Case file... · Web view5.Two slips showing the particulars of height & personal marks of identification duly attested are attached. 6.My present address is H.No 427/17 Bakshi Nagar,

Pension Case file

File No ………………………

Name of Govt Servant : Smt Veena Kumari

Father’s Name : Shri Desh Raj Sethi

Husband’s Name : Shri Ashok Kumar

Designation : Head Teacher

Office : GHS Shiv Nagar, Hisar (0888)

Date of Birth : 24-04-1959

Date of Joining in Service : 20-12-1982 on Adhoc, Regular since 01-11-1986

Date of Retirement : 30-04-2017

Class of Pension : Superannuation

Address : 421/17 Bakshi Nagar, Near RVTI, Thandi Sadak Hisar- 125001

Address after Retirement : 421/17 Bakshi Nagar, Near RVTI, Thandi Sadak Hisar- 125001

Mobile No. : 99924-94069

Available with: HMVAHARYANA.COM

Formal Application for Pension

To

Head Master,

GHS Shiv Nagar, Hisar. Dated:

Subject: Application for sanction of Pension.

Sir/Madam,

I am due to retire from service w.e.f 30/04/2017. My date of birth being completed 58/60 Years of age. I therefore, request that steps may kindly be taken with a view to the pension and gratuity admissible to me being sanctioned by the date of my retirement. I desire to draw my pension from (Hisar) Treasury.

2. I hereby declare that I have neither applied for nor received any pension or gratuity in respect of any portion of service qualifying for the pension and in respect of which pension or gratuity is claimed therein nor shall I submit an application thereafter without quoting a reference to this application and the orders which may be passed thereon.

3. Two specimen signatures of mine & of my spouse duly attested are attached.

4. Four passport size photographs jointly with my wife/husband Smt/Shri Ashok Kumar also duly attested are attached.

5. Two slips showing the particulars of height & personal marks of identification duly attested are attached.

6. My present address is H.No 427/17 Bakshi Nagar, Near RVTI, Thandi Sadak, Hisar, 125001 Mobile No 99924-94069 and after retirement will be same as above.

Yours faithfully,

Signature

Name : Veena Kumari

Designation: H.T (JBT)

Office: GPS Mela Kothi, Hisar

Form PEN-4 (Rule -75)

No.

ToPrincipal Accountant General (A&E), HaryanaLekha Bhawan, Sector 33-B, Chandigarh.

Subject: Pension Papers of Smt Veena Kumari, Head Teacher for authorization of pension/DCRG.

Sir,I am directed to forward herewith the pension papers of Smt Veena Kumari, HT of this office for further necessary action.

2. The details of Govt dues which will remain outstanding on the date of retirement of the Govt employee and which need and to be recovered out of the amount of DCRG are indicated below:-

A Balance of outstanding Loans and Advances Rs: Nil1. HBA2. Motor Car Advance3. Marriage Loan4. Computer Loan5. Any other LoanTOTAL Rs: Nil

B Over payment of pay and allowances including leave salary, if any Rs: NilC Income tax deductible at source under I/Tax Act 1961 (43 of 1961) Rs:D. Arrear of license fee etc.E Amount of License fee for occupation of Govt accommodation Rs:F Any other assessed dues and the nature thereof Rs:G The amount of gratuity to be withheld for the adjustment of un-assessed dues Rs:

Total Rs: Nil.

3. Your attention is invited to the list of enclosures which are being forwarded herewith. It is requested that authorization of Pension/DCRG, Commutation of Pension may please be made as earliest.

4. The receipt of the letter may please be acknowledged and this office be informed.

Yours faithfully,

H.M

List of Enclosures:1. Form Pen-1, 2 and Pen-3 duly completed.2. Service Book. 3. Two slips of specimen signatures of Govt Employee4. Four copies of passport size photographs with spouse.

