1

© MANUSCRIPT SERIES
GOVERNMENT OF TAMIL NADU
2009

FINANCE (PENSION) DEPARTMENT

G.O.No.455, Dated 15th September, 2009

(Avani 30, Thiruvalluvar Aandu 2040)

Pension – The Tamil Nadu Pension Rules, 1978 – Amendments - Issued.

Read:

G.O.Ms.No.211, Finance (Pension) Department, dated 27th May 2009.

-oOo-
ORDER:

The following Notification will be published in the Tamil Nadu

Government Gazette :-
NOTIFICATION.

In exercise of the powers conferred by the proviso to Article 309 of the

Constitution of India, the Governor of Tamil Nadu hereby makes the following
amendments to the Tamil Nadu Pension Rules, 1978.

AMENDMENTS.

In the said Rules, -

(1) for Form 1, the following Form shall be substituted, namely :-

“FORM 1
[see rule 48 (1)]
NOMINATION FOR RETIREMENT / DEATH GRATUITY
When the Government servant has a family and wishes to nominate one person or more
than one person, thereof.

I, …………………………………………………………………….………, hereby
nominate the person/persons mentioned below who is/are member(s) of my family, and
confer on him/them the right to receive, to the extent specified below, any gratuity, the
payment of which may be authorised by the Government of Tamil Nadu in the event of my
death while in service and the right to receive on my death, to the extent specified below,
any gratuity which having become admissible to me on retirement may remain unpaid at my
death.
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Original Nominee(s) Alternative Nominee(s)

Name, address, relationship

and age of the person or
Relation persons, if any, to whom the
Amount or right conferred on the nominee Amount or
ship with
Name and Share of shall pass in the event of the share of
the
address of the Age Gratuity nominee pre-deceasing the gratuity
Govern
nominee(s). payable to Government servant or the payable to
ment
each* nominee dying after the death each**
servant.
of the Government servant but
before receiving payment of
gratuity
(1) (2) (3) (4) (5) (6)

Place :

Date : Signature of the Subscriber.

Signature of two witnesses with Name and Address:

1.

2.

-/ Countersigned /-

Signature of Head of Office.

Office Address:

Note: (i) The Government Employee shall draw lines across the blank space below the last entry to prevent
the insertion of any name after he has signed.
(ii) Strike out which is not applicable.
(iii) If the Original Nominee(s)/Alternate Nominee(s) is/are minor, furnish the name and address
of the person with relationship to the Government Employee to receive the amount.
* This column should be filled in so as to receive the amount.
** The amount / share of the gratuity shown in this column should cover the whole amount / share
payable to the original nominee(s).”;
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(2) for Form 2, the following Form shall be substituted, namely :-

“FORM 2
[see rule 48 (1)]

NOMINATION FOR RETIREMENT / DEATH GRATUITY

When the Government servant has no family and wishes to nominate one person or more
than one person, thereof.
I, ……………………………………………………………………………….……, having
no family, hereby nominate the person/persons mentioned below and confer on him/them
the right to receive, to the extent specified below, any gratuity the payment of which may be
authorised by the State Government in the event of my death while in service and the right to
receive on my death, to the extent specified below, any gratuity, which having become
admissible to me on retirement may remain unpaid on my death.

Original Nominee(s) Alternative Nominee(s)

Name, address,
relationship and age of
the person or persons, if
any, to whom the right
Amount or conferred on the Amount or
Relationship nominee shall pass in
Name and Share of share of
with the the event of the nominee
address of the Age Gratuity gratuity
Government pre-deceasing the
nominee(s). payable to payable to
servant. Government servant or
each* each**
the nominee dying after
the death of the
Government servant but
before receiving
payment of gratuity
(1) (2) (3) (4) (5) (6)

Place :
Date : Signature of the Subscriber.

Signature of two witnesses with

Name and Address:
1.
2.
-/ Countersigned /-

Signature of Head of Office.

Office Address:
Note: (i) The Government Employee shall draw lines across the blank space below the last entry to prevent the
insertion of any name after he has signed.
(ii) Strike out which is not applicable.
(iii) If the Original Nominee(s)/Alternate Nominee(s) is/are minor, furnish the name and address of
the person with relationship to the Government Employee to receive the amount.
* This column should be filled in so as to receive the amount.
** The amount / share of the gratuity shown in this column should cover the whole amount / share payable
to the original nominee(s).” ;
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(3) for Form 5, the following Form shall be substituted, namely :-

“FORM 5
[See rules 53 (1), 55 (h), 57, 58, 58 (1), 61, 61 (1), 63, 64, 64 (2) & (3), 68 (7)]
COMBINED APPLICATION FORM FOR GENERAL PROVIDENT FUND
FINAL CLOSURE AND PENSION
PART-I
FOR RETIREMENT / REVISION CASES ONLY
(To be sent in duplicate)

1. Name of the Government :

Employee (IN CAPITAL LETTERS).

