To

__________________________

__________________________

Memo No.

Dated :

Subject : Pension Case of Sh. _______________________________ due to retire on ________________.

Sir,

Enclosed please find herewith the following pension documents/papers for taking further necessary action, please.

1. Application for Pension/DCRG Duplicate

2. Assessment for Pension/DCRG Duplicate

3. Form 12/A (Commutation of pension) 3 nos.

4. Request for commutation of pension 3 nos.

5. Consent for effecting rent/penal rent 3 nos.

6. EPF/PCP/Undertaking for payment/recovery of excess payment, if any

3 nos.

7. Personal mark of identification & height 3 nos.

8. Joint passport size photographs 3 nos.

9. Option for medical facilities after retirement 3 nos.

10. Specimen signatures of Mrs. & Mr. 3 nos.

11. Undertaking for not claiming interest on delay amount of pension etc. 3 nos.

12. Earned Leave Encashment Application 1 no.

DA/AS above

Your sincerely,

( )

APPLICATION FOR PENSION/FAMILY PERSON AND GRATUITY AND D.C.R.G. (Read instructions before filling up the form)

1. Name of Applicant :-

2. Father’s/Husband’s Name :-

3. Date of birth of applicant :-

4. Relationship of applicant with deceased employee (in case of family pension only).

5. Present or last appointment of employee :-

6. Date of ending of service :-

7. Details of military service :-

i) Period :-

ii) Pension drawn from military :-

iii) Gratuity drawn from military :-

8. Present address :-

9. Permanent residential address :-

10. Whether pension to be drawn through Bank or HPGC office :-

a) Name of HPGC Office :-

b) Application with Name of Bank A/c No. __________________City _________________(To be submitted in duplicate)

11. Detail of family members :-

Sr. No. Name Relationship Date of Birth

12. Class of pension or gratuity

applied for and cause of

application.

Superannuation i.e. 58 years

13. Thumb and finger impression (in case of illiterate persons only)

Thumb, Fore-Finger, Middle, F. Ring-F, Little-F

I hereby certify that :-

i) I undertake to refund any amount of pension and D.C.R.G paid to me in excess of that to which I may be actually entitled.

ii) I hereby declare that I have neither applied nor received any pension or gratuity and death-cum-retirement gratuity in respect of any portion of service included in this application and in respect of which pension or gratuity is claimed here in nor shall I submit any application hereafter without quoting reference to this application and order which may be passed.

iii) In case any outstanding recovery is found after release of pension, I hereby give my consent to recover the same from my subsequent payment of monthly pension.

( )

Witness.

1.

2.

The witnesses should be of 2 persons of respectability in the Village/town in which the applicant reside.

INSTRUCTIONS.

A. Enclosures required.

i) Three copies of passport size photograph with wife/husband duly attested by Head of Office.

ii) Three Specimen signature of wife and husband duly attested by Head of Office.iii) Three slips showing particulars of height and personal identification marks duly

attested (on hand face etc. in case of family pensioners).iv) In case pension is desired through bank.

Two application forms for pension through bank (Pension can be drawn only through any branch of State Bank of India and State Bank of Patiala).

b) Note.

i) Only 3 copies of photographs need be furnished. In case it is not possible for a Govt. employee to submit photograph with his/her wife/husband he may supply separate photographs. The photos should be attested by the Head of Office.

ii) Any subsequent change of address, should be notified to the Head of Office Sr. Accounts Officer/Pension Section, HPGC, Panchkula.

iii) In case it is not possible to give left hand fingers impressions due to physical disability he may give, right hand fingers impressions, if he has lost both hands than he may give too impressions.

iv) In case the claiment is a family pensioner i.e. widow an affidavit on from PS-5 confirming that no other widow of deceased is alive & she has not remarried should be attached.

v) In case of family pension, if there are major children, the affidavit on from PS-6 of major family members to forego their share of D.C.R.G. in favour of applicant/claiment also be supplied with this application.

FORM FOR ASSESSMENT AND SANCTION OF PENSION & D.C.R.G. (TO BE FILLED IN BY THE OFFICE).

