FORM 10 (PEN)

(Referred to in Rule 10.8)

(To be filled in and signed by the applicant himself/herself)

APPLICATION FOR FAMILY PENSION.

To

The_________________________________________________________

_____________________________________________

Dear Sir,

I have the honour to say that my husband/wife/--------------------------------------

has expired on (date)-------------------------I therefore request that the family pension

admissible under the rules may kindly be sanctioned to me.

2. I declare that I have neither applied for nor received any family pension .
3. Should the amount of the family pension granted to me be afterwards found
to be in excess of that to which I am entitled under the rules. I hereby
undertake to refund any such excess.
4. I wish no draw my pension from District Accounts Officer Treasury/Sub-
Treasury/National Bank of Pakistan,---------------------Branch at---------------
(Place)
5. The following documents duly attested, are enclosed:-
i. Three specimen signature of mine duly attested/Two sets of my Thumb
and finger impressions on the prescribed form.
ii. Three photographs of mine.
iii. List and particulars of family members
iv. Described Roll.
v. Death Certificate
vi. Non-marriage and non-separations certificate.

Yours faithfully

Signature_______________
Widow/Husband/Entitled
Member of the Family__________

Dated:- __________________ Postal Address______________________

 Part II
(To be completed by the Office/Department receiving the application for Pension.)
Section (i)-Particulars of applicant

1. Name of civil servant :__________________________________________

2. Father’s Name:________________________________________________
3. Nationality:___________________________________________________
4. Postal Address________________________________________________
5. Post held on the date of retirement/Death and Grade_________________
6. Date of Birth:__________________________________________________
7. Date of {Commencement of service________________________________
Retirement/Death______________________________________
Application for pension_________________________________
8. Length of Service: Y M D
From To
From To
From To

________________________________________________
Total___________________________________________
9. Government of commencement and ending of each spell of military service if
any:
From To
From To
_________________________________________
Total:____________________________________

10. Government under which service has been rendered, in chronological order:

Government of ______________from to i.e.___________________________________

Government of ______________from to i.e.___________________________________
Government of ______________from to i.e.___________________________________

11. Class of pension of gratuity applied for _______________________________

12. Average Emoluments______________________________________________
13. Proposed Gross pension/Gratuity_____________________________________
14. Proposed family pension____________________________________________
15. Proposed gratuity in lieu of 4th pension
16. Proposed value of commutation:____________________________________
17. Proposed net pension______________________________________________
18. Place of pension __________________________________________________

District Accounts Officer

Treasury/Sub-Treasury
National Bank of Pakistan
___________Branch.

19. Date from which pension is to commence_________________________________

Signature of Head of ___________

Office/Department_____________
 Section(2) Calculation of qualifying Service
Total length of Service as per Sol. 10 of Section (1)Non-qualifying Service.

_____________________________________
Period

From to _____________________________________
Y M D

(i) Extraordinary leave

(ii) Unauthorized absence
(iii) Spell of Service not qualifying for pension.
Total (i), (ii)&(iii)__________________

Not qualifying Service__________________________________

_________________________
Period
________________________Add From Y M D

(i) Period if any of Military Service or of war Service

Allowed to count for pension .
(ii) Benefit of condo nation of deficiency in total qualifying Service

Total(i) and (ii)

____________
Total qualifying Service_______________

Section (3) Calculation of “Average Emoluments”

Statement of emoluments during the last 36/12 months

Period Duration Monthly Rates Amount Draw

months and emoluments
days
From To M D Rs. Ps. Rs. Ps.

The total emoluments for 36/12 months are

Therefore “Average emoluments” work out to Rs. ÷36/12≡RsPM
Section (4) Calculation of Pension/ Gratuity.
Length of total qualifying service___________________Years
Emoluments/Average Emoluments: Rs.____________________
Amount of gratuity (in case where qualifying
Service is 5 years or more but less than 10 years: Rs.___________
Amount of gratuity on discharge from temporary
Service where qualifying service is 10 years.
Or more but less than 25 years: Rs._________________________

Please see relevant rules/orders before filling in this Section.

