FORM 7
(See Rule 123(1) of MCS (Pension), Rules, 1982)
No.
Dated :
To,
The Accountant General Maharashtra I, Mumbai.
Subject : Pension papers of . for authorigation of pension.
Sir,
I am directed to forward herewith the pension of . of department of the Institution for further necessary action.
Rs. Ps
(a) Balance of the house building NIL or conveyance advance
(b) Over Payment of Pay and NIL allowances including leave salary.
( c) Income Tax deductible at NIL
source under the Income Tax Act, 1961 (43 of 1961)
(d) Arrears of licence fee NIL for occupation of University accomodation.
(e) The amount of licence fee for NIL the retention of University accomodation for the permissible period of months beyond the date of retirement.
(f) Any other assessed dues and NIL the nature there of
(g) The amount of gratuity to be recovered for adjustment of Management Share & Interest thereon.
______TOTAL: Rs. ======Contd 2/-
3. (a) No department enquiry is either pending or proposed to be held against ______
(b) Departmental enquiry is pending/or proposed to be held against Shri/Smt./Kum and a provisional pension amounting to Rs. per month with effect from 19 to 19 has been sanctioned.
4. Your attention is invited to the list of enclosures which is forwarded herewith.
5. The receipt of this letter may be acknowledged and this office informed that necessary instructions for the disbursement of pension have been issued concerned Treasury Office.
6. The Administrative Officer (higher Education) Grants, Bombay Region may be authorised by you to draw and disburse the death-cum-retired gratuity in respect of . to the University office who will be enabled to recover the outstanding dues mentioned in para 2 from the amount of death-cum-retired Gratuity before making its payment to .______FORM 6
(See rules 120, 122,123(1) and (3) and 127(1) of M.C.S (Pension) Rules – 1982)
Form for Assessing Pension and Gratuity
PART I
1. Name of the employee : 2. Father’s Name : : . (and also Husband’s Name in the case of a female University employee)
3. Date of Birth (by Christian Era) :
4. Religion :
5. Permanent Residential Address showing village town, district and State :
6. Present or last appointment including name of : Establishment :
(1) Substantive :
(2) Officiating, if any :
7. Date of Beginning of Service :
8. Date of Ending of Service :
9. (i) Total Period of military service for which pension or gratuity was sanctioned : N.A.
(ii) Amount & nature of any pension/gratuity received for the military service : N.A.
(iii) Name of the College/ University under which service has been rendered previously :
(iv) Total period of College/university service for which pension or gratuity was sanctioned
10. Amount and nature of any pension/gratuity Received for the College/University service : 11. Office under which service been rendered in order of employment. : MANIBEN NANAVATI WOMEN’S COLLEGE,Vile Parle(W),Mumbai-56.
12. Class of pension applicable : Superannuation 13. The date on which action initiated to : Years Months Days
(i) Obtain the No demand certificate from the Executive Engineer concerned as provided In rule 119 of the Maharashtra civil service (Pension),Rules 1982. N.A.
(ii) Assess the service and pay qualifying for Pension as provided in Rule 121 of the Maharashtra Civil Service(Pension) Rules, 1982. N.A.
(iii) Assess the Government dues other than the dues relating to the allotment of government accomoda tion as provided in rule 134 of the Maharashtra civil services pension Rules,1982. N.A.
14. Details of omission, imperfection, or deficiencies : in the service book which have been ignored under Rule 121 of the Maharashtra Civil Service (Pension ) Rule, 1982 : ------No------
15. Total length of qualifying service (for the purpose of adding towards broken periods, a month is reckoned as thirty days). : N.A.
16. Period of non-qualifying service :
From To Y M D (i) Interruption in service condoned under Rule 48 of the Maharashtra Civil Services (Pension) Rules 1982
(ii) Extra ordinary leave specifically sanctioned not to qualify for pension : ------NIL------
(iii) Period of suspension not treated as quali fying service. : ------NIL------
(iv) Any other service not treated as qualifying service. : ------NIL------
Total : ------NIL------
17. Pay reckoned for gratuity : 18. Average pensionable pay :
@ Pay earned during the last ten months of service
Post held From to Basic Grade Total Pay Pay 3+4
1 2 3 4 5 6
Rs Rs Rs Rs
Grand Total :
Pensionable Pay :
Note: (i) In a case where the last ten months include some period not to be reckoned for calculating . average pay, an equal period backward has to be taken for calculating average pay. (ii) The calculation of average pay should be based on actual number of days contained in . each month.
