SERVICE PENSION FORWARDING LETTER

(G.O.Ms. No. 263 Date 23-11-1981

Lr.No………………….

From Date………….

____________________ To
____________________ The Accountant General (A&E)
____________________ Audit Officer, LFA, District_____
Andhra Pradesh

Sir,

Sub: Pension/Service Pension/Family pension and other Retiring Benefits in

respect of Sri/Smt. _______________________________ proposals
Submitted.

Ref: G.O. Ms. No. 262 Fin & Plg. (FW-PSC) Dept. Dt. 23-11-98
G.O. Ms. No. 263 Fin & Plg. (FW _ PSC) Dept. Dt. 23-11-98

I am to forward herewith the Service/Family Pension Papers of Sri/Smt

______________________________ who is due to retire/retired/expired while in service on
_______________________________ the following documents are forwarded herewith for
authorising pensionery Benefits.

1. Part – 1 : Information furnished by the Govt. Servant/Family Pension

Beneficiery.
2. Part - IIA : Information filled in by the Pension Sanctioning Authority.

3. Part – II B : Sanction Order of Pensionary Benefits.

4. Annexure – I : Discriptive Roll

5. Annexure – II : Nomination

6. Copy of Annexure – III

7. Service Register of Govt. Servant.

8. L.P.C

9. Death Certificate (in case of Death)

10 Legal heir certificate ( - do - )

11. _________________________

The receipt o;f above documents may please be acknowledged and arrangements
may be made to issue the PPO/Gratuity Payment Order and commutation Authorisation
early.

No. of enclosures ( ) Yours faithfully

1. Copy to Sri/Smt____________________________
2. Copy to the _______________________________

For information
 ANNEXURE – III
By REGISTERED POST
From
___________________-
___________________

(Pension sanctioning authority)

To

The_______________________

Disciplinary Authority/
Appointing Authority/
Head of the Department.)

Sub: Pension – Sanction of Pension and other Retiring Benefits in respect

o;f Sri/Smt. __________________ Designation_________________
Regarding.

I am to inform you that the Pension/Family Pension application form of Sri/Smt.

_______________ retired/retiring on __________ as _________________ was forwarded
to AGAP/LEA on _____________ As per the records held by me no disciplinary/judicial
proceedings are pending/contemplated against the above retiring/retired government
employee. I request you to verify whether any such case is pending against the above
employee which entials withholding or withdrawing pension or part of pension permanently
or for specified period as laid down under Rule 9 of RPRs 1980. If so the AG(A&E) / Dy.
Accountant General (Pension), O/o the AG(A&E), AP, Hyderabad/ Local Fund Officer may
be intimated accordingly by name either by Registered post or through a special messenger
within one month from the date of issued of this letter for withholding pensionary benefits as
contemplated in Govt. Memo/No. 33764-A/55/PSC/93, Finance & Planning (FW – PSC)
Department, dt. 15-10-1993 and reiterated in government memo No. 37254/361/A2/Pen-
I/98, Finance & Planning (FW -Pen.I) Department, dt. 4-7-1998. Copied of such orders
shall also be sent to the concerned Treasury officers/Ppo for withholding the pensionary
benefits. In this connection the instruction issued in Para 2, Part – II B of G.O Ms. No. 263,
Finance & Planning (FW-PSC) Department, dt. 23-11-1998 may by scruplously followed.

Yours sincerely

Station :

Date: (HEAD OF OFFICE)

12
Dated_____________ Day of ______________20_____________at______________

Witness:-
1. Signature name :
and Address

2. Signature name :
And Address

Signature of the Government Servant

Name:

Designation :

Office Seal :

Countersigned
Signature of Head of Office/Department:

Date:

Name and Designation :

Office Seal :

Note(1) : The Government servant who has a family may nominate one member
or more than one member of the family as difined in Rule 46(5) of AP
Revised Pension Rules, 1980
Note(2) : The government servant who has no family may nominate a person or
persons or a body of individuals whether in corporated or not.
Note(3) : The Government servant may not that the nomination with signature of
two witnesses shall only have the legal validity of a WILL
Note(4) : This nomination form is to be submitted by the employees in triplicate,
one for use of the pension sanctioning authority and two copies to be
forwarded to the Account General Local Fund Audit Offices.
Note(5) : For the purpose of Rules 46,47,48 and 49 of Revised Pension Rules
1980, family in to a Government servant means:-
i) Wife or wives in the case of a male Government Servant .
ii) Husband, in the case of a female Government Servant.
iii) Sons including step sons, posthumous son, and adopted
sons (whose personal law permits such adoption)
iv) Unmarried daughters including step daughters,
posthumous daughters and adopted daughter. (Whose
personal law permits such adoption)
v) Widowed daughters including step daughters and adopted
daughters.
vi) Father : Including adoptive partents in the case of
individuals where whose personal law
vii) Mother : Permits adoption.
viii) Brothers below the age ofr 18 years including step
brothers
ix) Unmarried sisters and widowed sisters including step sister
x) Married daughters, and
xi) Children of pre-deceased son.

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 CERTIFICATE UNDER ACT 14 OF 1992

Certified that Sri/Smt____________________________________ SGT. Asst was not

sanctioned 130-250/150-300 grade under trained graduate teacher and no amount is to be
recoverable from her/his under act 14 of 1992.

Signature

LEAVE CERTIFICATE
Certified that Sri/Smt. _________________________________ has not availed any
leave/had availed the following kind of leave during the period of his/her service.