2. Father’s Name / Husband’s :

Name in the case of Female
Government Employee.

3. Designation with Selection :

Grade / Special Grade.

4. Religion :

5. P.P.O. No. allotted by A.G’s. :

Office. [Applicable only for
Revision Cases].

6. G.P.F. No. with Departmental :

Suffix.

7. Date of Birth. 8. Date of Joining. 9. Date of Retirement.

10. Present Residential Address :

with PIN Code.

MOBILE No. :

11. Residential Address after :

Retirement with PIN Code.

12. Place of Payment of Pension :

(a) Pension Pay Office
(b) District Treasury
(c) Sub-Treasury
13. Whether the Pension is :
proposed to be commuted. Yes No
(Tick in appropriate place)

If Yes, fraction proposed to be : Fraction :

commuted
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14. Are you in receipt of Military :

Pension? Yes No

15. If Yes, P.P.O.No. and Treasury : P.P.O.No.

from which it is drawn may be PPO / District
furnished. Treasury /
Sub-Treasury

16. If you are in receipt of Military :

Pension, state whether you opt
for Military Family Pension or
Civil Family Pension. (Option
once exercised is final.)

17. List of Family Members :

including Wife / Husband.

Whether
Sl. Marital Date of Handicapped /
Name (s) Relationship Mentally
No. Status Birth
Retarded *

* Medical Certificate to be enclosed.

18. Name of Guardian in case of :

mentally retarded children.

DECLARATION
I hereby declare that I have neither applied for nor received any Pension or
gratuity in respect of any portion of the service qualifying for this pension and in
respect of which pension and gratuity are claimed herein nor shall I submit an
application hereafter without quoting a reference to this application and the orders
which may be passed thereon.
I do hereby declare to refund the pension or gratuity authorized by the
Accountant General, Chennai, if afterwards found to be in excess of the amount to
which I am entitled under the Rules.
I hereby certify to make good any loss caused to the Government by way of
any overdrawal of pay, allowances, leave salary or other admitted obvious dues as a
result of negligence or fraud on my part in service in the department in a lumpsum
or in suitable installments from my pension.

Place :
Date : Signature of Government
Employee with Date.
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PART-II
TO BE FILLED IN BY THE DEPARTMENTAL OFFICER
1. A.G’s Office Reference No. in :
which the proposals were
returned with objections earlier.

2. Date of Beginning of Service. :

3. Date of Ending of Service. :

4. Gross Qualifying Service. :

5. Non-Qualifying Service. :

6. Additional Qualifying Service :

under Rule 27 / Due to
Voluntary Retirement /
Contingent Service / Military
Service.

7. Net Qualifying Service. :

8. Total Period of Military Service :

and Military Pension / Gratuity
received. (Details of remittance
to be furnished separately).

9. Scale of Pay :

10. Pay Last Drawn (Special Pay, :

Personal Pay drawn if any to be
shown separately)

11. Class of Pension applicable :

12. Whether any charges are :

pending against the Government
Employee? If so, furnish the
details thereof.

13. Office served in the last three :

years.

14. a. Drawing Officer for G.P.F. :

with Full Postal Address and
PIN Code.

b. Phone No. of the Office with :

STD Code.

c. e_mail ID / FAX :
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15. Treasury / PAO for G.P.F. :

16. a. Drawing Officer for D.C.R.G. :

with Full Postal Address and
PIN Code.

b. Phone No. of the Office with :

STD Code.

c. e_mail ID / FAX :

17. Treasury / PAO for D.C.R.G. :

18. Particulars of Last G.P.F. :

Deduction [Last 12 Months
Details].
Total Sub-
Date &
Pay for GPF Sub- Recovery / Amount Account Voucher
Place of
Month scripion Refund of Cr. of No.
Payment.
Schedule. Account

(1) (2) (3) (4) (5) (6) (7)

19. Details of Temporary Advance / :

Part Final Withdrawal
sanctioned in the last 12 months
(If no debit is drawn in last 12
months, the details of last debit
drawn should be specified).