19.. Date on which Form 5 has been from the Employee (To be obtained eight months before the date of retirement of employee) :
20. (a) Proposed pension :
(b) Proposed relief on pension :
21. Proposed death-cum-retirement gratuity :
22. Date from which pension is to commence :
23. Proposed amount of provisional pension : (If departmental or judicial proceedings is instituted against the University employee before retirement ) : ---NIL----
24. Details of Government dues recoverable out of gratuity and Head of Account to which they are to be credited Licence fee for the allotment of Government accodmmodation(see sub rule(2) (3) and (4) of rule 133 of Maharashtra Civil Service(Pension) Rule,1982. : ---NIL----
Dues referred to in Rule 134 of Maharashtra Civil Service (Pension) Rule 1982. : ---NIL----
25. Whether nomination made for : Yes (i) Death-cum-retirement gratuity :
(ii) Family Pension 1950, if applicable :
26. Whether Family Pension, 1964 applies to the University employee and if so : Yes
(i) Pay reckoning for the family Pension : Rs.
(ii) The amount of the family pension becoming payable to the family of the University employee, if death takes place after retirement :
(a) before attaining the age of 65 years, : Rs. OR (b) After attaining the age of 65 years : Rs.
(iii) Complete and up-to-date details of the family as given in Form 3 :
Sr. No Name of the member of the Date of Birth Relationship with Family the University Employee
1 2 3 4
27. Height :
28. Identification Marks :
29. Place of Payment of Pension : Pay and Accounts Office (Government Treasury, or Branch of Public Bandra (E), Mumbai-400051. Sector Bank/Nationalised Bank)
30. Head of Account to which pension and : “266-Pension and other Retirement gratuity are debitable benefits-J-Pension to employees of State Aided Educational Institutions.
Signature of the Head of Office FORM 5
(See Rules 121(1)( c) and 123(1) of MCS (Pension) Rules, 1982)
Particulars to be obtained by the Head of Office from the retiring university employee eight months before the date of his/her retirement.
1. Name of the : 2..(a) Date of Birth : (b) Date of Retirement :
3. Four Specimen Signature slips : Attached ( to be furnished in separate sheet) duly attested by the Head of Office
4. Four copies of Passport size joint photograph with : Attached Wife or Husband (to be attested by the Head of Office) 5. Four slips showing the particulars of height and : Attached personal identification marks duly attested by the Head of Office 6. Present Address :
7. Address after Retirement : Same as above 8. Name of the Government treasury or the branch of : Pay and Accounts Office, Bandra, Public sector bank/Nationalised bank through Mumbai – 400 051 Which the pension is to be drawn.
9. Details of the Family in Form 3. : Attached Separately.
Place Mumbai Signature of the Employee ( )
Dated Signature of Head of the Institute
Yours faithfully,
Officer Two slips each bearing the left hand thumb and finger impression duly attested may be furnished by person who is not literate enough to sign his name(If) such employee on account of physically disability is unable to give left hand thumb and finger impression he may give thumb and finger impression of the right hand. Where an employee has lost both the hands, he may give his too impressions. Impressions should be duly attested by The Head of Institution. Two copies of the passport size photograph of self only need be furnished- (i) If the employee is governed by rule 116 of Maharashtra Civil Service (pension) Rule 1982. (ii) If the employee is governed by rule 117 of Maharashtra civil service (pension) Rule 1982. Where it is not possible for employee to submit a photograph with his wife or her husband he or she may submit separate photograph. The photograph shall be attested by The Head of Institution. Institution specify a few coutpicuous mark, not less than two if possible any subsequent change of address should be notified to The Head of Institution, applicable only where Rule 116 of Maharashtra Civil service(pension), Rule 1982,applies to the employee. Principal.
FORM 3
(See Rule 116(14) of MCS (Pension) rules 1982)
DETAILS OF FAMILY
Name of the University Employee :
Designation : Deptt/Section : Date of Birth :
Date of appointment :
Details of the members of my family * as on :
Sr. Name of the members Date of Relationship with the Signature of Remark No. of family birth University employee Head of Office
1 2 3 4 5 6
I hereby undertake to keep the above particulars up-to-date notifying to the Audit officer/Head of office any addition or alteration.
Place : Mumbai Signature of Employee Dated the : ( )
* Family for this purpose means family as defined in clause(b) of sub-rule(16) of rule 116 of Maharashtra Civil Service (Pension) Rules, 1982. FORM I
(See Rule 115(1) of MCS(Pension) Rules 1982)
NOMINATION FOR DEATH-CUM-RETIREMENT GRATUITY
When the University employee has a family and wishes to nominate one member, or more than one member, thereof.
