Athax KHOVEL EITE - FORM 7 Pension (inter-active)

FORM 7

FORM 7 [See Rules 58, 60, 61(1) and (3) and 65 (1)]
Form for assessing Pension / Family pension and Gratuity
PART 1
1.	Name of the retiring Government employee	Name of the retiring Government employee
2.	Father’s/ Husband’s name	Father’s/ Husband’s name
3.	Height	Height
4.	Marks of Identification	Marks of Identification
5.	Date of Birth	Date of Birth
6.	Service to which belongs	Service to which belongs
7.	Particulars of post held at the time of retirement:
	(a) Name of the office	Name of the office
	(b) Post held	Post held
	(c) Whether the appointment mentioned above was under Government or outside the Government on foreign service terms?	Government
8.	Whether declared substantive in any post under the Central Government?	YES/NO.
9.	Date of beginning of service:	Date of beginning of Service.
10.	Date of ending of service:	Date of ending service.
11.	Cause of ending of service	Superannuation etc.
12.	In the case of compulsory retirement, the orders of the competent authority, whether pension may be allowed at full rates or at reduced rates and, in case of reduced rates the percentage at which it is to be allowed	Not applicable
13.	In case of removal/ dismissal from service whether orders of competent authority have been obtained for grant of compassionate allowance and if so, at what rate,	Not applicable
14.	Particulars relating to military service, if any---
	(a) Period of military service	from date to date
	(b) Terminal benefits drawn/being drawn for military service towards civil pension?	Rs./-
	(c) Whether opted for counting of military service towards civil pension?	Yes/NO
	(d) If answer to (c) above is in the affirmative whether the terminal benefits have been refunded.	Yes/NO/NA.
	(e) In case of ex-servicemen who are eligible for Family pension under the armed forces Rules, whether opted to retain family pension under the Armed Forces Rules or to draw family pension	N/A. etc
15.	Particulars relating to service in Autonomous body, if any
	(a)Particulars of Service:	Not Applicable or Applicable

Name of Organisation	Post held	Period
Row		From	To
Not applicable	Not Applicable	n/A	n/A

	(b) Whether the above service is to be counted for pension	YES/NO
	(c) Whether the Autonomous organization has discharged its pensionary liability to the Central Government?	YES/ NO
16.	Whether any departmental or judicial proceedings are pending against the retiring employee	YES?NO
17.	Qualifying Service -----
	(a). Detail of omission, imperfection or deficiencies in the Service Book which have ignored [under	Details
	(b). Period not counting as qualifying service	nonqualifying service
	i. Boy Service (2^nd provisio to Rule 13)	boy service
	ii. Extraordinary Leave not counting as qualifying service (Rule 21)	EOL not counting for as qualifying
	iii. Periods of suspension not treated as qualifying service (Rule 23)	suspension not treated as qualifying service
	(iv) Interruption in service [Rule 27(1)(b) and Rule 28(c)]	Not applicable or State.
	(v) Periods of foreign service with United Nations bodies for which United Nations pension has been availed	Periods of foreign service
	(vi)Any other period not treated as qualifying service (give details)	Any other period not treated as qualifying service (give details)
	(c) Additions to qualifying service ---
	(i)Military Service (Rule 19)	Military Service (Rule 19)
	(ii)War Service (Rule 20)	War Service (Rule 20)
	(iii)Weightage on voluntary retirement on being declared surplus (Rule 29)	Weightage on voluntary retirement
	(iv) Weightage under Rule 30	Weightage under Rule 30
	(v) Benefit of service in an Autonomous Body (rule 37)	Benefit of service in an Autonomous Body
	(vi)Weightage under Rule 48-B	Weightage under Rule 48-B
	(d) Net qualifying service	Net qualifying service
	(e) Qualifying service expressed in terms of completed six monthly periods (period of three months and over is treated as completed six monthly period)	Qualifying service expressed in terms of completed six monthly periods

18.	Emoluments---
	(a) Emoluments drawn during 10 months preceding retirement
	From	To	Rate of Pay	Amount
	Date	Date	Rs.	Rs.

