Thumb Impression)

Phone No.
Address: --------------------------------------------
--------------------------------------------------------

(Signatures of attesting officer

with date& Name Stamp)

NOTE:- THE ABOVE CERTIFICATE (S) IS /ARE TO BE SGNED BY GAZETTED

GOVERNMENT OFFICER/ MILITARY COMMISSIONED OFFICER / MAGISTRATE / SUB-
REGISTRAR / PENSIONED OFFICER / CHAIRMAN UNION COUNCILS/ MEMBER OF THE
FEDERAL OR PROVINCIAL ASSEMBLIES / MANAGER OF BANKS.