Gross Pension Rs._____________________
Less 40% (if the applicant wishes Rs._____________________
to surrender 40% of pension).
Net Pension. Rs._____________________
Section (5)– Calculation of gratuity in lieu of pension.
Years
Length of total qualifying service Rs._____________________
Amount of pension surrendered Rs._____________________
Rate of gratuity for every rupee surrendered
________________________
Lump sum gratuity admissible Rs._____________________
Section (6)–Commuted value of pension.
(i) Amount of pension to be commuted Rs._____________________
(ii) Age next birthday Years:__________________
(iii) Rate of commuted value for every one rupee. Rs._____________________
(iv) Commuted value of pension Rs._____________________
Section (7)–Orders of the Sanctioning Authority.
1. The undersigned is satisfied that the service of _________________________
has been satisfactory. The grant of full pension and /or gratuity which the
Audit officer may find to be admissible under the rules is hereby sanctioned.
OR
The undersigned is satisfied that the service of _________________________
has been satisfactory and it has been decided that the full pension and / or
gratuity found by the Audit Officer to be admissible under the rules should be
reduced by the specific amount or percentage given bellow:––
Amount or percentage of reduction in pension_______________________
Amount or percentage of reduction in gratuity______________________
Sanction is hereby accorded to the grant of pension and / or gratuity as so
reduced.
2. The payment of pension and or gratuity may commence from
_______________. Before issuing the pension payment order, the Audit
Officer may kindly as certain whether the Least Pay and No Demand
Certificate have been received by him. In case the Last Pay Certificate and / or
No Demand Certificate has /have not been received with the pension paper,
the Audit Ofiicer should issue P.P.O subject to the production of the Last Pay
Certificate and/or an undertaking, at the time of first payment of
pension/gratuity, by the pensioner, or his/her family (in case of his/her death)
to the effect that any demand coming to the notice within a period of one year
after the issue of P.P.O would be recovered from him/her.
 Signature_______________

Designation______________

PART III
(For use in the Account General’s Officer)

(i) The calculations contained in the preceding page have been checked.
(ii) Length of qualifying service accepted in Audit________________________
(iii) Reasons for difference, if any between this and the length of qualifying
service worked out by the Department.
(iv) Commuted value of pension Rs._____________________
(v) Reasons for discrepancy, if any, between this amount and the calculated by
the Department.
(vi) Amount of family pension. Rs._____________________
(vii) Reasons for discrepancy if any, between this amount and that calculated by
the Department.
(viii) Amount of gratuity in lieu of \th of
Pension surrendered.
(ix) Amount of commutation for the
Pension commuted.
(x) Reasons for discrepancy, if any, between this amount and that calculated by
the Department.
(xi) Amount of net pension payable. Rs._____________________
(xii) The pension will commence from ___________________________________
(xiii) Allocation of the pension and gratuity:
Pension Gratuity
Government of ________________________
Government of ________________________
Government of ________________________
Defence Estimates_______________________
___________ ___________
Total:– ___________ ___________
(xiv) Anticipartory pension of Rs.___________(Rupees ______________________
______________________) per month, granted with effect from __________
______________________ vide P.P.O. No.____________________ under
rule ______________________ to be adjusted in the final P.P.O.
(xv) Amount of original commuted: Rs._____________________
(xvi) Amount of pension surrendered for gratuity Rs._____________________
(xvii) Checked with the L.P.C. and “No Demand Certificate”.
(xviii) P.P.O issued vide No.______________________ dated__________________
 Assistant Accountant General
Assistant Accounts Officer.

FORM No. 7
(Referred to in Rule 8.7)
N.B. This form is to be used only if the commuted value of pension has not been applied
for in the pension application.
FORM A
COMMUTATION OF CIVIL PENSIONS
SECTION I
FORM OF APPLLICATION
I_________________________________desired to commits
Rs. ________________of my pension of Rs. ___________Ps.____
A month. I certify that I have correctly furnished the following particulars as required:-

Place_______________________Signature_______________
Date________________________Desigantion_______________
Address_____________________________________________

1. Date of Birth_____________________________________
2. Date of retirement_________________________________
3. Amount of pension to be commuted__________________
4. (a) Portion of pension already commuted
(b) Particulars of any application for commutation of pension ever been rejected
or ever accepted/declined to accept commutation of pension on the basis of an
addition of years to the actual age recommended by the medical authority.
5. District Accounts Office/Treasury/Sub-Treasury /Branch of the National Bank of
Pakistan from where commutation money is to be drawn.
6. If drawing pension abroad which accounts Officer issued the authority to payment
of pension.
 SECTION II

Forwarded to __________________________________________
(here enter the designation and address of sanctioning authority)
Subject to the medical authority’s recommending commutation, the lump-sum payable
will be as stand below.

Sum payable, if the commutation on the basis of normal age,

Becomes absolute before the applicant’s next i.e ____years. Rs.
Birthday which falls on__________________________________

Do Do Plus
1 years, i.e______________________________ Years Rs.
Do Do Plus
2 years i.e.____________________________ Years Rs.
Do Do Plus
3 years i.e ___________________________ Years Rs.
Do Do Plus
4 years i.e ___________________________ Years Rs.
Do Do Plus
5 years. i.e _____________________________ Years. Rs.
Sum payable the commutation on the basis of normal age.
 PENSION AND COMMUTATION CALCULATION MEMO
1. Name of Govt. Servant : ________________________________________
2. Father’s Name : ________________________________________
2A. Date of Birth : ________________________________________
2B. Date of Appointment : ________________________________________
3. Designation : ________________________________________
Govt. Boys/Girls/Sec./Lower Secondary School