I, . hereby nominate the person/persons mentioned below who is/are member(s) of my family and confer on him/them the right to receive, to the extent specified below, nay gratuity that may be sanctioned by the Government of Maharashtra in the event of my death while in service and the right to receive on my death, to the extent specified below, any gratuity which having become admissible to me on retirement may remain unpaid at my death :
Sr. No. Original nominee(s) Alternate nominee(s)
Name(s) and add- Relationship with Age Amount or Name, address, rela- Amount ress(es) of the University share of tionship and age of or share of Nominee/nominees employee gratuity person or persons, gratuity payable to if any ,to whom the payable Each right conferred on the to each nominee shall pass in the event of the nomi- nee predeceasing the University employee or the nominee dying after the death of the University employee but before receiving payment of gratuity.
1 2 3 4 5 6 7
(i) This column should be filled in so as to cover the whole amount of gratuity. (ii) The amount/share of the gratuity shown in this column should cover the whole amount/share payable to the original nominee(s).This nomination supersedes the nomination made by me earlier on ______which stands cancelled.
Dated this day of at Mumbai
Witness to signature : (1) Signature of the employee, (2) ( )
Note: (i) The employee shall draw lines across black space below the last entry to prevent the . insertion of any name after he ahs signed. (ii). Strike out which not applicable. (To be filled by the Head of Institution) Nomination by : Designation : Office : Principal
Proforma for acknowledging the receipt of the Nomination Form by the Head of Institution
To,
Sir,
In acknowledging the receipt of your nomination, dated the _____--______cancellation. Dated the ______--______of the nomination made earlier in respect of gratuity in Form _____I______I am to state that it has been duly placed in record.
Place : Mumbai
Dated the Signature of Head of the Institution
Designation:
Note : If employee is advised that would be in the interest of his nominees if copies of the nominations and the related notice and acknowledgements are kept in safe custody so that the may come into the possession of beneficiaries in the event of death. Enclosure of Form 5
(Under Item No.3)
(I) SPECIMEN SIGNATURE SLIP
Specimen Signature of : 1.______
2.______
3.______
Certified that the above specimen signature . was taken in my presence.
Dated : Signature :
Name :
Designation :
******************************************************************************* (Under Item No.4)
(II) PENSIONER’S PHOTOGRAPH
PASSPORT SIZE
Signature of the Pensioner ( )
Certified that the signature and the photograph are those of .
Signature : Name :
Dated : Designation :
******************************************************************************* (Under Item No.5) (IV) DESCRIPTIVE ROLL
1. Height : :
2. Personal Marks, if any, on the hand face etc :
Certified that the above identification marks are those of Shri/Smt./Kum. Signature :
Name : Dated : Designation :
Enclosure of Form 5
(Under Item No.3)
(III) THE THUMB AND FINGER IMPRESSION CARD
Little Finger Ring Finger Middle Finger Fore Finger Thumb
Certified that the thumb and finger impressions are those of Mrs. Asma Shaherwalla the left hand of :
1.
Signature :
Name :
Dated : Designation : LAST PAY CERTIFICATE
1. Name of the College/ University and Address :
2. Name in full of the employee :
3. Designation :
4. Qualification : Sr.No Examination Year of Class University ______Passing Obtained ______
1.
2.
5 Date if appointment :
6. Date of Retirement :
7. Nature of appointment : Permanent
8. Date upto which last salary has been drawn :
9. Scale of Pay :
10. Rate of last pay and Basic D.P D.A H.R.A C.L.A T.A Total allowance drawn p.m.
11. Date of next increment :
12. Whether the employee has i) Resigned ii) Terminated SUPERANNUATION iii) Dismissed
13. If resigned, a) The notice was served Yes/No b) Resignation is accepted Yes/No c) Notice pay in will of notice period is credited Yes/No d) If (c ) is Yes then amount of Notice Pay credited ---NIL---
14. If terminated/dismissed, give ---NIL--- reasons thereof in brief.
15. Remarks , if any : ---NIL--
Place : Mumbai.
Date : Signature of Head of Office
Name of the Institute : Maniben Nanavati Women’s College & Address Vallabhbhai Road, Vile Parle (W), Mumbai – 400056.
Statement showing the breaks in service of .______during the entire period of her service from to
Sr. No. Period of Date Reason Whether Authority Remarks Breaks condoned condoning the break
1 2 3 4 5 6 7
There is no break in her service from to
PRINCIPAL No. Event Certificate
This is to certify that no event has occurred in the service period of ______from ______i.e. the date of her appointment up to 30-04-2012 i.e. up to the date of retirement / up to the date of preparation of her pension papers, which will result in re-calculation of amount of pension and / or her gratuity.
