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)AUTHORITYAPPENDIX ‘B’ APPLICATION FOR CLOSING OF DSOP FUND ACCOUNT AND PAYMENT OF BALANCE PART ISir,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. ______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my Provident Fund account during the last one year immediately preceding the date of release from ServiceOR (2) I have withdrawn from my fund a/c the following amount during the last one year preceding the date of release :-Nature of withdrawal Amount Date of drawal Temporary advance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 withdrawalDate : Yours faithfully, -2-PART IIReceived a sum of Rs……………………………(Rupees...……………………only for full and final settlement of may provident fund.Date : (Duly Pre-receipted over (01 Rupee Revenue StampSignaturePART IIIThe 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 IVChecked and passed for payment of Rs …………………..(Rupees ………………………………………………………………..only).Date :CDA (N) Mumbai PART VPayment of Rs …………………………..(Rupees …………………………………………only) made by cheque / Draft /M.O.No ……………………………..through imprest of ……………...... attached on Fund Account Ledger Card.For Logistics Officer-in- chargeDate Naval Pay Office MumbaiIn lieu of IAFA 115APPENDIX ‘C’CONTINGENT BILLExpenditure 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 AddressName 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 YearsDetails :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)AUTHORITYAPPENDIX ‘F’INS Angre Shahid Bhagat Singh Road Mumbai – 400023 File : 240/16 DateNO DEMAND CERTIFICATE ( Para 79 , Financial Regulation Part – II for the Indian Navy)CERTIFICATE OF COMMANDING OFFICERThis 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 OfficerSERVICE EXTRACT APPENDIX ‘G’ Rank ______Name ______P.No. ______SI NO UNIT RANK FROM TO DESIGNATION01. INS Mandovi SLt Aug 2002 Dec 2002 Under Training 02. INS Mysore SLt Dec 2002 Dec 2002 Under Training03.. INS Shivaji SLt Dec 2002 Jan 2003 Under Training04. INS Valsura SLt Jan 2003 Dec 2003 Under Training05. INS Savitri SLt Dec 2003 May 2004 Under Training06. INS Valsura SLt May 2004 Oct 2004 Under Training07. Naval Dockyard (V) Lt Oct 2004 Apr 2007 Asst. Manager IT08. INS Betwa Lt Apr 2007 Aug 2008 Weapons Maintenance Officer09. 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 Position11. 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 AddressBank Details Email id :Station : Date : (______) Rank & Name P.No.COUNTERSIGNED Unit StampCommanding Officer Place : Date :

Application for Closing of Dsop Fund Account And

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