Month Amount Voucher No. Date of Payment

(1) (2) (3) (4)

CERTIFICATE
It is certified that:
1. All the particulars furnished above have been fully verified with reference
to office records and are found correct.
2. Advance / withdrawal from GPF was granted during the last 12 months as
detailed in Column 18 above.
3. No Charges are pending / Charges are pending against the individual.
(Details furnished separately)@
4. Provisional Pension not paid / Provisional Pension paid (Details
furnished separately) @
5. Conditions laid down in Rule 11(2) and Rule 11(3) of the Tamil Nadu
Pension Rules, 1978 have been satisfied and the same has been
recorded in Service Book.
@
Strike out whichever is not applicable.
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CHECK LIST / LIST OF ENCLOSURES

1. Service Book(s). [No. of Volumes] : [Enclosed / Not Enclosed]

2. Recent Joint Passport size Photo :

with Spouse, Specimen
Signature/ left hand thumb
impression (in the case of
illiterate) and Descriptive Roll of
the Government Employee, all in
triplicate, duly attested [furnished
in the Annexure].

3. Sanction order in respect of :

Non-Government Aided Educa-
tional Institution cases and
Missing Employee.

4. In case of Teachers, :
Non-Employment/Re-employment
Certificate.

5. Copy of First Information Report :

in respect of Missing Employee.

6. Nomination for General Provident :

Fund (GPF).

7. Nomination for Death cum :

Retirement Gratuity (DCRG).

8. Nomination for Life Time Arrears :

of Pension.

9. Nomination for Commutation of :

Pension (in duplicate).

10. Medical Certificate in original in :

Form 23 as prescribed in Rule 36
of Tamil Nadu Pension Rules for
invalidation cases issued by
Medical Board.

11. Certificate of Medical Opinion of :

the Doctors for admitting
Commuted Value of Pension in
the cases of Invalidation and
Compulsory Retirement cases.
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12. Ratification Order of Government :

for waiving any shortfall in notice
period due to sanction of
Extraordinary Leave with /
without Medical Certificate (in
respect of Voluntary Retirement
cases).

13. Military Verification Certificate. :

14. Copy of the Chalan for refund of :

Gratuity received with Interest for
Military Service.

15. Copy of Proceedings issued in the :

case of Compulsory Retirement /
Voluntary Retirement /
Invalidation cases.

16. Copy of Government Order :

imposing cut in Pension issued on
completion of Disciplinary
Proceedings / Dropping the
Charges.

17. Copy of Adoption Deed, in case of :

adopted children.

18. Copy of Medical Certificate in the :

case of Mentally Retarded
Children / Handicapped Children.

Place :
Date :
Signature of the Head of Office /
Department with Seal.

INSTRUCTIONS
1. Please send the application in DUPLICATE.
2. Please fill up all columns in capital letters.
3. Incomplete application will not be processed.
4. Annual Account Statement of General Provident Fund need not be sent.
5. Last Fund deduction particulars mean deduction to General Provident
Fund before stopping recovery.
6. For arriving at the Commuted value of Pension, dated signature of the
Government servant in Part I is compulsory.
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ANNEXURE

(To be sent in triplicate)

1. Joint Passport size Photo of the :

Government Employee with
spouse. (Name of the Government
servant and spouse should be
written).

Joint Photo

Name of Government Employee :

Name of the Spouse :

Counter Signature of the Head of

Office with Seal.

2. Specimen Signature / Left Hand : 1.

Thumb impression in case of
illiterate.
2.

3.

3. Descriptive Roll of Government : 1.

Employee. [Personal Marks of
Identification].
2.

3. ” ;
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(4) for Form 17, the following Form shall be substituted, namely :-

“ FORM 17
[see rules 72 (4), 74 (3) and 76 (2)]

COMBINED APPLICATION FOR GENERAL PROVIDENT FUND

FINAL CLOSURE AND FAMILY PENSION

PART-I
FOR DEATH WHILE IN SERVICE / EXTENSION OF FAMILY PENSION CASES
(To be sent in duplicate)

1. Name of the Government :

Employee (IN CAPITAL LETTERS).

Designation and Department. :

2. Date of Death. :

3. Date of Retirement in case of :

death after retirement.

4. Name of the Applicant / :

Guardian in case of minor.

5. Relationship of Applicant / :
Minor with Government
Employee.

6. Religion. :

7. Date of Birth in case of Minor :

with proof.

