CAGE - II : Details Information for Broad Banding Revision

CAGE - III : PDA Details (To be filled)

Percentage of Disability Drawn as on or after 01-01-1996

Invalided out from service whose Disability Pension / Disability element PPO has been notified

Original (Service/Disability)Pension PPO No. (”S ro D”)

Regt. Number

Rank Last

From To % of Disability

Assessed percentage (%)

Amount of DE ( ) Revised Disability( )

Group Clause of Discharge

R.O. Code

DE - PPO No. if any

A.

C.

1. 2. 4.

16. 17.

20.

18.

21.

19.

7.

9.

10.

11.

(a)

9A.

(b)

(d)

( )c

(e)

8.

5. 6.

3.

D.

B. D E

F. Latest Corr. Dis. Pen. PPO No. (”D Corr” or “DE Corr or “DRA”)

G. Whether the individual’s disability has been rounded off w.e.f. 01-07-2009 (Y/N)

12. PDA Code 13. DPDO Code 14. PDA State Code 15. Bank/Sub Treasury Code

E. Pensioner’s Name

Date of

BSR Code Link Bank

Bank Branch

In case of death of individual Date of Death

Bank Account No.

PDA Station

BSR Code Paying Branch

Existing Service Element Existing Disability Element

Date of Invalided out/Deemed invalided out

Date from which Disability/ War Injury has been assessed for life

Enrollment

Link Bank Address

drawn as on 01-01-1996 drawn as on 01-01-1996

Invalidment

BASIC PARTICULARS

LPC-CUM-Data Sheet for Grant of Disability Pension (PBOR-ARMY)

BROAD BANDING PCDA(P) ALLAHABAD PHP-001/2014

Prior to 1-1-1996LPC-CUM-Data Sheet for Revision of Disability Awards Who were medically Invalided out / Deemed to be

Aud/Sr.Audtr Aud/Sr.AudtrAAO

PAO

AAOAO/Sr.AO AO/Sr.AO

Record Office

No.

Date

R.O. Pr.CDA (P)

CHECKED/APPROVEDAFFIX LPC SEAL HERE

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