बुधवार, 12 फ़रवरी 2020

All Over Form for pension पेन्षन/सेवानिवृत्त ग्रेच्युटी/राषिकरण के लिए प्रारुप



¼ 1 ½
mRrj izns’k ikoj dkjiksjs’ku fy0
isU’ku izi= ¼ Hkkx&1½
    isU’ku@lsokfuo`Rr xzsP;qVh@jkf’kdj.k ds fy, izkFkZuk i=          


lsok esa]
      izcU/k funs’kd
      e0fo0fo0fu0fy0                  
      4&,] xks[kys ekxZ y[kuÅA                  ¼dk;kZy;k/;{k dk inuke rFkk irk½
     
egksn;]
    esjk fooj.k fuEuor~ gSA  eq>s isU’ku] lsokfuo`Rr xzsP;qVh rFkk isU’ku dk jkf’kdj.k Lohd`r djus dh d`ik djsa %& 
        
 
                                                          vfHkKku la0

   
                                                          lEizs{kk la0      
1
Ukke                            

2
firk @ifr dk uke              

3
Lksokfuo`fRr ds i’pkr~ dk irk      
¼d½ LFkk;h fuokl LFkku
¼[k½ i= O;ogkj dk irk             

4
tUe frfFk                       

5
lsok izkjEHk djus dh frfFk         

6
lsok fuo`fRr dh frfFk             

7
vfUre in] tgkW ls lsok fuo`Rr gq,] dk inuke   rFkk dk;kZy; dk uke ,oa irkA                    

8
e`R;q gksus dh n’kk esa ukfeuh dk uke ,oa irk ftls thou dkyhu vo’ks”k dk Hkqxrku fd;k tk,A

9
isU’ku dk Hkkx ;k isU’ku dh /kujkf’k ftldk jkf’kdj.k visf{kr gSA

10
Hkqxrku fdl [k.M ls vkgfjr    
djuk pkgrs gSa A




                                                  ¼2½



11& ifjokj dk fooj.k %&
dze la0
ifjokj ds lnL;ksa ds uke
tUefrfFk
lsok fuo~rd  lsod ls laca/k
fookfgr@ vfookfgr
irk
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2&





3&





4&





5&






      

                                                                                            Hkonh;

fnukad %

                                                                                   ¼dkjiksjs’ku lsod ds gLrk{kj ½
?kks”k.kk

eSa ,rn~ }kjk ?kks”k.kk djrk gWw fd esjs }kjk izLrqr fd;k x;k mi;qZDr fooj.k lgh gSA eq>s fu;ekuqlkj isU’ku@lsok&vkuqrksf”kd] lsokfuo`fRr xzsP;qVh rFkk isU’ku dk jkf’kdj.k Lohd`r dj fn;k tk;sA  eS Hkyh HkkWfr voxr gWw fd ;fn eq>s vuqeU; /kujkf’k;kW Hkfo”; esa vf/kd ik;h tk;sxh rks eq>s vf/kd izkIr /kujkf’k;kW okil djuh gksaxhA  eSa opu nsrk gWw fd eq>s mijksDrkuqlkj vkxf.kr okLrfod /kujkf’k dh Lohd`fr ds mijkUr mijksDrkuqlkj Lohd`r /kujkf’k ds iqujhf{kr fd;s tkus esa dksbZ vkifRr ugha gksxh vkSj eSa vf/kd izkIr /kujkf’k dks rRdky dkjiksjs’ku dks okil dj nwWxkA




nks lk{kh ftudh  mifLFkfr esa gLrk{kj                                             ¼ dkjiksjs’ku lsod ds gLrk{kj ½
fd;s x;s ¼ ;FkklEHko mlh dk;kZy; ds lnL;
gksus pkfg;s tgkW ls lsokfuo~`r gq, ½

1&                    
     inuke %& ---------------------------------------------------------------------------                                                           
irk %& -----------------------------------------------------------------------------------
          
2&      
     inuke %& ---------------------------------------------------------------------------                                                           
     irk %& -----------------------------------------------------------------------------------
          
    fnukad % ----------------------------------
                                                            dk;kZy;k/;{k ds gLrk{kj rFkk inuke
                                  fnukad




¼3½
mRrj izns’k ikoj dkjiksjs’ku fy0
isU’ku izi=¼ Hkkx&2½
¼ikfjokfjd isU’ku rFkk e`R;q xzsP;qVh ds fy, izkFkZuk i=½

lsok esa]
  



egksn;]
        esjk rFkk e`r dkjiksjs’ku lsod dk fooj.k fuEuor~ gSA  eq>s ikfjokfjd isU’ku rFkk e`R;q xszP;qVh Lohd`r djus dh d`ik djsa A