1. Name of Corporation’s employees :-

2. Father’s/Husband Name :-

3. Date of birth of Board’s employees.

4. Date of retirement/death :-

5. Class of pension/D.C.R.G.

6. (A) Length of service (Table-I)

(Detail of qualifying service)_______________________________________________________________________Name of Govt. From To Total period Less non- Qualifyingunder which qualifying service.employed in serviceorder of (See Table-II)employment._______________________________________________________________________

Details of Non-qualifying service (Table-II)

S. No.

Name of

From To Period

Interr-uption

Extra ordinary leavenot qualifying for pension

Suspen-sion not treated as qual- ifying

Any other servicenot treated as qual- ifying (Boy service etc.)

Total non-qual- ifying service under each Govt.

7. Remarks by the receiving authority.

1. As to character and past conduct of employee.

2. Explanation of any suspension or degradation.

3. Regarding any gratuity or pension already received by applicant

(See Chapter-VII of pb. C.S.R. Vol.II).

4. Any other remarks.

5. Specific opinion of the Receiving Authority whether the service claimed is

established and should be admitted or not.

(See rule 9.7 (ii)_ and 9.12 (a) (ii) of Pb. C.S.R. Vol.II.

Countersigned.

Signature

of Head of Office/Department.

B. Orders of the Pension Sanctioning Authority.

The undersigned having satisfied himself that the service of Shri._________________________ employed as ___________ has been thoroughly satisfactory hereby order the grant of full pension and/or gratuity which may be accepted by the Sr. Accounts Officer, HPGC, Panchkula as admissible under the rules. The grant of this pension and/or gratuity shall commence from _____________________and payable to ____________________.

A sum of Rs._________________ on account of ________________ is to be held over from the Death-cum-retirement gratuity till the outstanding dues are assessed and adjusted.

OR

The undersigned having satisfied himself that the service of Shri _______________________________ employed as ___________________ has not been thoroughly satisfactory hereby orders that the full pension and/or gratuity which may be accepted the Sr. Accounts Officer, HPGC, Panchkula as admissible under the rules shall be reduced by the specified amount or percentage indicated below :-

Amount or percentage or reduction in pension Rs.____________________Amount of percentage of reduction in gratuity Rs._____________________

The grant of this pension and/or gratuity shall take effect from__________________________________.

A sum of Rs.______________________ on account of ____________________ is to be held over from the Death-cum-retirement gratuity till the outstanding dues are assessed and the following service of the officer has been approved for the grant of special additional pension admissible under the rules :-

Posts/Posts held _____________________ Period of service _____________________

This order is subject to the condition that should the amount of pension and/or gratuity as authorized by the Sr. Accounts Officer, HPGC, Panchkula be afterwards found to be in excess of the amounts to which the pensioners is entitled under the rules, he/she will called upon to refund such excess. A declaration from the pesioner accepting the condition has been obtained and is given in his/her application for pension.

Signature Designation ofAuthority Sanctioning Pension.

Note :- The following documents should also be sent with this from.

1. Unconditional LPC (showing clear-cut recovery position).

2. Service book in case of Non. Gazetted official.

3. Service statement in case of Gazetted officer.

4. N.D.C. on Form PS-13 for whole of HPGC, BCB, U.T., P.S.E.B., B.B.M.B.

5. EPF/PCP Certificate.

6. Workmen Compensation Certificate in case of death of an employee.

7. Calculation statement.

To

_______________________

_______________________

Subject : Commutation of 40% Pension.

Sir,

It is informed that commutation of pension is required to meet with social liabilities and addition and alteration of my house etc.

Yours faithfully,

( )

FORM PEN-12/A

(See Rules 11.1,11.11,11.18,11.19,11.20,11.21)

Form of application for commutation of fraction of pension without Medical Examination.

(To be submitted in duplicate after retirement but within Six Months or the date of retirement).

PART-I

ToFA&CAO (Pension Section) Here indicate the designationHPGC, Panchkula. and full address of the Head

of Office.

Sub :- Commutation of Pension without Medical Examination.

Sir,

I furnish below the relevant particulars and request that I may be permitted to commute a part of my pension as indicated below :-

1. Name (In block letters)

2. Designation at the time of retirement.

3. Father’s name (also husband’s Name in case of a female Govt. employees).

4. Name of office/Department in which employed.

5. Date of birth/by Christain era).

6. Date of retirement.

7. Class of pension on which retired.

8. Amount of pension authorized (in case final amount of pension has not been authorized indicate the amount of provisional pension).

9. Fraction of pension proposed to be commuted.

10. Designation of the Accounts Officer who authorized the pension and No. & Date of the pension payment order if issued.

11. Disbursing Authority for payment of pension

Contd..2..