HM

Pension at a Glance

Name Smt Veena Kumari

Father’s Name Shri Desh Raj Sethi

Husband’s Name Shri Ashok Kumar

1. Designation : Head Teacher

2. Office : GHS Shiv Nagar, Hisar (0888)

3. Date of Birth : 24-04-1959

4. Date of Entry in to Govt Service : 01-11-1986

5. Date of Retirement : 30-04-2017

6. Rules under which pensioner benefits were settled : Pension Rule

7. Total period of service : 31 Years 06 Months 00 Days

8. Period not recognized as service : 04 Years 10 Months (Adhoc)

9. Period recognized as service : 31 Years 06 Months 00 Days

10. Last month emoluments on which Pension is fixed : Rs 69200

11. Total amount of Pension :

12. Total amount of family pension :

13. Death-cum-Retirement Gratuity :

14. %age/amount of family pension commuted :

15. Amount of commuted value of pension authorized :

16. Place of Payment of Pension : Hisar

17. Remarks :

HM

Form PEN-2 (Rule-71)

1. Name of Govt Servant : Smt Veena Kumari

2. Designation : Head Teacher

3. Office : GHS Shiv Nagar, Hisar (0888)

4. Date of Birth : 24-04-1959

5. Date of Retirement : 30-04-2017

6. Present Address : 421/17 Bakshi Nagar, Thandi Sadak Hisar

7. Address after Retirement : 421/17 Bakshi Nagar, Thandi Sadak Hisar

8. Mobile No. : 9924-94069

9. Details of the members of the family as on :

Sr No

Name of Family Members

Date of Birth

Relationship with Govt Employee

Aadhar No Personal Identification Marks

Remarks

1 Shri Ashok Kumar Husband

2 Amit Son

3 Sumit Son

4 Varun Son

10. Name of Treasury : Hisar

11.Enclosed the following documents:-

a. Two slips off specimen signatures to be attested by Head of Office

or any gazetted officer authorized by him. Sheet Attached

b. 4 Copies of passport size photographs size joint photo of employee with spouse Sheet Attached

c. Form PEN-1 (Detail of Family Members) Sheet Attached

12. Option for Commutation of Pension :

(Fraction of Pension proposed to be commuted.)

Sign of Govt Emp.

One Passport Size Joint Photo Attested

FORM PEN-3 (Rule-75)

Form for Assessing Pension/Family Pension, Commutation of Pension and DCRG in Double Copies.

1. Name of Govt Employee : Veena Kumari

2. Father’s Name : Shri Desh Raj Sethi

3. Husband’s Name : Shri Asok Kumar

4. Bate of Birth : 24-04-1959

5. Marks of identification of Employee :

6. Present Address of Employee : 421/17 Bakshi Nagar, Thandi Sadak, Hisar

7. Address after retirement : Same as above

8. Particulars of the post held at the time of retirement

A. Name of Office : GHS Shiv Nagar, Hisar (0888)

B. Post held : Head Teacher

C. Pay Scale (Basic Pay) : 69200

9. Class of pension applicable :

10. Date of Beginning of Service :11. Date of ending service : 30-04-201712. Particulars relating to military service : Nil

13. Total length of service : ……YY ……………MM ………….DD14. Period of non-qualifying service From To YY MM DD

A. Interruption in service 00 00 00

B. Extraordinary Leave 00 00 00

C. Period of suspension 00 00 00

D. Any other service 00 00 00

E. Total Period of Non-Qualifying service 00 00 00

15. Net qualifying service (Col 13-14) in term of YY MM DD

Completed six monthly periods (Period of 3

months and above is treated as completed

six month period. Nil

16. Detail of period, if any, treated as duty in case of From Nil

a Govt employee who has been reinstated after having ( …. YY ….MM ……..DD)

been suspended, compulsory retired, removed or Order No ………………….

One Passport Size Joint Photo Attested

dismissed from service. Dated……………………

17. Emoluments last drawn at the time of retirement:-

A. Emoluments reckoned for pension and family pension: ………………………………

B. Emoluments reckoned for Death cum retirement gratuity: …………………………..

18. Date of receipt of Form Pen-2 duly completed :

19. Proposed Pension:

Basic P ( 69200)/2 * ………………….(Qualifying service in half year (Max 40)/40 = Rs ………………

20. Proposed death cum retirement gratuity:

Basic P ( 69200)/4 * ………………….(Qualifying service in half year /66) = Rs ………………

21. Proposed family pension:

A. Ordinary family Pension : Last Pay drawn * Prescribed %age (Now 30%)

= 69200 X

B. Enhanced Family Pension : Equal to 50% of last emoluments in case of death while in service.

22. The amount of family becoming payable to the family of the deceased Govt employee, if death takes

place after retirement.