1
e`r dkjiksjs’ku lsod dk uke

                                          
2
e`r dkjiksjs’ku lsod ds firk @ifr dk uke


3
e`r dkjiksjs’ku lsod }kjk /kkfjr vfUre in dk uke rFkk foHkkx dk;kZy; dk uke ,oa irk


4
D;k e`r dkjiksjs’ku lsod isU’ku ik jgk Fkk \ ;fn gkW rks %&
¼d½ lsokfuo~fRr dk fnukad
¼[k½ isU’ku Hkqxrku djus okys vf/kdkjh dk inuke ,oa irk

5
izkFkhZ dk
¼d½  uke
¼[k½  firk @ifr dk uke
¼x½  tUefrfFk
¼?k½  e`r lsod ls lEcU/k


6
e`R;q ds mijkUr fo/kok vFkok  ifjokj
ds lEcfU/kr lnL; dk irk ftls
ikfjokfjd isU’ku Lohd`r dh tk;sxh %&
¼d½  LFkk;h fuokl LFkku %

¼[k½  i= O;ogkj dk irk %

       
¼d½  ikfjokfjd isU’ku dc ls -------------------------------------dc rd ----------------------------------------:-  -----------------------------------
¼[k½  e`R;q xzsP;qVh        :-  --------------------------------------------------------


fnukad %                                                                   ¼izkFkhZ ds gLrk{kj ½
                                                                                 ;k vxawBs dk fu’kku         
¼4½

7- dkjiksjs’ku lsod dh e`R;q dk fnukad&                      -------------------------------------------------------------------------
   ¼e`R;q izek.k i= layXu gS½
8 e`r dkjiksjs’ku lsod ds ifjokj dk fooj.k %              

dze la0
ifjokj ds lnL;ksa ds uke
tUefrfFk
e`rd  lsod ls laca/k
fookfgr@ vfookfgr
irk
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2&





3&






9-  [k.M dk uke tgka ls Hkqxrku visf{kr gS%             --------------------------------------------------------------------------------
10- vfUre ikfjokfjd isa’ku @xzsP;qVh dh /kujkf’k %             
    ¼;fn dksbZ Lohd`r dh x;h gks½
¼d½ ikfjokfjd isa’ku dc ls ------------------------------dc rd----------------------------:0-----------------------------------
¼[k½ e`R;q xzsP;qVh :0------------------------------------------------------------------

                                                                                            Hkonh;

fnukad %

                                                                                   ¼dkjiksjs’ku lsod ds gLrk{kj ½
?kks”k.kk

        eSa ----------------------------------------------------------------------------------------------iRuh@ifr@iq= @iq=h LoxhZ; Jh ----------------------------------------------------------------dh ¼foHkkx @ dk;kZy; dk uke ½ --------------------------------------------------------------------------------------}kjk nh tkus okyh ikfjokfjd isU’ku rFkk e`R;q xzsP;qVh Lohdkj djrs gq, ;g ?kksf”kr djrk@djrh gWw fd ;fn fu;ekuqlkj vuqeU; ikfjokfjd isU’ku rFkk e`R;q xzsP;qVh ls vf/kd /kujkf’k fdlh =qfVo’k Hkqxrku dj nh tkrh gS rks mlds iqujh{k.k esa rFkk vf/kd Hkqxrku dh x;h /kujkf’k dh okilh esa eq>s dksbZ vkifRr u gksxh A

fnukad %                                                                             ¼izkFkhZ ds gLrk{kj ½
                                                                                   ;k vxawBs dk fu’kku  
nks lkf{k;ksa ds gLrk{kj %
¼1½      uke ----------------------------------------------------------------
        in uke -----------------------------------------------------------
        irk --------------------------------------------------------------------
¼2½      uke ----------------------------------------------------------------------
        in uke---------------------------------------------------------------
        irk     ----------------------------------------------------------       
                                                          
                                                                                    dk;kZy;k/;{k ds gLrk{kj
                                                                                 fnukad %


¼ mi;qZDr lk{kh ;FkklEHko mlh dk;kZy; esa dk;Zjr gksus pkfg, tgkW e`rd deZpkjh dk;Zjr Fkk vU; fLFkfr esa vkgj.k ,oa forj.k vf/kdkjh lkf{k;ksa ds lEcU/k esa vius foosd ls fu.kZ; ysxsaA½