8. P.P.O. No. allotted by A.G’s. :

Office (applicable only for
revision cases)

9. G.P.F. No. with Departmental :

Suffix.

10. Residential Address with PIN :

Code.

MOBILE No. :

11. Place of Payment of Pension :

(a) Pension Pay Office.
(b) District Treasury.
(c) Sub-Treasury.
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12. Are you in receipt of Family :

Pension from any other source? Yes No

13. If Yes, P.P.O. No. and Treasury : P.P.O.No.

from which it is drawn may be PPO / District
furnished. Treasury /
Sub-Treasury

14. List of Family Members. :

Whether
Sl. Marital Date of Handicapped /
Name (s) Relationship Mentally
No. Status Birth
Retarded*

* Medical Certificate to be enclosed.

15. Name of Guardian in case of :

mentally retarded children.

16. Death Certificate / :

Legal Heir ship Certificate / :
Proof of Date of Birth in case of :
minor children. (Enclose separately.)

17. If the applicant is second wife, :

Date of Marriage with proof and
Details of first wife and children
born through both wives may be
furnished. [Copy of Death
Certificate / Court Orders for
divorcing the first wife, as the
case may be, to be furnished]

Place :
Date : Signature of the Applicant /
Guardian.
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PART-II
TO BE FILLED IN BY THE DEPARTMENTAL OFFICER

1. A.G’s Office Reference No. in :

which the proposals were
returned with objections earlier.

2. Date of Beginning of Service. :

3. Date of Ending of Service. :

4. Gross Qualifying Service. :

5. Additional Qualifying Service :

due to Contingent Service.

6. Non-Qualifying Service. :

7. Net Qualifying Service. :

8. Scale of Pay :

9. Pay Last Drawn (Special Pay, :

Personal Pay drawn if any to be
shown separately).

10. Office served in the last three :

years.

11. Has the Subscriber filed any : Yes No

nomination for G.P.F.?

If YES, enclose the same in :

Original or Attested Copy.

12. a. Drawing Officer for G.P.F. :

with Full Postal Address and
PIN Code.

b. Phone No. of the Office with :

STD Code.

c. E_mail ID / FAX :

13. Treasury / PAO for G.P.F. :

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14. a. Drawing Officer for D.C.R.G. :

with Full Postal Address and
PIN Code.

b. Phone No. of the Office with :

STD Code.

c. E_mail ID / FAX. :

15. Treasury / PAO for D.C.R.G. :

16. Details of Temporary Advance / :

Part Final Withdrawal
sanctioned in the last 12 months
(If no debit is drawn in last 12
months, the details of last debit
drawn should be specified).

Month Amount Voucher No. Date of Payment

CERTIFICATE

It is certified that:

1. All the particulars furnished above have been fully verified with reference to
office records and are found correct.
2. Advance / withdrawal from General Provident Fund was granted during the
last 12 months as detailed in Column 16 above.
3. Provisional Pension has been / has not been paid (Details furnished
separately) @
4. Conditions laid down in Rule 11(2) and Rule 11(3) of the Tamil Nadu Pension
Rules, 1978 have been satisfied and the same has been recorded in Service
Book.
@
Strike out whichever is not applicable.
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CHECK LIST / LIST OF ENCLOSURES

1. Service Book(s). [No. of Volumes] : [Enclosed / Not Enclosed]

2. Recent Passport size Photo, :

Specimen Signature / left hand
thumb impression (in the case of
illiterate) and Descriptive Roll of
the claimant, all in triplicate, duly
attested. (furnished in the
Annexure).

3. Attested copy of Legal Heir :

Certificate and Death Certificate.

4. Proof of Date of Birth in the case :

of children.

5. Dependency Certificate from the :

claimant in case of parent.

6. Income Certificate issued by :

Revenue Authorities.

7. Non-remarriage Certificate duly :

countersigned by any Gazetted
Officer.

8. Sanction order in respect of Non- :

Government Aided Educational
Institution cases and Missing
Employee / Pensioner cases.

9. Guardianship Certificate issued :

by Court of Law, if payments is to
be authorized through Guardian
on behalf of minor / mentally
retarded children.
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10. Medical Certificate issued by :

Senior Civil Surgeon of the same
discipline where payment is to be
authorized to physically
handicapped children.

11. Copy of First Information Report :

in respect of missing employee /
pensioner cases.

12. Nomination for GPF /DCRG :

13. Death Certificate of first wife or :

copy of Court Orders for divorce.