A. Before attaining the age of 65 years : Rs ……………………………………

B. After attaining the age of 65 years : Rs…………………………………….

S

r

Name of member of the family Date of Birth Relationship

with Govt

Employee


2 Amit Son

3 Sumit Son

4 Varun Son

23. Date from which pension is to commence : 01-05-2017

24. Proposed amount of provisional pension, if department or judicial proceeding instituted against the

Govt employee are pending at the time of retirement : ………………Nil………………

25. Detail of Government dues recoverable out of DCRG : Nil

A. Licence fee for the allotment of Govt accommodation, rule 72 : Nil

B. Other dues referred in rule 73 : Nil

26. Whether valid nomination made for DCRG subsists, if yes, enclose copy : Nil

27. Commutation of pension if applied before retirement or with-in one year after retirement:-

A. The portion of pension to be commuted: (Up to 50% of pension for

Judicial Officers and up to 40% of pension for others. :……………………………………

B. Commuted value of pension = Portion of Pension to be commuted

X (*)Factor from table under rule 96 x 12. : …………………………………….

C. Amount of residuary pension after deducting commuted portion

Of pension [Sr No 19 – 27 (a)] : ……………………………………..

28. Place of payment of pension (Treasury or Bank) : Treasury Hisar.

Place: HisarDated: HM

Pension/Commutation/DCRG/Family Pension Calculation Sheet

[Rule 75 (1) (vii)]

Name Veena Kumari, Designation Head Teacher

1. Calculation of Pension :-A. No. of Half Year of qualifying service to the maximum of 40 years. :

……………………………………..B. Last Pay Drawn Rs : …………………C. Pension = (A) ……………………………………./40 X (B) Rs 69200/2

Rs = ……………………………………

2. Commutation :-40% of Pension. Amount multiplied by the factor as per commutation table depending on the age on next birthday as provided in table in Chapter XI i.e the employee retiring at the age of 58 years, the factor 8.371 meant for next birthday i.e 59 shall be applicable.

Amount Rs ……………… X 8.371 X 12= Rs ........ ….. ……

3. Calculation of DCRG (Death-cum-Retirement Gratuity):-

A. Emoluments (Last Pay Drawn):

Basic Pay (69200) +DA (2%) 1384 =

Total Rs = 70584

C. Completed 6 monthly period subject to maximum of 66.(70 in case of Grup D) (Fraction of 3 months & more to = ……………………………be counted half year)

D. DCRG = [(A) …………………… X (*) (B) ……………………..]/ 4

= Rs ………………………………..

4 Calculation of Family Pension :-a. Ordinary Family Pension

Rs ……………. (69200) X 30% = Rs …………………………. (Minimum Rs 3500)b. Enhanced Family Pension for last 10 years : Same as per amount of Pension as 1.

(D) above.

HM

Form Part –III (A)Qualifying Service

From To Name of Previous Deptt/Organization

Post held and Emoluments drawn

Details of terminal benefits received and deposited, if any

Signature and designation of certifying officer

Remarks

1 2 3 4 5 6 7

HM

Detail of Non Qualifying Service

Name : Veena Kumari Designation: Head Teacher

Govt of Haryana

Name of Establishment

From To Period of Interruption not qualifying for pension Total Non Qualifying Period

Extra Ordinary Leave not qualifying for person

Suspension Period not qualifying for person

Any other period not treated as qualifying

1 2 3 4 5 6 7 8From To From To From To

Govt of Haryana

Elementary Education Department, Haryana

HM

FORM PEN-1 (Rule 4 I(2)]Nomination for DCRG if the Govt employee has a family or has not a family at that time.I, Veena Kumari, working as Head Teacher has a family the detail of which is as under:-