¼5½
mRrj izns’k ikoj dkjiksjs’ku fy0
isU’ku izi=¼ Hkkx&3½
¼isU’ku@ikfjokfjd isU’ku Lohd`fr gsrq izi=½
izkFkhZ dk fooj.k

1
dkjiksjs’ku lsod dk uke %
in uke rFkk dk;kZy; dk uke %

2
dkjiksjs’ku lsod dh e`R;q dh n’kk esa
ikfjokfjd isU’ku@e`R;q xzsP;qVh gsrq
ykHkkFkhZ dk uke rFkk lsod ls lEcU/k


   3-  uewus ds gLrk{kj %
       ¼d½  dkjiksjs’ku lsod ds ¼ mlds thfor jgus ij djok;s tk;sxsa ½ 
                                                                             1& 
                                                                2&     
                                                                3&

¼[k½  dkjiksjs’ku lsod dh iRuh ;k vU;                      1&
             ykHkkFkhZ ds ¼mlds thfor jgus vFkok e`R;q                2&
             gksus nksuksa n’kkvksa esa djok;s tk;sxsa ½                     3&


    4-   ;fn dkjiksjs’ku lsod ;k mldh iRuh @ ifr vFkok                  
        vU; izkFkhZ vaxzsth] fgUnh vFkok mnwZ esa gLrk{kj
        djus esa vleFkZ gS rks nk;sa vFkok ck;s vaxwBs ,oa
        vaxqfy;ksa ds fu’kku
¼d½ dkjiksjs’ku lsod ds                                           ykxw ugha
¼[k½ iRuh @ ifr ;k vU; izkFkhZ ds                                  ykxw ugha


    5-   oS;fDrd igpku
        ¼d½  dkjiksjs’ku lsod ds igpku fpUg @ÅWpkbZ%&          
                ¼[k½  ikfjokfjd isU’ku ds igpku fpUg ,oa ÅWpkbZ%&         
    

          QksVksxzkQ
    6-   dkjiksjs’ku lsod dh iRuh @ ifr ds lkFk ikliksVZ
        vkdkj esa la;qDr QksVksA dkjiksjs’ku lsod dh e`R;q dh n’kk
        esa izkFkhZ dk ikliksVZ vkdkj esa viuk QksVks ¼QksVks dh                         
        rhu izfr;kW nh tk;saxh ftuesa ls nks vyx&vyx izi=ksa
        ij fpidkbZ tk;saxh rFkk ,d izfr ,d NksVs fyQkQs esa
        isU’ku izi= ds lkFk vyx ls yxk nh tk;sxh A
                                                                            


lR;kfir

       dk;kZy;k/;{k ds gLrk{kj rFkk uke                                       ---------------------------------------------------------------------
       fnukad %                                                                       ------------------------------------------------------------------



¼6½
mRrj izns’k ikoj dkjiksjs’ku fy0
isU’ku izi= ¼ Hkkx&4½
lsok dk bfrgkl] vodk’k ,oa fooj.k

        dkjiksjs’ku lsod dk uke o in %&                                                       tUe frfFk&
dzekad
Dkk;kZy; dk uke tgkW dk;Z fd;k
in dk uke
dc ls dc rd
¼dsoy fnukad ½
fn;s tk,A
vodk’k vlk/kkj.k vodk’k] fuyEcu izksUufr] inoufr] izfrfu;qfDr] O;o/kku dh vof/k ¼dkj.k lfgr ½ o LoHkko bafxr fd;k tk;sA
dc ls dc rd
;fn dksbZ vof/k isU’ku;qDr ugha gS rks dkj.k lfgr mldk fooj.k fn;k tk;sA
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                                                     dk;kZy;k/;{k ds gLrk{kj ,oa irk % ------------------------------------------------                                                                         
                                                       fnukd % ---------------------------------------------------------------




¼7½
mRrj izns’k ikoj dkjiksjs’ku fy0
isU’ku izi= ¼Hkkx&5½
¼dk;kZy;k/;{k ds mi;ksx gsrq½

1&      dkjiksjs’ku lsod dk uke %                                          
2&      dkjiksjs’ku lsod dh tUefrfFk                                     
3&      lsok esa vkus dk fnukad                                           
4&      lsok fuo`fRr dk fnukad                                                   
                                                               
