FORM 2 Form for assessing Pension and Gratuity (To be sent in duplicate if payment is desired in a different circle of accounting unit) PART-1 1. Name of the Government servant 2. Father's name (and also husband's name in case of female Government servant) 3. Date of birth (by Christian era) 4. Religion 5. Permanent residential address, showing Village, Town, Street, Lane, Pin code, Police Station, District and State 6. Present or last appointment including Name of establishment and Department (i) Substantive (ii) Officiating, if any 7. Date of beginning of service 8. Date of ending of service 9. (a) Total period of Military service, of any (b) Date of commencement and each period of Military service (c) Amount and nature of any pension/ gratuity received for the military service 10.Amount and nature of any pension/gratuity received for previous civil service 11.Government under which service has been Year Month Days rendered in order of employment 12.Class of pension applicable 13.The date on which action initiated to (i) Obtain the 'No demand certificate' from the Estate Officer/Executive Engineer, P.W.D. etc (ii) assess the service and emoluments qualifying for pension and (iii) assess the Government dues other than the dues relating to the allotment of Government accommodation 14. Details of omission, imperfections or deficiencies in the service book which have been ignored 15. Total length of qualifying service for the purpose of adding towards broken periods, a month is reckoned as thirty days 16. Periods of non-qualifying service (Any reference to be mentioned) (i) Interruption in service condoned (ii) Extra-ordinary leave not qualifying for pension (iii) Period of suspension not treated as qualifying service (iv) Any other service not treated as qualifying service Total non-qualifying service period 17.Emoluments reckoning for gratuity 18. Average emoluments for calculation of pension *Emoluments drawn during the last ten months of service Post held From To Pay Personal Pay/Special Pay Average Emoluments * (i) In a case where the last ten months include some period not to be reckoned for calculating average emoluments an equal period backward has to be taken for calculating average emoluments. (ii) The calculation of average emoluments should be based on actual number of days contained in each month. 19. Date on which Form-1 has been obtained from the Government servant (to be obtained eight months before the date of retirement of Government servant) 20. (i) Proposed pension (ii) Proposed relief, on pension 21. Proposed gratuity/death-cum-retirement gratuity 22. Date from which pension is to commence 23. Proposed amount of Provisional Pension (if Departmental or Judicial proceedings were instituted against the Government servant before retirement) 24. Details of Government dues recoverable out of gratuity : (i) Licence fee/rent for allotment of Government Accommodation (ii) Other dues, if any 25. Whether nomination made for (i) Death-cum-retirement gratuity 26. Whether Family Pension Rules, 1964 are applicable to the Government servants and if so : (i) Pay reckoning for the family pension (ii) The amount of the family pension becoming payable to the family of the Government servant, if death takes place after retirement (iii) Complete and up-to-date details of family as given in Form1-A Sl.no. Name of the member of Date of birth Relationship the family with the Government servant 27. Height 28. Identification marks 29. Place of payment of pension (Treasury, Sub-Treasury or Branch of Public sector bank) 30. Head of Account to which pension and gratuity are debitable Signature Date PART-II SECTION ACCOUNT ENFACEMENT 1. Total period of qualifying service, which has been accepted for the grant of superannuation of retiring or invalid or compensation or compulsory retirement pension and gratuity, with reasons for disallowances; if any,(other than disallowances indicate Part-1 of this Form) 2. Amount of superannuation or retiring or invalid or compensation or compulsory retirement pension or gratuity that has been admitted 3. The date from which superannuation or retiring or invalid or compensation or compulsory retirement pension or gratuity is admissible 4. Head of Account to which superannuation or retiring or invalid or compensation or compulsory retirement pension or gratuity is chargeable 5. The amount of the family pension 1964 becoming payable to the entitled members of the family in the event of death of the Government Servant after retirement Designation (Head of Office) SECTION-II 1. Name of the Government Servant 2. Class of pensions or gratuity 3. Amount of pension authorized 4. Amount of gratuity authorized 5. Date of commencement of pension 6. Amount of family pension in the event of death after retirement 7. The amount of retire admissible on pension 8. The Government dues recoverable out of the gratuity before authorizing its payment 9. The amount of cash deposit or the amount of gratuity held over for adjustment of unassessed Government dues 10.Date on which the pension papers received by The Accounts Officer Accountant General Assam