- 2 -

a) Treasury/Sub-Treasury (Name and complete address of the Treasury/Sub-Treasury to be indicated).

b) i) Branch of the Nationalised Bank with complete postal address.

ii) Bank Account No. to which monthly pension is being credited each month.

iii) Purpose :-

( )

Place :-

Date :-

Note :- The payment of commuted value of pension shall be made through the disburing authority from which pension is being drawn. It is not open to an applicant to draw the commuted value of pension from disburing authority other than the disburing authority from which pension is being drawn.

The applicant should indicate the fraction of the amount of monthly pension (Subject to maximum of one third thereof) which he desires to commute and not the amount in rupees.

Score out which is not applicable.

CONSENT FOR EFFECTING THE RENT/PENAL RENT DUE OR THAT BECOME DUE BEFORE OR AFTER RETIREMENT/DEATH DUE TO ILLEGAL OCCUPATION OF HPGC/GOVT. ACCOMMODATION BEYOND PERMISSIBLE TIME LIMIT.

(TO BE SIGNED BY THE RETIRING NIGAM EMPLOYEES/LEGAL HEIR)

I hereby give my consent in terms of erstwhile HSEB notification No.

80/Geg-45/L dated 10.09.90 that the Rent/Penal Rent due to that become due before or

after my retirement or death due to overstay of a Nigam/Govt. accommodation allotted to

me during my service time, beyond permissible time limit for any reason whatsoever,

may be deducted from my Pension/Family Pension/DCRG including commuted portion

of Pension and Leave Encashment and other dues etc. as the case may be.

( )

1. Signature.

(Address & occupation of witness)

2. Signature.

(Address & occupation of witness)

(The undertaking should be witnessed by two person of respectability in the town, village

& pargana in which the applicant resides).

Personal Identification marks of Sh. ______________________________

1. Name

2. Designation

3. Height

4. Identification Marks

To

___________________________

___________________________

Subject : Option for fixed cash medical allowance after retirement.

Sir,

I hereby opt for fixed cash medical allowance after my retirement i.e.

31.08.2008 (AN).

( )

Specimen Signatures in respect of Sh. ______________ and wife Smt. _____________

Signature of Sh. Signature of Smt.

Attested

WHOM IT MAY CONCERN

Certified that I am not a member of EPF/PCP. It is further certified that I am a member of

GPF having Account No. HSEB-__________. Certified that if any excess payment of

Pension, Gratuity, Commutation of Pension, Leave encashment and GPF etc. is

received by me the same will be refunded.

Attested

( )

UNDERTAKING

I, ___________________ S/o Sh. ____________________ employed as

___________________ due to retire on ____________ here by give an under taking

that under signed will not claim any interest on the delayed payments of pension,

gratuity, commutation of pension, leave encashment and GPF etc.

Attested

( )

HARYANA POWER GENERATION CORPORATION LIMITED

APPLICATION FOR EARNED LEAVE OF SHRI ____________________________

Name of officer/official and the appointment he holds.

Period and nature of leave applied for and the article of the CSR or the Fundamental rules under which claimed

Last leave enjoyed

Recommendations of superior officer with suggestions as to arrangement for absentee’s work.

As per record Recommended without/with

substitute

Purpose of leave

leave encashment on account of retirement

Address while on leave

( )

N.B. The article under which leave is claimed should

always be noted in column. (2)

To

_____________________________

_____________________________

Memo No.

Dated :

Subject : Final withdrawal of GPF Amount in respect of Sh. ________________ due to retire on _________ against his GPF A/c No. HSEB-________.

Sir,

Enclosed please find herewith the following GPF documents/papers for taking further necessary action, please.

1. Form ‘A’ Triplicate

2. Form ‘B’ Triplicate

3. Specimen signatures 3 nos.

4. Passport size photographs 3 nos.

5. Identification of marks 3 nos.

6. PCP/EPF/Undertaking regarding excess payment 3 nos.

7. Under taking regarding for not claiming intention delayed payment 3 nos.

DA/AS above

Your sincerely,

( )

FORM ‘A’

FORM OF APPLICATION FOR FINAL PAYMENT OF THE PROVIDENT FUND

Account No. HSEB-

TOThe FA&CAO-cum-SecretaryHPGCL Employees Provident Fund Trust.Panchkula.(Through the Head of Office)

Sir,

1. I am due to retire/have proceeded on leave preparatory to retirement (for ………...…..…… ………………………..month) have been discharge/dismissed/have resigned finally from BOARD/ COPORATION service and my resignation has been accept w.e.f. _____________ forenoon/afternoon.