5&      dqy vof/k ¼ 4&3½                                                          
6&      lSU; lsok tks isU’ku ds fy;s vgZ gSa] dh vof/k                         &
7&      vU; lsok ¼ ;fn dksbZ gks ½ ftls isU’ku
        gsrq vgZ ekuk x;k                                                 &
8&      isU’ku vugZ lsok &
        ¼d½  20 o”kZ dh vk;q izkIr djus ds iwoZ dh lsok                      
        ¼[k½  lsok esa foPNsn                                               &
        ¼x½  isU’ku ds fy, vugZ fuyEcu dh vof/k                          &
        ¼?k½  dksbZ vU; lsok tks isU’ku gsrq vugZ gks                          
             ¼ dkj.k lfgr mYys[k fd;k tk; ½                     ;ksx   &
                                                                       ------------------------------------------------
                                                                 
9&      isU’ku gsrq vgZ lsok dh dqy vof/k                                                  
        ( 5+6+7-8 )                                                                                                                         
10&     isU’ku dk izdkj izfrdj@v’kDrrk@fjVk;jfjax                               
11&     lsokfuo`fRr ds fnukad dks ewyfu;e
9 ¼21½ ¼1½ esa ifjHkkf”kr osru ewy osru :0                    :
12&     vkSlr ifjyfC/k;kWa dk vkx.ku                               :0 --------------------------------------------       
                       

/kkfjrk in
fnukad
ls
fnukad
rd
ifjyfC/k;kW
ewy fu;e 9¼21½ ¼1½ esa
vU;
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¼ 8 ½

13&     isU’ku dk vkx.ku                                         ;Fkk ns;
                                                                                                  

14&     lfoZl xzsP;qVh dk vkx.ku                                  ;Fkk ns;       
        ¼isU’ku vgZ lsok 10 o”kZ ls de
        gksus ij isU’ku ds LFkku ij
vuqeU; ½
15&     lsokfuo`fRr xzsP;qVh dk vkx.ku                              ;Fkk ns;               
16&     lsok fuo`fRr @ e`R;q xzsP;qVh dh                             ;Fkk ns;
        /kujkf’k ls dVkSrh ¼ ;fn dksbZ gks ½

17&     ‘kq) lsokfuo`fRr  @ e`R;q xzsP;qVh dh /kujkf’k                  ;Fkk ns;              
18&     ikfjokfjd isU’ku dk vkx.ku
        ¼d½  lkekU; nj                                          ;Fkk ns;      
        ¼[k½  7 o”kZ dh lsok ds mijkUr e`R;q dh n’kk esa fnukad        
             lkekU; nj dk nks xquh nj  -----------fnukad ------ ------------ls ------------------------ rd        ;Fkk ns;       

19&     isU’ku @ ikfjokfjd isU’ku izkjEHk gksus dk fnukad     
20&     isU’ku dk Hkkx vFkok /kujkf’k tks vkosfnr gS rFkk     
        ftldk jkf’kdj.k vuqeU; gSA
21&     jkf’kd`r ewY; dk vkx.ku                                  ;Fkkiz;ksT; fu;ekuqlkj
22&     jkf’kdj.k ds mijkUr vuqeU; isU’ku dh /kujkf’k               ;Fkk vuqeU;
       
23&     dk;kZy;@[k.M dk uke tgkW ls isU’ku] lsokfuo`fRr vFkok        
        e`R;q xzsP;qVh@jkf’kdj.k ds Hkqxrku vkgfjr fd;s tk;sxsaA
24&     vufUre isU’ku @ ikfjokfjd isU’ku                                
        ¼;fn Lohd`r dh x;h gks rks Lohd`fr dh lR;izfr layXu dh tk;s ½
       
25&     vufUre lsokfuo`fRr@e`R;q xzsP;qVh                                  
        ¼;fn Lohd`r dh x;h gks rks Lohd`fr dh lR;izfr layXu dh tk;s ½

26&     isU’ku izi=ksa ds izs”k.k dh frfFk ds iwoZ vFkZkr~ fnukad                    -------------------
        ¼;g frfFk lsok fuo`fRr ds Bhd vkB ekg iwoZ dh gksuh pkfg, ½ rd

¼1½  Hkou fuekZ.k esa ls :         dh /kujkf’k nsuk ‘ks”k gS @ dksbZ /kujkf’k ‘ks”k ugha gSA

¼2½  eksVj dkj @ eksVj & lkbfdy @ LdwVj @eksisM vkfn vfxze esa ls :0      dh /kujkf’k ‘ks”k gS@dksbZ
    /kujkf’k ‘ks”k ugha gS A ¼izek.k&i= layXu½

        ¼3½  fdlh vU; izdkj ds vfxze esa ls :-       dh /kujkf’k ‘ks”k gS @ dksbZ /kujkf’k ‘ks”k ugha gSA