Sr Name of Family Members

Date of Birth


Aadhar No Remarks


2 Amit Son

3 Sumit Son

4 Varun Son

I hereby nominate the following person(s) who is/are member(s) of my family or who is/are not member(s) of my family and confer on him/them the right to receive my gratuity the payment of which shall be sanctioned by Government in the event of my death while in service and the right to receive on my death to the extent specified below, any DCRG which having become admissible to me in case of death while in service or death after retirement before the receipt of DCRG:-

Original Nominee (s) Alternate nominee(s)

Name & Address of the nominee(s)


Age Amount or Share of gratuity payable to each

Name, Address & relationship, age of the person(s) if any, to whom the right conferred on the nominee shall pass in the event of nominee predeceasing the Govt employee or the nominee dying after the death of the Govt employee but before receiving payment of gratuity

Amount or share gratuity payable to each.

1 2 3 4 5 6

2 Number of person(In Words) as original Nominee : …………………………………..

3 Namber of person(s) as Alternate Nominee(s) : ……………………………………

4 This nominee supersedes the nomination made by me earlier, which stands cancelled.

5 The amount/share of the DCRG shown in column 4 and 6 shall cover the whole amount of

DCRG.

Dated this ……………….. day of ……………….. 2017 at …………..Hisar (Haryana)

Sign of Govt Employee

Witnesses:Sr Name Full Address Signatures1

2

(To be filled by Head of Office)

Nominee by ………………. Sign of Head of Office……

Designation …………….. Dated

Office: ……………….. Designation

Form Pen – 1

Acknowledgement by the Head of office regarding receipt of nomination form.

To

Veena Kumari W/o Shri Ashok Kumar,

421/17, Bakshi Nagar, Thandi Sadak,

Near RVTI (Girls), Hisar.

Madam,

In acknowledging the receipt of your nominee, dated the ……………………../ cancellation,

dated the ……………………….. of the nomination made earlier in respect of Death cum Retirement

Gratuity in Form Pen-1. I am to state that it has been duly placed on record.

AG, Haryana

Four Joint Photographs with Spouse, Attested (Rule 75 (1) (vii)

Name Veena Kumari, Designation Head Teacher, Name of spouse Shri Ashok Kumar

Date of Retirement 30-04-2017 Last place of posting: GHS Shiv Nagar Hisar (0888)

…………………………………………………………………………………………………………………………………………… ………. …..

Specimen Signatures/Thumb ImpressionName : Veena Kumari, Designation: Head Teacher

Date of Retirement: 30-04-2017 Last place of Posting: GHS Shiv Nagar, Hisar (0888)

A Attested

Head

Specimen Signatures/Thumb Impression Specimen Signatures/Thumb Impression

Specimen Signatures/Thumb ImpressionName : Veena Kumari, Designation: Head Teacher

Date of Retirement: 30-04-2017 Last place of Posting: GHS Shiv Nagar, Hisar (0888)

A Attested


Specimen Signatures/Thumb Impression of SpouseSpecimen Signature & thumb impression of Shri Ashok Kumar Spouse of Veena Kumari Designation HT

who is due to retire on 30-04-2017

A Attested


Specimen Signatures/Thumb Impression of SpouseSpecimen Signature & thumb impression of Shri Ashok Kumar Spouse of Veena Kumari Designation HT

who is due to retire on 30-04-2017

A Attested

Head

1 2

1 2

1 2

1 2


Particulars of Identification Marks of Retiree


Personal Marks of Identification ………………………………..

HM




HM




HM

Particulars of Identification Marks of Spouse of Retiree

Name Shri Ashok Kumar, Spouse of Smt Veena Kumari, Head Teacher


HM




HM




HM

No Judicial/Departmental Proceedings Certificate

Certified that no Judicial/Departmental Proceedings have been instituted/pending against Smt

Veena Kumari, Head Teacher.

Date of Retirement : 30-04-2017

Date of Birth : 24-04-1959

HM

Retirement Order

Smt Veena Kumari, Head Teacher GHS Shiv Nagar, Hisar (0888) will be relieved of her/his duties

on 34-04-2017 A.N on her/his retirement from service.