	(b) If the officer was on foreign service immediately preceding retirement, the notional emoluments which he would have drawn under Government but for being on foreign service.	Not applicalbe etc
	(c) Average emoluments reckoned for pension.	Rs.
	(d) Emoluments reckoned for retirement gratuity/death gratuity	Rs.
	(e) Emoluments reckoned for family pension	Rs.
19.	Date on which the retiring employee submitted his application for pension in Form 5.	Some Date

20.	Complete and up to date details of the family as given in Form3 ADD ROW DELETE
	Sl. No.	Name of the Member of the family	Date of Birth	Relationship with the Govt. Servant
	--	--	--	--

21.	Whether Nomination made for death gratuity/retirement gratuity	Yes/NO.
22.	The date on which action initiated to
	(a) Obtain the ‘No demand’ certificate from the Directorate of Estates as provided in Rule 57.	Some Date /YES.
	(b) Assess the service and emoluments qualifying for pension as provided in Rule 59	Some Date /YES..
	(c) Assess the Government dues other than the dues relating to the allotment of Government accommodation as provided in Rule 73(1)	Some Date /YES.Rs.
23.	Details of Government dues recoverable out of Gratuity :--
	(a) Licence fee for Government accommodation	Rs.
	(b) Dues referred to in Rule 73	Rs
24.	(a) Proposed pension / service gratuity	Proposed Pension
	(b) Proposed dearness relief on pension (as on date of retirement)	Proposed DR
	(c) Date from which pension is to commence	Date pension commence
25.	Rate of Family pension :--
	(a) Enhanced rate	Rs. enhance rate
	(b) Period for which family pension will be payable at enhance rate.	Period enhance
	(c) Ordinary rate	Rs. Ordianry rate
	(d) Date from which ordinary rate of family pension will be payable	Date ordinary
26.	Amount of retirement gratuity / death gratuity.	Rs. Amount
27.	Commutation of Pension
	(a) Period for which family pension will be payable at enhance rate Whether simultaneously applied for commutation of pension with the pension application (applicable only in the case of those who retire on Superannuation pension.)	Period enhanced
	(b) The portion of pension commuted	Portion commuted
	(c) Commuted value of pension	Amount in Rs.
	(d) Amount of residuary pension after deducting commuted portion.	Amount in Rs.
	(e) Date from which reduced pension is payable.	Some Date
28.	Name and address of Bank/ Pension accounting office from where pension is to be drawn	Name & Add. of Bank
29.	Head of account to which pension and gratuity are debitable	"266 - Pension & ORB"
30.	Post retirement address of the retiree	Post retirement Address

		Signatue of the Head of Office

PART II
1.	Date of receipt of Pension Papers by the Accountant Officer from the Head of Office	Some Date
2.	Entitlements admitted
	A. Length of Qualifying Service	Years Months etc
	B. Pension
	(i) Class of Pension	Class ofpension
	(ii). Amount of Monthly Pension	Rs. Some amount
	(iii) Date of Commencement	Some Date
	C. Commutation of Pension :-
	(i) Commuted value of portion of pension commuted, if any	Commuted value
	(ii) Residuary Pension after commutaion.	Residuary pension
	(iii) Date from which reduced pension is payable.	date payable
	(iv) Date of Restoration of commuted portion of pension subject to the pensioner continuing to live	some date
	D. Retirement./ Death Gratuity
	(i) Total Amount Payable	Rs. Some amount
	(ii) Amount to be adjusted towards govt. dues.	Some amount
	(iii) Amount to be withheld for adjustment of unassessed dues	Some amount or NIl
	(iv) Net Amount to be released	Rs. Some amount
	E. Family Pension:-
	(i) At enhanced rate.	Rs. enhanced rate
	(ii) Period for which family pension at enhanced rate is payable.	Period of enhanced rate
	(iii) At normal rates.	Normal rate
3.	Head of account to which the amount of pension, retirement / death gratuity and family pension are to be debited.	"266 - Pension & ORB"


		Accounts Officer