¼9½


¼4½  dkjiksjs’ku Hkou esa vkokl djus gsrq fnukad      rd :0       dh /kujkf’k fdjk;s  ds :i esa vo’ks”k  gS@ dksbZ /kujkf’k vo’ks”k ugha gS rFkk lsokfuo`fRr ds fnukad     rd  :0      vkSj nsuk ‘ks”k jg tk;sxk A ¼izek.k&i= layXu½

¼5½  vkfMV ds ifj.kke Lo:i :0       dh /kujkf’k ns; gS@dksbZ /kujkf’k  ‘ks”k ugha gS A

¼6½  foHkkxh; vFkok fdlh vU; dk;Zokgh ds ifj.kke Lo:i :0      dh /kujkf’k ns; gS@dksbZ /kujkf’k ns; ugha gS A
¼7½  vU; enksa esa ¼ en Li”V dh tk;s ½ :0        dh /kujkf’k ns; gS @dksbZ /kujkf’k ns; ugha gSA

    ¼8½  Jh              ¼dkjiksjs’ku@lsod dk uke½ ds fo:) dksbZ U;kf;d@foHkkxh; vFkok iz’kklukf/kdj.k tkWp yfEcr ugha gS A
   
    ¼;fn yfEcr gS rks mldk laf{kIr fooj.k] tSls ;fn ljdkj dks foRrh; gkfu igqWapk;h x;h gks rks mldk vkHkkj ,oa /kujkf’k vFkok ;fn xEHkhj nqjkpj.k ds nks”kh gks rks mldk fooj.k fn;k tk;s A ½


       
fnukad %
                                                                    dk;kZy;k/;{k ds gLrk{kj
                                             rFkk inuke
                                               fnukad















                                              ¼ 10 ½
mRrj izns’k ikoj dkjiksjs’ku fy0
isU’ku izi= ¼ Hkkx&5 v½
¼ dk;kZy;k/;{k ds mi;ksx gsrq ½
deZpkjh Hkfo”; fuf/k izek.k&i=

1&     dkjiksjs’ku lsod dk uke %         
2&     dkjiksjs’ku lsod dk inuke %                      
3&     lsok esa vkus dh frfFk %                            
4&     lsok fuo`fRr dh frfFk %                            
5&     deZpkjh Hkfo”; fuf/k ds vUrxZr fd;s x;s va’knku dk fooj.k % &
dzz0
la0
d-Hk-fu- ls vkofjr dk;kZy; dk uke
in
dc  ls
dc rd
lsod dk va’k
dkjiksjs’ku dk va’k
dqy ;ksx
[kkrk la[;k
LFkkukUrj.k @okilh dk lanHkZ@fooj.k
va’knku
C;kt
va’knku
C;kt
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6&    deZpkjh dk va’k :0 ‘kwU; ¼C;kt lfgr ½ mlds lkekU; Hkfo”; fuf/k [kkrk la[;k &            esa ¼bdkbZ½          }kjk ekg esa ØsfMV fd;k tk pqdk gSA  
7&    dkjiksjs’ku dk va’k :0 ‘kwU; ¼C;kt lfgr ½ esa isU’ku fjtoZ [kkrk esa  }kjk ØssfMV fd;k tk pqdk gS@deZpkjh dks                                      okil fd;k tk pqdk gSA 
8&    izek.k ds QkeZ **ds** deZpkjh Hkfo”; fuf/k vk;qDr -------------- dk i=kWd&layXu gSA
9&    deZpkjh Hkfo”; fuf/k ;kstuk ds lnL; ugha jgs gS A
mijksDr lwpuk rSukrh ds leLr dk;kZy;ksa ls izkIr lwpuk ds vk/kkj ij nh tk jgh gSA
       layXud%& mijksDrkuqlkjA
       fnukad%&                                                                  
                                                                 dk;kZy;k/;{k ds gLrk{kj
                                        rFkk inuke
                                          fnukad


fVIi.kh % 5]6]7]8]o 9 tks ykxw ugha gS dkV fn;k tk;sA
fVIi.kh % mijksDr fcUnq 5 ¼2½ esa mu dk;kZy;ksa dk uke fy[kk tkuk gS
       ftlesa deZpkjh Hkfo”; fuf/k ds vUrxZr dVkSrh dh xbZ gSA