2. I request that arrangement may kindly be made to pay the entire amount of my GP FUND at my credit in Account number refer to above as required under the regulation through the office of the CAO/GPF, HPGCL, Panchkula.

3. Particulars of my personal marks of identification viz photograph left hand thumb and fingure impressions (in the case of illiterate subscribers) in duplicate duly attested by the Gazetted officer of the corporation are enclosed.

4. The under mentioned life insurance policies financed by me from my provident fund A/C may kindly be released.

Policy No. Name of the company Sum assured

5. (a) I certify that I have neither drawn any temporary advance nor made any final withdrawal from my Provident Fund Account.

OR

(b) Detail of the temporary advances drawn by me/final withdrawal made by me from my GP Fund are given below.

Section ………………………………………… Amount of Advance ………………………….

Dated ………………………………………….Refundable/Non refundable ………………….

Yours faithfully

( )

Note : Incase of Gazetted Officers the specimen signature should be attested by another Gazetted Officer.

FORM ‘B’

1. The application of Shri ________________________________ alongwith other connected documents viz. specimen signatures in duplicate, passport size photography duly attested, (affidavit of legal heir duly attested from 1st class Magistrate and Form ‘C’ in case of death of the subscriber) etc. for the final withdrawal of GPF forwarded to the FA&CAO (G.P. Fund section) HPGCL Panchkula for further necessary action.

2. The Provident Fund A/c No. Shri/Smt./Kumari (as verification from the statements furnished to his/her from year to year is HSEB-____________.

3. He/She has finally retired/has proceeded on leave preparatory to retirement for …………months/had been discharged/dismissed/has resigned finally from Company’s service and his/her resignation has been accepted with effect from 30.06.2008 Afternoon.

4. The last G.P. Fund deduction was made for the month of ……………… paid in …………... ……………….. for (Rs. ………………………………………………….).

5. (a) Certified that he/she was neither sanctioned/paid any temporary advance nor any final withdrawal from his/her Provident Fund A/c.

5. (b) Certified that the following temporary advances/final withdrawals were sanctioned to him/her and drawn from his/her Provident Fund A/c.

Amount of advance

6. Certified that no amount was withdrawn/the following amount were withdrawn from his/her Provident Fund A/c for payment of Insurance premia or for the purchase of policy.

Policy No. Amount

7. It is certified that no demands of the Company/following demands are due of recovery.

Signature of Head of Office/Deptt.

Specimen signature in respect of Sh. __________________________________

1.

2.

3.

Attested

To be used for all Miscellaneous payment and advance for which special forms are not prescribed.

D.F.R. (26) HARYANA POWER GENERATION CORP. LIMITED ACCOUNT FORM (DOCKET VOUCHER FORM)

Name of Payee : ________________________________________________________

Address _______________________________________________________________

Particulars of Charges/ or Payments to be Made

Amount Payable

Depit (Full Budget Refer to be given A/C. Chargeable)

Rs. P. Rs. P.

Major Head _________

Sub Major Head

Detailed Head

Cr. (Contra) if any

A/C _______________

Authority

Remarks if any

Total Total

Rupees (in words) ___________________________ (To be filled in when__________________________________________ necessary

1. Prepared by ____________________________ Entered in Register kept the purpose at

2. Checked by _______________________ Desg. ______________________________________ Item No. ______ Page No. ________

(a) Entered by __________________3. Approving Authority ______________________________ (b) Checked by _________________ Designation ___________________________ Auditor’s Initials _____________4. Audited _______________________________ (d) Passed on to in cash by

Cashier for Cheque Designation ___________________________ the payment By adjuster.5. Paid by cheque No. _____________________ on _______________ Bank _______________ (Signature of officer

Authorising payment with Signed by (a) ___________________________ stamp of the officer) (b) ___________________________________ Voucher No. ________________ Payment Received ______________________ Dated _____________________

By check as above

Signature of payee

To

_______________________________

_______________________________

Memo No.

Dated :

Subject : Drawn of pension through Bank.

I am to inform that I intend to draw the pension through

_________________________________ as I am having S/B Account No.

__________________________ in the said branch, kindly get arrange the same

accordingly please.

Thanking you.

Your sincerely,

( )