Application for Closing of Dsop Fund Account And

APPENDIX ‘A’

IN (PAY) 238 A GEN FORM Casuality LEAVE – ACCUMULATION –ACCUMULATION UNIT

GX. NO : GX Date : AMPM : Dt of occ :

Maker : Maker Date : Authorizer : Authorize Date :

Sr.No. Per.No. Name Rank 01.

Details :

PERMITTD TO ENCASH ACCUMULATED ANNUAL LEAVE VIDE NAVPAY SIGNAL DTG 071244/JUL DETAILS OF ACCUMULAD LEAVE AS FOLLOWS :

YEAR : NO OF DAYS ______

UP TO YEAR 2014- 315 DAYS 2015-0

(Unit Stamp)

AUTHORITY

APPENDIX ‘B’ APPLICATION FOR CLOSING OF DSOP FUND ACCOUNT AND PAYMENT OF BALANCE

PART I

1. I, Service/P.No______Rank ______Name______

Due to retire / have retired proceeding on leave pending retirement / have been,discharged / dismissed from service with effect from______I request that my subscription to provident Fund be discontinued from pay of ______

2. I request that final payment of balance in the provident fund be made to me through my bankers as shown below for credit to my account No. ______or may be paid in cash or sent by money order at the following address at my expense.(delete whichever is inapplicable).

Bankers Residential address

______

3. The under mentioned Life Insurance Policies financed by me from my Provident Fund may be released .

Policy No. ______

Certificate that :-

(1) I have not drawn any temporary advance of final withdrawal from my Provident Fund account during the last one year immediately preceding the date of release from Service

OR (2) I have withdrawn from my fund a/c the following amount during the last one year preceding the date of release :-

Nature of withdrawal Amount Date of drawal Temporary advance Final withdrawal

Date : Yours faithfully,

PART II

Received a sum of Rs……………………………(Rupees...……………………only for full and final settlement of may provident fund.

Date : (Duly Pre-receipted over (01 Rupee Revenue Stamp

Signature

PART III

The details furnished by the individual are correct as per Fund Ledger Account as on ………... Details of nominee are furnished below as per document :-

Name : ______DOB : ______

Date : For Logistics Officer-in-Charge Naval Pay Office

PART IV

Checked and passed for payment of Rs …………………..(Rupees ………………………………………………………………..only).

Date :

CDA (N) Mumbai PART V

Payment of Rs …………………………..(Rupees …………………………………………only) made by cheque / Draft /M.O.No ……………………………..through imprest of ……………...... attached on Fund Account Ledger Card.

For Logistics Officer-in- charge

Date Naval Pay Office Mumbai

In lieu of IAFA 115

APPENDIX ‘C’

CONTINGENT BILL

Expenditure on account of TERMINAL GRATUITY

Incurred by (Rank)______(Name)______(P.No.)______

Authority :- GOI, MOD letter No. 2(5) 187/D(Revision Services) dated Oct 87 and GOI, MOD. Dept. of Ex- Servicemen Welfare , New Delhi letter 17(4)/2008(2)/(Pen/Pol) dated 12 Nov 08 and IHQ, MOD(N) letter______Dated______

………………………………………………………………………………………………………… Details of Expenditure Amounts

…………………………………………………………………………………………………………On account of “Terminal Gratuity” on completion Short Service Commission without break in Service for the period from ______To______(Total of service______Years______Months______Days). Rs.______

Certified that :-

The amount in question has not been claimed / received by me.

Signature______Name ______Rank______P.No.______Rs.______

Net Amount due (in words) Rupees______only) Banker Address

Name of Account Holder (s)______Name of the Bank______Bank A/C No.______IFSC Code______MICR No.______Branch Code______ECS Code______Bank Branch Address______Re 1/- Revenue Stamp Received Payment Signature______Name ______Rank______P.No.______II COUNTERSINGED BY THE COMMANDING OFFICER Place:______Date :______Enclosures :- Forwarded to :-

The Logistics Officer-in-Charge (for O/DEMOB Section) Naval Pay Office Mumbai-400023

(Unit Stamp)

CERTIFICATE BY THE OFFICER APPENDIX ‘D’ I______(Rank)______(Name)______(P.No.) was granted short service commission in the indian navy w.e.f______.I have been released from naval service on ______after completion of ______years ______months___days vide IHQ MOD (N) PDOP letter______2. I hereby certify the following :- (a) That I had no break in service.