¼11½
mRrj izns’k ikoj dkjiksjs’ku fy0
isU’ku izi= ¼ Hkkx&2½
¼vfUre ns; izek.k i=½
¼lsokfuo`Rr ds mijkUr fn;k tk;sxk½


izs”kd]
      izcU/k funs’kd
      e0fo0fo0fu0fy0]
      4&,] xks[kys ekxZ] y[kuÅA       
      
      
lsok esa]
     


la[;k % ----------------------------------------------------------------------              fnukWad %
       
fo”k; %&      lEiw.kZ lsokdky dk vns;rk izek.k&i=A
egksn;]
bl dk;kZy; ds                                ds isU’ku izi= vkidks bl dk;kZy; ds i= la[;k&
-------------------------------------------------fnukad&------------------------------------- }kjk Lohd`rkFkZ vxzlkfjr fd;s x;s FksA  mijksDr vf/kdkjh }kjk lsokfuo`Rr gksus ij fnukWad &           dks dk;ZHkkj NksM+ fn;k x;k gSA
2&       mijksDr vf/kdkjh ds vfUre nl ekg dh okLrfod ifjyfC/k;ksa ds lEcU/k esa iwoZ izsf”kr lwpuk ds mijkUr dksbZ ifjorZu ughagqvk gS %&
vfUre @ vfUre nl ekg dh vkSlr ifjyfC/k;ksa dk iqujhf{kr vkx.ku  %&
ekg dk uke                     osru                 xzsM osru           ;ksx
                            
                            
3&       bl dk;kZy; ds mi;qZDr i= }kjk fnukWad&          dks mijksDr vf/kdkjh ds fo:) fuEu inksa esa muds fo:) fuEufyf[kr /kujkf’k ‘ks”k n’kkZ;h x;h Fkh %&
          1&       Hkou fuekZ.k vfxze                                                            :0   
          2&       eksVj dkj@ eksVj lkbfdy@ LdwVj@ eksisM                                  :0     
         3&      fdlh vU; izdkj dk vfxze                                                   :0  
         4&      dkjiksjs’ku vkokl ls lEcfU/kr /kujkf’k                                         :0     
         5&      vkfMV ds ifj.kke Lo:i ns; /kujkf’k                                          :0  
          6&       foHkkxh; vFkok vU; dk;Zokgh ds ifj.kke Lo:i  ns; /kujkf’k                   :0  
7&       vU; enksa ¼en Li”V dh tk;½ ds vUrxZr ns; /kujkf’k                                   :0                                                                                                        &&&&&&&&&&&&&&&&&&&                                                                                         ;ksx :0  
                                                                        &&&&&&&&&&&&&&&&&&

                                                   ¼ 12 ½

4&      mijksDr dkjiksjs’ku lsod }kjk lsokfuo`fRr ds fnukWad rd mi;qZDr lHkh /kujkf’k;ksa dk Hkqxrku dj fn;k x;k gS@ fuEu /kujkf’k;kWa ‘ks”k gSa %&
          1&       Hkou fuekZ.k vfxze                                                            :0   
          2&       eksVj dkj@ eksVj lk;fdy@ LdwVj@ eksisM                                  :0   
          3&       fdlh vU; izdkj dk vfxze                                                   :0   
          4&       ljdkjh vkokl ls lEcfU/kr ns; /kujkf’k                             :0   
          5&       vkfMV ds ifj.kke Lo:i ns; /kujkf’k                                          :0   
          6&       foHkkxh; vFkok vU; dk;Zokgh ds ifj.kke Lo:i ns; /kujkf’k           :0   
          7&       vU; enksa ¼en Li”V dh tk;½ ds vUrxZr ns; /kujkf’k                          :0   
                                                                                           &&&&&&&&&&&&&&&&
                                                                                 ;ksx :0 
                                                                                           &&&&&&&&&&&&&&&&
8&       fuEukWafdr lsok vof/k;ksa dk vns;rk izek.k&i= izkIr u gks tkus ds dkj.k cU/k i= ¼layXud&1@ layXud&2½ layXu fd;k tk jgk gS %&
                   in uke                                    dk;kZy; dk uke                          lsok vof/k
            ….                                                          …….                                          ……
9&       mijksDr dkjiksjs’ku lsod ds fo:) lsokfuo`Rr ds fnukWad dks yfEcr U;kf;d @ oSHkkfxd tkWap dh fLFkfr fuEuor~ gS %& dksbZ ugha
5&       mijksDr dkjiksjs’ku lsod dks dk;kZy; vkns’k la[;k         fnukWad       ¼ftldh izfr layXu gS½ }kjk  :0  dh vufUre isU’ku izfrekg rFkk la[;k fnukWad      }kjk :0 ‘kwU; dh /kujkf’k vufUre lsokfuo`fRk xzsP;qVh ds :Ik esa Lohd`r dh tk pqdh gSA
          vkils vuqjks/k gS fd vki mi;qZDr lsod dh lsokfuo`fRrd@ e`R;q xzsP;qVh ls mijksDr izLrj 4 esa lsokfuo`fRr @e`R;q ds    
         fnukWad dks ns; :0     dh dVkSrh djds vfUre isU’ku@ikfjokfjd isU’ku@lsokfuo`Rr@e`R;q xzsP;qVh Lohd`r djds
         v/kksgLrk{kjh dks lwfpr djus dk d”V djsaA