14. Copy of Adoption Deed in case of :

adopted children.

15. Copy of Medical Certificate in the :

case of Mentally Retarded
Children.

Place :
Date :
Signature of the Head of Office /
Department with Seal.

INSTRUCTIONS

1. Please send the application in DUPLICATE.

2. Please fill up all items in capital letters.
3. Incomplete application will not be processed.
4. Annual Account Statement of General Provident Fund
need not be sent.
5. Last Fund deduction particulars mean deduction to General
Provident Fund before stopping recovery.
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ANNEXURE

(To be sent in Triplicate)

1. Passport size Photo of the :

Applicant / Guardian in case of
minor with Name.

Photo

Name of Applicant. :

Name of Guardian in case of :

minor.

Counter Signature of the Head of

Office with Seal.

2. Specimen Signature / Left hand : 1.

thumb impression of the
applicant / guardian.
2.

3.

3. Descriptive Roll of Applicant / : 1.

Guardian. [Personal Marks of
Identification].
2.

3. ” ;
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(5) Forms 6 and 7 shall be omitted ;

(6) after Form 5, the following Form shall be inserted, namely :-

“FORM 5–A
[see rule 48 ]

NOMINATION FOR LIFE TIME ARREARS OF PENSION

I, ………………………………………………………… (Name of the Pensioner in
Capital Letters), hereby nominate the person / persons named below under Rule 48 of Tamil
Nadu Pension Rules, 1978.
Name and address
Contingency on
Date of other nominee in Date
Name and Relationship Relation happening of
of case the nominee of
address of the with the ship with which nomination
Birth / under column (1) Birth /
nominee(s). pensioner. pensioner shall become
Age predeceases the Age
invalid.
pensioner.

(1) (2) (3) (4) (5) (6) (7)

NOTE: If nominee / alternate nominee is minor, furnish the name and address of person who may receive
the arrears of pension.

Place :

Date : Signature of the Subscriber.

Signature of two witnesses with

Name and Address:
1.
2.

-/ Countersigned /-

Signature of Head of Office.

Office Address: ”.

(7) for the expression “Form 6” wherever it occurs, the expression “Form 5”
shall be substituted ;
(8) for the expression “Form 7” wherever it occurs, the expression “Form 5”
shall be substituted ;
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(9) in rule 48, in sub-rule (1). for the expression “Form 1 or Form 2”, the
expression “Form 1 or Form 2 or Form 5-A” shall be substituted.

(By Order of the Governor)

K. GNANADESIKAN
PRINCIPAL SECRETARY TO GOVERNMENT

To
All Secretaries to Government.
All Departments of Secretariat.
The Legislative Assembly Secretariat, Chennai - 600 009.
The Governor's Secretariat, Raj Bhavan, Chennai - 600 025.
The Director of Stationery and Printing, Chennai - 600 002.
(2 Copies for publication in the Tamil Nadu Government Gazette)
All Heads of Departments.
The State Information Commission, 378, Anna Salai, Teynampet, Chennai – 600 018
The Accountant General (A&E), Chennai - 600 018. (By name)
The Accountant General (A&E), Chennai -600 018
The Principal Accountant General (Audit-I), Chennai - 600 018.
The Accountant General (Audit-II), Chennai – 600 018.
The Accountant General (CAB), Chennai - 600 009.
The Registrar, High Court, Chennai - 600 104.
The Secretary, Tamil Nadu Public Service Commission, Chennai – 600 002.
The Commissioners of all Corporations.
All District Collectors / District Judges / Chief Judicial Magistrates.
The Pension Pay Officer, Chennai - 600 006.
All Treasury officers / Sub-Treasury Officers.
All State Government owned Boards / Corporations.
Copy to:
The Finance [(OP.I) / (OP.II) / (OP.III) / (OP.Misc.) / (PGC) / (PC) /
(BG II) / (Budget Misc.) / (Pub)] Department, Chennai - 600 009.
Law (Finance Scrutiny) Department, Chennai – 600 009.
The Secretary to Chief Minister, Chennai - 600 009.
The Director of Pension, D.M.S. Complex, Chennai - 600 006.
The Principal Secretary / Commissioner of Treasuries & Accounts, Chennai – 600 015.
The Director of Local Fund Audit, Chennai - 600 108.
All Municipal Commissioners.
All Panchayat Union Commissioners.
Stock File / Spare Copies.

-/ Forwarded : By Order /-

SECTION OFFICER.