FORM-7 Form for Assessing Pension and Gratuity [See rules 58, 60, 61(1) and (3) and 65(1)] (To be sent in duplicate if payment is desired in different circle of accounting unit) 1. Name of the Government servant ................. 2. Father's name and also husband's name in the case of a female Government servant................ 3. Date of birth (by Christian era)................... 4. Religion .................. 5. Permanent residential address showing village, town , District and State ................. 6. Present or last appointment i/c name of establishment:- (i) Substantive ................. (ii) 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 ........... (ii) 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 rendered in order of employment ..years .Months ..Days 12. Class of pension applicable.................... 13. The date of which action initiated to: (i) Obtain the "No Demand Certificate" from the Directorate of Estates as provided in rule 57.......... (ii) Assess the Government dues other than the dues relating to the allotment of Government accommodation ............ (iii) Assess the service and emoluments qualifying for pension as provided in Rule 59 ............. (iv) Assess the Government dues other than the dues relating to the allotment of Government accommodation as provided in Rule 73(1) .............. 14. Details of omission, imperfections or deficiencies ....Years....Months....Day in the Service Book which have been ignored under Rule 59 (1) (b) (ii).. 15. Total length of qualifying service (for the purpose of adding service broken periods, months reckoned as thirty days) ............. 16. Period of non- qualifying service:- (i) Interruption in service condoned under Rule 28........... (ii) Extraordinary leave non-qualifying for pension........... (iii) Period of suspension not treated as qualifying.......... (iv) Any other service not treated as qualifying service 17. Emoluments reckoning for gratuity....... .Rs....... 18 Average emoluments.......... Rs...... Detail attached separately with this Form (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 (iii) Date on which form has been obtained from the Government servant..... 20 (i) Proposed pension...........Rs.......... (ii)Proposed gratuity relief........Rs.......... 21. Proposed gratuity (DCRG).........Rs........... 22. Date from which pension is to commence............... 23. Proposed amount of provisional pension if departmental or judicial proceeding is instituted against the Government servant before retirement........... 24. Details of Government dues recoverable out of the gratuity:- (i) License fee for the allotment of Government accommodation[See sub-rule (2), (3) and (4) of Rule 72].... (ii) Dues referred to in rule 73................... 25. Whether nomination made for:- (i). Death -cum-retirement gratuity.................. (ii) Family Pension 1950, if applicable.... 26. Whether Family Pension 1964 applied to the Government Servant if so- (i) Emoluments reckoning for the Family Pension..Rs...... (ii) The amount of the Family Pension becoming payable to the family of the Government servant, if death takes place after retirement.. (a) before attaining the age of 65 years.....Rs........ (b) after attaining the age of 65 years.....Rs........ (iii) Complete and upto date details of the family members as given in Form 3: Sr. No. Name of the member of Date of birth Relationship with the the family Government servant 2 4 1 3 27. Height. ............ 28. Identification marks. ............. 29. Place of payment of pension (Treasury, Sub- Treasury or Branch of public Sector Bank of the pay and accounts office) ............ 30 Head of account to which pension and DCRG are debitable..................... ( Signature of pension) Sanctioning authority PART-II (Section-1) ACCOUNTS ENFACEMENT 1. Total period of qualifying service which has been accepted for the grant of superannuation or retiring or compensation or compulsory retirement pension and gratuity, with reasons for disallowance, if any ( other than disallowance in indicated in Part-I 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, compensation or compulsory retirement, pension or gratuity is admissible. 4. Head of Account 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. (Section-II) 1 Name of the Government servant .................... 2 Class of pension 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:- (i) if death takes place before 65 years of age ................... (ii) If death takes place after 65 years of age ................ 7 The amount of graded relief admissible on pension ............... 8. The Government dues recoverable out of gratuity before authorizing its payment. 9. The amount of cash deposit or the amount of gratuity held over for adjustment of un-assessed Government dues ............... 10. Date on which the pension papers received by the Account Officer...........