         Jh                   ls lEcfU/kr fuEufyf[kr vfHkys[k layXu gS %&
1& vfUre osru izek.k &i=
2& lsokfuo`fRr gkssus ij vfUre dk;ZHkkj izek.kdA
3& fnukad&               rd dk vns;rk izek.k i=½
layXud % ;FkksifjA                                             
                                                                                         Hkonh;]


                                                                                        ¼dk;kZy;k/;{k ds gLrk{kj½                                               
la[;k %       @---------------------------@----------------------------------@¼izi=½                           fnukWad %          
izfrfyfi %&      Jh fouksn dqekj ‘kekZ] K-202, Exotica Fresco sector -137 Noida (U.P.)  dks lwpukFkZ izsf”krA                                                                                                                                                                                                                               
                                                                                                 Hkonh;

                                                                                        ¼dk;kZy;k/;{k ds gLrk{kj½

¼ 13 ½
                  dkjiksjs’ku vkokl fjDrrk izek.k&i=

       izekf.kr fd;k tkrk gS fd --------------------------------------------------------------------------------------us@ds ifjokj ds lnL;ksaa us dkjiksjs’ku vkokl [kkyh dj fn;k gS rFkk rRlEcU/kh leLr ns;ksa dk Hkqxrku Hkh dj fn;k gSA
gLrk{kj dk;kZy;k/;{k
                                                                         frfFk o lhy

izk:i  & 2
dkjiksjs’ku vkokl vkoafVr rFkk v/;klu u gksus ds lEcU/k esa izek.k&i=

       izekf.kr fd;k tkrk gS fd ------------------------------------------------------------------------------------ dks dksbZ dkjiksjs’ku vkokl u rks vkoafVr fd;k x;k Fkk vkSj u gh muds }kjk v/;kflr Fkk rFkk muds fo:) bl lEcU/k esa dksbZ ns; cdk;k ugha gSA
gLrk{kj dk;kZy;k/;{k
                                                                         frfFk o lhy


lh0 ,l0 vkj0 ds vuqPNsn 531 ¼ch½ ds vUrxZr ?kks”k.kk
¼dsoy jktif=r vf/kdkfj;ksa }kjk Hkjk tkuk gS½

       eSa ?kks”k.kk djrk gwWa fd eSa lsok fuo`Rr ds mijkUr nks o”kZ rd fdlh okf.kfT;d laLFkku esa ;k Bsdsnkj ds :i esa ;k mlds deZpkjh ds :i esa dk;Zjr ugha jgwWaxk ¼tks fd lkoZtfud dk;Z ftlesa jsyos rFkk j{kk ls lEcfU/kr dk;Z Hkh lfEefyr gSa½ tc rd fd eSa mDr dk;Z djus dh m0iz0 ikoj dkjiksjs’ku fy0 ls iwoZ esa gh Lohd`fr izkIr u dj ywWaA


      ------------------------------------------------  
      ----------------------------------------------
       fnukWad --------------------------------


                                              ¼14½

(B.O. No. 1911-Pension-3/UPSEB/95/107(P)/93 dt. 11.09.95)
NOMINATION OF HEIR BY THE PENSIONER

I  ............................ holder of P.P.O.  No. ………… do hereby nominate Smt. …………………..  my wife aged …….....………………………………………….. is the person to whom My life time arrears of pension if any shall be payable in the event of my death.


                                                                                                       ---------------------------------
Dated:                                                                                   (Signature of the Pensioner)


Nomination should be made in duplicate. One copy of which will be retained in the office of the ------------------------------ (Distribution and pension Payment Authority) and the other should be sent to the concerning Deputy Chief Accounts officer for being kept  with the pensioner papers of the pensioner.