4. Place of Posting : ________________________________________

5. a) Last Basic Pay (Due/Drawn) : ___________________________________
b) Other Pay : __________________________________
c) Total of (a+b) : __________________________________
d) Total qualifying FROM TO Y-M-D
Service for Pension :____________ __________ ___________
6. Gross Pension Due
Admissible under
Rule (a) and (b) :___________________________________
7. Additional Pension due
for competed year in excess
of 30 years qualifying service
at 2% for full year :___________________________________
8. Any other Pension admissible :___________________________________
9. Total Gross Pension (6+7+8) :___________________________________
10. 50% of Gross Pension
dues for commutation :___________________________________
11. 25% of Gross Pension
commutation if any :___________________________________
12. Age on next Date of Birth :___________________________________
13. Rate of Commutation due as
Per age Group :___________________________________
14. Total Value of Commutation :___________________________________
15. NET Pension admissible :___________________________________
16. Commencement Date of Pension :___________________________________

Signature of Initing Authority

and Designation
 NO DEMAND CERTIFICATE
Certificate that no dues including over-payment, losses sustained by the Govt., on
account of financial irregularities and audit observations etc., are retired _____________
_________________ of Govt. Boys/Girls/Sec./Lower Secondary School_____________
_______________________________________________________________________
_
Karachi with the exception of the following:

(i)

(ii)

(iii)

MARKS OF IDENTIFICATION
Marks of Identification in respect of Mr./Mrs.Mrs./Miss.Mst._______________________
_______________________________________________________________________
_ retired ________________________________ Govt. Boys/Girls/Sec./Lower
Secondary School
_________________________________________________________________
Karachi.

1. __________________________________________
2. __________________________________________

ATTESTED:
Signature________________
Post held at the Date
of Retirement____________
Address:________________

________________________
 ________________________

________________________

OPTION IN FAVOUR OF 40% COMMUTATION OF GROSS PENSION

I _____________________________________S/o. D/o. W/o. __________________
(Designation ___________ (Place of posting) Govt. Boys/Girls/Sec./Lower
Secondary School______________________________________________________
____________________________________________________________________
_ hereby OPT. for commutation of 40% of my Gross Pension as introduced by the
Government of Sindh vide Finance Department Letter No. FD(SR-1)-1(51) dated
06.11.2001.

Place: Karachi.
Signature _______________
Dated:__________________ Name __________________
Post with posting _________
ATTESTED:
________________________
________________________
________________________

UNDERTAKING

I undertake to make good Government dues, if any relating to me and my office in

connection with all sorts of Government Liabilities, overpayment, cost of
Government property, House Rent, Income Tax observations etc. from my family in
the event of my death, the demand coming to notice within a period of one year after
the issue of pension payment order.
To be Verified by the
Immediate Officer
Signature of the Pensioner ______________
Full Name ___________________________
Date _________________
Permanent Address ___________________

____________________________________

____________________________________

DECLARATION OF NON- RECEIPT OF PENSION GRATUITY

I hereby declare that I have neither applied for non received any Pension of
Gratuity in respect of my Portion of service included in this application and in respect
of which pension or gratuity is claimed herein, non shall I submit an application
hereafter without quoting a reference to this application and to the orders which may
be passed thereon.

Place: KARACHI Signature________________

Date___________ (Name) _________________
Counter Sign. Post held at the time
of Retirement ____________
Address:________________
_______________________
_______________________
Karachi.

PERMANENT ADDRESS
PERMANENT HOME ADDRESS OF MR./MRS./MISS. MST. ________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
__.

ATTESTED
Signature________________
Date of Retirement____________________
 DECLARATION REGARDING PLACE OF PAYMENT
I wish to draw my Pension from Government through Treasury at
KARACHI.

ATTESTED: Signature _____________________

Name ________________________
Date of Retirement ____________________
Address: ____________________________

____________________________________

____________________________________

____________________________________
SPECIMEN SIGNATURES IN RESPECT OF

MR.Miss./Mrs./Mst. ____________________________________________________
Retired __________________________ Govt Boys/Girls Sec./Lower Secondary
School ______________________________________________________________
Karachi.
1) _________________________________________________________________
_
2) _________________________________________________________________
_
3) _________________________________________________________________
_

ATTESTED:

Certificate Regarding Non-Allotment of Government Accommodation regarding

to Mr. /Mrs./Miss./Mst. _________________________________________________
retired ______________________________ Govt.Boys/Girls/Sec./Lower Secondary
School ______________________________________________________________
Karachi.
 RENT CLEARANCE CERTIFICATE
It is certified that Mr./Mrs./Miss./Mst. _____________________________________
_____________________________ Retired: ________________________________
has never occupied any accommodation provided by the Govt. No dues of Estate
Office, Karachi, on account of house rent for the Government accommodation are
outstanding against him/her and no Clearance Certificate, is therefore, needed in
his/her case from the Estate Office.

ATTESTED:
______________________________
(Signature of the Initiating Authority)

Stamp: _____________________________

LEAVE ACCOUNT
Statement showing leave availed by Mr./Mrs./Miss./Mst. ______________________
S/o. D/o. ___________________________ Retired on: ________________________
Leave on full Leave taken on Extraordinary
S.No From To average pay Half average pay leave average pay Remarks
Y. M. D Y. M. D Y. M. D