HM

Option for Fixed Medical Allowance

I hereby opt to fixed medical Allowance with pension on retirement. Certified that I am already

availing/not availing Fixed Medical Allowance.

HM Veena Kumari, Head Teacher

Undertaking regarding adjustment of long term loans and advances and rent of Government accommodation

There is/are no long term advance(s) and any other advance(s) outstanding/pending and rent

of Govt accommodation if at all any due is found, I undertake to repay/refund the same.


Undertaking to Refund of Excess Amount

I hereby undertake that any excess payment that may be found to have been made as a result

of incorrect fixation of pension or any excess payment detected in the light of discrepancies noticed

subsequently will be refunded by me to the Government either by adjustment against future payments

due to me or from the second installment of arrears or otherwise.


Undertaking to Refund of Excess Payment as per Court Orders

I hereby undertake that a result of any rectification or adjustment in the pension granted to me

on the strength of some interim order of the court of law or on the basis of any interim order by any

Court of Law, any excess amount which may be found to have been made as a result of releavant

appropriate decision taken by the Govt on the final decision of the court of law, will be refunded by me

to the Govt either by adjustment against future payments due to me or otherwise. I further undertake

to abide by such relevant appropriate decision of the Govt taken on the final decision of such Court of

law as the case may be.


Declaration for Refund of Excess Payment of Pension & DCRG etc.Whereas the HM GHS Shiv Nagar, Hisar (0888) has consented to grant me the sum of Rs

…………….. per month as the amount of my pension w.e.f May 2017, the sum of Rs ……………….. as the

amount of my commutation of pension and the sum of Rs ………………………. as the amount of my

gratuity/death-cum-retirement gratuity. I hereby acknowledge that in accepting the said amount (s). I

fully understand that the pension, gratuity/death cum retirement gratuity, is the subject to revision

and the same being found to be in excess of that to which I am entitled under the rules and I promise

to raise no objection to such revision. I further promise to refund any amount in excess of that which I

may be eventually found entitled.


Authority Letter to Recover Govt Dues from Pension

I hereby authorize HM GHS Shiv Nagar, Hisar (0888) to recover any Govt dues such as

overpayment of pay, allowances, leave salary or admitted and obvious dues such as house rent, PLI

premium, outstanding house building advance, TA and other advances or any amount, if any

discrepancy is found recoverable from me at any stage from my pension.


Declaration Regarding Non Receipt of Pension or DCRG

I hereby declare that I have neither applied for nor received any pension or gratuity in respect

of any portion of the service included in this application and in respect of which pension or gratuity is

claimed herein, nor shall I submit an application hereafter without quoting a reference to this

application and the orders which may be passed thereon.


Declaration Regarding Provisional Pension

Whereas the HM GHS Shiv Nagar, Hisar has consented provisionally to advance me the sum of

Rs ………………….. per month in anticipation of the completion of the entries necessary to enable the

Government to fix the amount of pension, I hereby acknowledge that in accepting this advance, I fully

understand that my pension is subject to revision on the grounds that the provisional pension now to

be paid to me exceeds the pension to which I may be eventually found entitled. I further promise to

repay any amount advanced to me in excess of the pension to which I may be eventually found

entitled.


Certificate Regarding Military Service

Certified that I have not rendered any military service, nor I have received any pension or

gratuity.


Departmental Data Sheet

DDO Code : Hisar-0888 Class of Pension : SuperannuationName : Veena Kumari Sex : FemaleDesignation : Head Teacher Group/Class : IIIAddress Before Retirement : 421/17, Bakshi Nagar, Thandi Sadak, Near RVTI (Girls), HisarAddress after Retirement : As Above. Mobile No.:Department : Elementary Education, Haryana.Place/Distt of Retirement : GHS Shiv Nagar, Hisar, District : Hisar.DDO Retired from : GHS Shiv Nagar, Hisar.T.O for Pension : Hisar. T.O For DCRG : Hisar.Bank Detail : Bank: Dena Bank, Hisar. Branch: Red Square Market HisarBank A/C No : 11511000GPF No. : HR-EDU-1Date of Birth : 24-04-1959 Date of Appointment :Date of pensionable service : Date of Retirement : 30-04-2017Date of M.C invalidating Govt Servant : N.ADate of Lodging FIR in absconding cases : N.APeriod of Foreign Service : N.AWhether contributions received for above period : N.ALength of Military Service : N.AAmount of Military Pension/Gratuity, if any : N.A