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CONSENT FORM
Pensioners written statement about consent of recovery or over payment , if any.
I, ______hereby give consent that any over payment found or money remaining outstanding against me on account of Pay, Leave Salary, Allowances, Advances, Loans, House rent etc may be recovered from my pension or gratuity.
Mumbai Signature of Pensioner
Date : ______FORM - B (See rules 5(2); 12; 13(3); 14(1) and 15(3) )
Form of application for commutation of fraction of superannuation Pension without medical examination when applicant desires that the payment of the commuted value of pension should be authorized at the of issue of the Pension Payment Order.
(To be submitted in duplicate at least three months before the date of retirement) PART – I To, The The Account General, Mumbai – 400 020
Subject : Commutation of pension without medical examination
Sir/Madam, I Desire to commute a fraction of my pension as indicated below in accordance with the provision contained in Maharashtra Civil Service (Commutation of Pension) Rules, 1984. The necessary particulars are furnished below :
1. Name ( in block letters)
2. Father’s name
3. Designation
4. Name of the Office/Department In which employed
5. Date of Birth ( by Christain era) 6. Date of retirement on superannuation/VRS 7. “Fraction of Superannuation pension proposed to be commuted. 40% of pension 8. ** Disbursing authority from which Pay and Accounts Office Bandra (E), pension is to be drawn after retirement Mumbai -400 051.
(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
A/C No. : (ii) Bank Account number to which monthly pension is to be credited each month.
Signature
Present Postal Address : PART – II
Acknowledgement
Received from ______
Application in Part –I of Form B for commutation of a fraction or pension without medical examination.
Place: ______Signature
Date: Head of office
Note : If the application has been received by the Head of Office before the expiry of three months before the date of retirement on superannuation, this acknowledgement should be detached from the form and handed over to the applicant. If the form has been received by post, it has to be acknowledged on the same days and the acknowledgement send under registered cover to the applicant. In case it is received after the specified date, it should be accepted only if it has been put into the post on or before that date subject to the production of evidence to that effect by the applicant.
PART – III
I ) Forwarded to the Audit Officer ( here indicate the address and designation)
With the remarks that –
II) the particulars furnished by the applicant in Part-I have been verified and are correct; III) the applicant is eligible to get a fraction of his/her pension commuted without medical examination. IV) the commuted value of pension determined with reference to the Table applicable at present comes to Rs. and V) the amount residuary pension after commutation will be Rs. /-
2. The pension papers of the applicant completed in all respect were forwarded under this Department/Office letter No. dated It is requested that the Payment of commuted value of pension may be authorised at the time of issue of the Pension Payment Order which may be issued one month before the retirement of the applicant.
3. The receipt of Part-I of this Form has been acknowledged in Part –II which has been forwarded separately to the applicant on.
4. The commuted value of pension is debitable to Head of Account, under Finance Department, “ Demand No. “ 266 – Pension and Other Retirement Benefits-B-Commuted Value of Pensions”
Place : Signature Date Head of Office
MANIBEN NANAVATI WOMEN’S COLLEGE VALLABHBHAI ROAD, VILE PARLE (W) MUMBAI-400056.
F.R.A. CERTIFICATE
1. Certified that ______(Designation) ______of this College is working in this College from ______To ______the date of Superannuation.
2. Certified that ______is employed in our College which is recognized an aided by the Government of Maharashtra and is affiliated to the non Agricultural University in the Maharashtra State viz. S.N.D.T. University and that she worked as a full time employee for the entire period of service From ______to ______during the above period of her service. She is a full time employee of this College.
3. Certified that her appointment as a Associate Professor was approved by the . University during the above period.
OR
3. Certified that she was employed by this College and that her appointment is within the norms laid down by the Government, under the staffing pattern for the Teaching Staff during the above period.
4. Certified that her salary paid by this College is covered under the salary payment scheme of the Government of Maharashtra for the purpose of salary grant paid to this College and the expenditure on her salary is held admissible for grant, during the above period.
Place : Mumbai PRINCIPAL
Date: Certificate regarding No Dues, No Demand & Departmental Enquiry.
CERTIFIED that there are no dues against______, Desingation :______, and that I have no demands from Government and / or the Management.
CERTIFIED that no Departmental enquiry is pending against ______
Place : Mumbai.
Date : Principal
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