¼ 15 ½
layXud&1
      iwoZorhZ ifj”kn vkns’k la[;k&653&th@jkfoi&dk&1&102,@1978] fnukad 17-03-83 ds vuqikyu esa vfUre bdkbZ }kjk lEiw.kZ lsok vof/k dk vns;rk izek.k i= lHkh bdkb;ksaa ls eaxkuk pkfg,A  ;fn fdlh dkj.ko’k fdlh bdkbZ ls ;g izek.k i= izkIr u gks ik;s rks bl {kfriwfrZ foys[k dks Lohdkj fd;k tk;sA ijUrq fdlh Hkh n’kk esa lsokfuo`Rr ds iwoZ ds ikap o”kksZ dk vns;rk izek.k i= djuk furkUr vko’;d gSA 

buMsfefuVh ckUM@{kfriwfrZ foys[k

     ;g {kfriwfrZ foys[k fnukad-----------------------------------------------------ekg----------------------------------lu~ 20----------------------------bZ- dks Jh -------------------------------------------------------------------------------------------------------iq= Jh------------------------------------------------------------------------------fuoklh -----------------------------------------------------------------------------------¼ck/;dkjh½ }kjk mRrj izns’k ikoj dkjiksjs’ku fy0¼ftls ,rn~ i’pkr dkjiksjs’ku dgk x;k gS½ ;r%
1-     mi;qZDr ukfer ck/;dkjh dkjiksjs’ku dh lsok esa fnukad -----------------------------------------------------------------------¼in½ ij ikoj dkjiksjs’ku fy0 --------------------------------------------------------------------------------------- ¼[k.M@bdkbZ½ esa dk;Zjr gS@FkkA
2-     mi;qZDr ukfer ck/;dkjh fnukad ------------------------------------------------dks lsokfuo`Rr gksus tk jgk gS@gks x;k gSA
3-     ck/;dkjh ds fgr esa isU’ku rFkk vkuqrksf”kr vkfn dh Lohd`fr fd;s tkus ls iwoZ dkjiksjs’ku ds l{ke@ lEcfU/kr vf/kdkjh }kjk ck/;dkjh ds fgr esa vns;rk izek.k i= tkjh fd;s tkus dh vko’;rk gS] ijUrq mDr izek.k i= vHkh rd tkjh ugha fd;k tk ldk gS rFkk mlds tkjh gksus esa vfHkys[kksa dh tkap@ lafo{kk esa vHkh dqN vkSj le; yxus dh lEHkkouk gSA
4-     ck/;dkjh ds fgr esa dkjiksjs’ku isU’ku rFkk vkuqiksf”kd vkfn dh Lohd`r djus ds fy, bl ‘krZ ij rS;kj gS fd ck/;dkjh] fuEu lk{;ksa dh mifLFkfr esa ,d {kfriwfrZ foys[k fu”ikfnr djsaxs ftlls fd dkjiksjs’ku dh {kfriwfrZ gks lds rFkk rFkk lEHkkfor {kfr ls dkjiksjs’ku lqjf{kr gks lds tks fd ck/;dkjh dh lsokfuo`Rr ds fnukad vFkok bl {kfriwfrZ foys[k ds fu”iknu dh frfFk ls nks o”kksZ ds le;dky esa ck/;dkjh ds fo:) cdk;s vFkok vU; fdlh :i esa ik;h tk;sA
vr% ;g foys[k lk{k¡du djrk gS fd %&
¼1½    

¼ 16 ½
¼igpku fpUg½

uke ---------------------------------------------------------------------------------inuke --------------------------------------------------------------------------------------                             m0iz0ikoj dkjiksjs’ku fy0 ds igpku fpUg %&

                                                                  izekf.kr 
uke ---------------------------------------------------------------------------------inuke --------------------------------------------------------------------------------------                             e/;kapy fo|qr forj.k fuxe fyfeVsM ds uewuk gLrk{kj %&
1-         -----------------------------------------------------------------------------------
2-         --------------------------------------------------------------------------------
3-         ------------------------------------------------------------------------------
                                                                  izekf.kr 

uke ---------------------------------------------------------------------------------inuke --------------------------------------------------------------------------------------                             e/;kapy fo|qr forj.k fuxe fyfeVsM ds nk;s@ck;s gkFk ds vaxwBs ,oa vaxqfy;ksa ds fu’kku %&
ck;k¡ gkFk                                        nk;k¡ gkFk


                                                                  izekf.kr 



¼ 17 ½

¼ izek.k & i= ½
      izekf.kr fd;k tkrk gS fd Jh -------------------------------------------------------------inuke -------------------------------------------------------------foRrh; o”kZ ------------------------------------------------------------ls ------------------------------------------------------rd esa lkekU; Hkfo”; fuf/k [kkrk la[;k ------------------------------------------------------------- ds fy, djk;h x;h dVkSfr;ksa dk fooj.k fuEuor gS %&
Ø0la0
osru chtd ekg
Hkqxrku ekg
tek dh x;h jkf’k
1
2
3
4














                                                                                                                                                                                                                             













dqy tek /kujkf’k



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