1.

2.

3.

Signature

SUSPENSION CERTIFICATE
Certified that Sri/ smt. ____________________________ has not been suspended any
time during his/her service

Signature

RESPONSIBILITY CERTIFICATE
I ____________________________s/o _____________________ retd as
____________________S/o The ____________________ do here by declare that, if any
amount found to be excess paid due to erroneous calculation, noticed at a later date, I shall
be ready to refund the same without any objection in the matter.

Station:
Dated : Drawing Officer Pensioner

ATTESTED
 CERTIFICATE
NO ALLEGATIONS CERTIFICATE

Certified that no allegations are pending against

Sri/Smt.____________________________- (Designation)
_______________________________School_________________________

Signature

NO DUE CERTIFICATE

Certified that no Govt. dues are recoverable from Sri/Smt.

____________________________ SG.Asstt./S.Asst. ___________________________
Govt. ____________________________ towards the :

1) Sales proceedings of A.P Trading Corporation.

2) Nationalised text books and notebooks as they are not supplied/supplied to him

Signature

AUDIT OBJECTIONS CERTIFICATE

Certified that there are no audit objections are pending in respect of

Sri/Smt______________
__________________________________________________________________________

Signature

RECOVERIES UNDER ACT 14 OF 1992

Certified that Sri/Smt _______________________________________________________

(Arts Graduates) was sanctioned 130-250/150-300 grade W.E.F though he/she was
untrained graduates by virtue of Court order/Department order claim amount is recoverable
from him as per act 14 of 1992.

a) the amount has been recovered and recorded in the SB at Page No. ( )

b) The amount has not been recovered .

c) Not applicable.

Signature
D. LEFT HAND THUMB AND FINGER IMPRESSIONS OF SERVICE
PENSIONER/FAMILY PENSIONER/GRATUITANT/ GUARDIAN OF
MINOR OR HANDCAPPED CHILD : (TO BE GIVEN BY THE
ILLETERATE OR THOSE UNABLE TO SIGN AND FOR OTHERS IT
IS OPTIONAL)
Details Thumb Fore Middle Ring Little finger
finger finger finger finger
Service
Pensioner
Family
Pensioner/
Gratuitant/

Guardian of
Minor
Handicapped
child.

Place: Attested by
Date: Signature:

Name :
Designation :

Office Seal:
(Attestation has to be done by a Gazetted Officer of AP State Government in Service)
Note: 3copies will be forwarded to Accountant General /Local Fund Audit officer by
pension Sanctioning Authority and one will be retained by the Pension Sanctioning
Authority.
9
 ANNEXURE II
NOMINATION

(The Government servant may use separate forms, if he wishes to make different
nominations for each type of payment mentioned below)
I hereby nominate the person/persons mentioned below and confer on him/her /them
the right to receive Life time Arrears of Pension, Retirement Gratuity that may be
sanctioned by government, in the event of my death while in service and right to receive
on my death Life Time Arrears of Pension, Retirement Gratuity, commuted value of
pension, Death Relief which having become admissible to me on retirement which may
remain unpaid at my death..

Name and address of Nominee (s)

Relationship with government Servant.

Age

Amount of share payable to each in Col.1

Contingencies on the happening of which the nomination shall become invalid. (Death
need not be mentioned)

Name and address, relationship and age of. the alternative nominee(s) in Col. 1shall
pass in the event of nomination to him/her/them becoming ineffective.

Amount or share payable to each in Col. 6

1 2 3 4 5 6
7
 This nomination supercedes the nomination made by me earlier on ______________

NB: The Government Servant shall draw lines across the blank space below the last
entry to prevent the insertions of any name after he/she has signed.

10

DETAILS OF RECOVERIES

Nature of recovery _______________________________________________________

Amount Rs_____________________________________________________________
To be recovered in _________________________________ installments.

DEDUCTIONS MADE FROM LEAVES SALARY

From______________ To________________ on account of __________Rs.___________

From______________ To________________ on account of __________Rs.___________
From______________ To________________ on account of __________Rs.___________

Name Pay Gratuity Fee Fund and Amount of Remarks

of etc other income tax
month Rs deductions recovered
Ps Rs. Rs. Rs.
Ps. Ps. Ps

April

May

June

July

Aug

Sep

Oct.
 Nov

Dec.

Jan.

Feb.

March.

LAST PAY CERTIFICATE

Last pay
certificate_____________________________________________________________
Of the
_______________________________________________________________________
Proceeding
on_________________________________________________________________

2.he/she has been paid upto ____________________ at the following rates

PARTICULARS Rs. Ps DEDUCTIONS

Rs. Ps

Substantive

Officiating Pay
3. He/She made over charge of the Office
of___________________________________
___________________________on the ________________noon of
______________
4. Recoveries are to be made from the pay of Government Servant as detailed on
the reverse.
5. He/She has been paid leave salary as detailed above deductions have been
made as noted on the reverse.

PERIOD RATE AMOUNT

From _____________ to ________________ at Rs. _______________a month

___________
From _____________ to ________________ at Rs. _______________a month
___________
From _____________ to ________________ at Rs. _______________a month
___________

6. He/She is entitled to draw the following

7. He/She is also entitled to joining time
for__________________________________
8. The details of the income tax recovered from him/her upto the date from the
beginning of the current year are noted on the reverse.
Date______________________ Signature :_______________________________
Name: ______________________________
Designation: ______________________________