(b) That I have filed the following claims for TA/DA/LTC advances drawn during the last 06 (six) months of service.

(i) LTC claim forwarded vide ______dated______. (ii) TY Duty claim(s) forwarded vide ______dated______.

(c) That I am not holding any Govt. Accommodation on my name as on date.

(d) That the particulars of Furlough Leave during my entire service are as follows:-

(i) ______days w.e.f______(ii) ______days w.e.f______

(e) That I had No lower deck service/______years of lower deck service.

(f) That I had No service as a Sailor/Sepoy/Airman/Civil Govt. Servant.

(g) That I have not taken any employment during my Terminal leave.

(h) That I have relinquisbec my duties as (SSC) on ______(j) That my Post Retirement Address and email ID for the purpose of all correspondence is as follows : ______(k) That my Bank particulars for the purpose of all retirement benefits is as follows:- Name of Account Holder(s)______Name of the Bank ______Bank A/C No.______IFSC Code______MICR No______Branch Code______Bank Branch Address______Signature______Name______Rank______P.No.______II COUNTERSINGED BY THE COMMANDING OFFICER Place : ______

Date : ______

(Unit stamp) Genform APPENDIX ‘E’

IN (PAY) 238 A GEN FORM Casuality MISCELLANEOUS – RETIREMENT FROM ACTIVE SERVICE – RETIRED/RELEASE SSC OFFICER UNIT GX. NO : GX Date : AMPM : Dt of occ :

Maker : Maker Date : Authorizer : Authorize Date :

Per.No Name Rank Leave Years

Details :

THE ABOVE MENTIONED SHORT SERVICE COMMISIONED OFFICER IS RETIRED FROM ACTIVE SERVICE W.E.F. …………VIDE IHQ MOD(N) / DOP LETTER …………DATED ………..PROCEEDING .___DAYS OF BAL OF ____FOLLOWED BY ___DAYS TERMINAL LEAVE WEF ___APR ____.CEASED TO DRAW RIK(O). POST RETIREMENTADDRESS …………………………………………………………… PHONE NO ………………… EMAIL ………………………

(Unit Stamp)

AUTHORITY

APPENDIX ‘F’

INS Angre Shahid Bhagat Singh Road Mumbai – 400023 File : 240/16 Date

NO DEMAND CERTIFICATE ( Para 79 , Financial Regulation Part – II for the Indian Navy)

CERTIFICATE OF COMMANDING OFFICER

This is to certify that to the best of my knowledge and belief there are no Public dues / claim outstanding againt Lt Cdr ______. The Offricer is being released from Service w.e.f. ____

Unit Stamp Commanding Officer

SERVICE EXTRACT APPENDIX ‘G’ Rank ______Name ______P.No. ______

SI NO UNIT RANK FROM TO DESIGNATION

01. INS Mandovi SLt Aug 2002 Dec 2002 Under Training 02. INS Mysore SLt Dec 2002 Dec 2002 Under Training

03.. INS Shivaji SLt Dec 2002 Jan 2003 Under Training

04. INS Valsura SLt Jan 2003 Dec 2003 Under Training

05. INS Savitri SLt Dec 2003 May 2004 Under Training

06. INS Valsura SLt May 2004 Oct 2004 Under Training

07. Naval Dockyard (V) Lt Oct 2004 Apr 2007 Asst. Manager IT

08. INS Betwa Lt Apr 2007 Aug 2008 Weapons Maintenance Officer

09. FTTT(MB)/Angre Lt Aug 2008 May 2009 Dy Manager GG & Addl ASW

10. INS Kalinga Lt Cdr May 2009 Aug 2011 Oi/c Brahmos Technical Position

11. NTG(MB)/Angre Lt Cdr Aug 2011 Aug 2012 Deputy Oi/c Addl

(______) Rank & Name ______P.No. ______

COUNTERSIGNED

(Unit Stamp)

APPENDIX ‘H’

CERTIFICATE OF ‘NO EMPLOYMENT DURING TERMINAL / ANNUAL LEAVE 1. This is to certify that, I______taken up any employment during my terminal leave / annual leave. 2. My Permanent residential address and bank particulars are as given below :-

Permanent Address

Bank Details

Email id :

Station : Date : (______) Rank & Name P.No.

COUNTERSIGNED

Unit Stamp

Commanding Officer Place : Date :