Year Month DaysGross Service (Regular)Daily Wages/TMRNon Qualifying ServiceWeightage (Voluntary Retirement)Net Qualifying Service

Last Pay Drawn : Pay in Pay Band :

N.P.A : N.A Grade Pay :

Other Allowances : Total Basic Pay :

D.A : @ 2%

HM

Last Pay Certificate (LPC)

Office of the HM, GHS Shiv Nagar, Hisar (0888)

1. LPC of Smt Veena Kumari, Head Teacher.

2. He/She has paid upto : December 2016.

Particulars:-

Basic Pay : DA :

HRA : Medical Allowance :

Deductions:-

GIS : 30 Income Tax. : GPF : Nil.

3. He/She has made charge of the office of GPS Mela Kothi, Hisar on dated…..

4. Recoveries from servant are : Nil

5. He/She has been paid leave salary as detailed : Nil.

6. He/She is entitled to draw the following scale of pay increment accurse on: N.A

7. Joining Time : N.A

Detail of Recoveries : Nil

Salary Deductions made from Leave Salary : Nil

HM

Office of HM GHS Shiv Nagar, Hisar (0888)

Subject : Sanction of Leave Encashment.

Sanction is hereby accorded under Rule 65 of Haryana Civil Services (Leave) Rules 2016

for withdrawal of Rs……………….. (Rupees ……………………………………………………

……………………………… ………….. Only) on account of payment of ……………. Days earned leave

payable to Smt Veena Kumari, Head Teacher, GPS Mela Kothi, Hisar retired on 30-04-2017.

It is further certified that ……… days earned leaves are due as per balance in his/her service

book. The expenditure will be debited under Major Head (Salary Head of Account).

HM

Copy forwarded to the following for information and necessary action:-

1. Accountant General, Haryana, Chandigarh.

2. T.O, Hisar

HM

Calculation sheet of Encashment of Earned Leave.

Cash Payment = [Earned Leaves X (Basic Pay + DA)] / 30

Rs. =

Not in Case.

Office of HM GHS Shiv Nagar, Hisar (0888)

Subject : Sanction of Group Insurance Scheme, 1985.

1. Sanction is hereby accorded under Rule 11 of GIS 1985 for withdrawal of Rs………………..

(Rupees …………………………………………………… ……………………………… ………….. Only) on account

of payment of Savings Insurance Fund to Smt Veena Kumari, Head Teacher, GPS Mela Kothi,

Hisar Husband’s Name Shri Ashok Kumar, GIS No. ……………………… an employee of this

office in group-C, retired on 30-04-2017.

2. Certified that Smt Veena Kumari was a member of GIS since …………………… Monthly

subscription of Rs .30 (Rs Thirty Per Month Only) was deducted from his/her salary.

3. The expenditure will be debited as under:-

Head : 8011 Insurance & Pension Fund

Minor Head : Haryana State Govt Employee GIS

Sub-Head : Insurance Fund/Savings Fund.

HM

Copy forwarded to the following for information and necessary action:-

1. Accountant General, Haryana, Chandigarh.

2. T.O, Hisar

3. Official concerned.

4. Pension File.

HM

M/s Poonia & Poonia Associates.Pension Case, Data On-Line,

Etc

All types of Free Files Available on HmvaHaryana.Com ---- Files

(Column). All Files e.g Pension Case Files, Final Payment of

GPF, Payment of GIS, Marriage Advance File, GPF

Refundable/Non Refundable files, LTC Files, Extension in

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Uploaded By: Ramesh Poonia, Hisar.

Documents

Case file... · Web view5.Two slips showing the particulars of height & personal marks of identification duly attested are attached. 6.My present address is H.No 427/17 Bakshi Nagar,