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28. Name and address of Bank/PensionAccounting Office from wherePension is to be drawn29. Head of Account to which pensionand gratuity are debitable30. Post retirement address of the retireePlace:Date:
PROFORMAParticulars to be obtained by the Head of Office from the retiringGovernment Servant1) Name of the Govt.servant2) a) Date of Birth :b) Date of Retirement :3) Two Specimen signature (to befurnished in two separate sheets)Duly attested by a GazettedGovernment Servant4) Three copies of Pass Port sizejoint photograph with wife,husband (to be attested by aGazetted Government Servant)5) Two slips showing theparticulars of height andpersonal Identification marksduly attested by the GazettedGovernment Servant6) Present Address7) Address after retirement\8) Name of the Treasury /PublicSector Bank through which theGovt.servants wants to draw hispension9) Details of the Family in Form 310) Indicate whether Family Pensionis admissible from any othersource – Military or State Govt.and/or a Public SectorUndertaking/AutonomousBody/Local Fund under theCentral or a State GovernmentPlace:Date:
Page 3 and 4: 17. Qualifying Service:(a) Details
Page 8 and 9: FORM - 3(See Rule 54(12)1. Name of
Page 10 and 11: HEIGHT AND PERSONAL IDENTIFICATION
Page 12 and 13: JOINT PHOTOGRAPH OF SHRI ..........
Page 14 and 15: FORM - 1A(See rules 5(2), 12, 13(3)
Page 16 and 17: PART-IIReceived from Shriapplicatio

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