FORM 7 (Referred to Article 284-B) FORM FOR ASSESSING PENSION AND GRATUITY. PART I 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 and Nationality. 5. Permanent residential address showing Village Town/District and State. 6. Present or last-appointment including name of establishment. (i) Substantive. (ii) Officiating, if any. 7. Date of begining of service. 8. Date of ending service. 9. (i) Total period of military service for which pension/gratuity was sanctioned, if any. (ii) Amount and nature of any pension/gratuity received for the military service, if any. 10. Amount and nature of any pension/gratuity received for previous civil service, If any. 11. Government under which service has-been rendered in order of employment. 12. Details of qualifying and non-qualifying service contained in the service book/roll or history of service attached: (a) Interruption and non-qualifying service. (b) Length of qualifying service 13. Class of pension or service gratuity applied for by the Government servant and cause of application. (in case of invalid pension, medical certificate to be attached). 14. Emoluments reckoning for gratuity. 15. Average emoluments reckoning for pension. 16. Proposed Pension. 17. Proposed death-cum-retirement gratuity. 18. Proposed service gratuity, if any. 19. Date from which pension is to commence. 20. Proposed amount of the provisional pension if departmental or judicial proceeding is instituted against the Government servant before retirement. 21. Whether nomination made for (i) Death-cum-retirement gratuity (ii) Family pension 22. Whether the Government servant has paid all the Government dues. 23. Whether any reduction in pension has been made by the appointing authority, if so, enclose a copy of sanction to reduction in Form 6. 24. Complete and up to date details of family as given in Form 3 25. Height 26. Identification marks 27. Place of payment of pension/gratuity Treasury or Sub-Treasury 28. Head of Account to which pension and gratuity are debitable S.No Name of the member of the family Date of Birth Relationship with Government Servant 1 2 3 4 1. 2. 3. 4. 5. Place: Dated the ________________________ Signature of Head of Office. PART II 1. Interruption(s) From To 2. Extraordinary leave not qualifying for pension. 3. Period of suspension not treated as qualifying 4. Any other service not treated as qualifying Total PART III AUDIT ENFACEMENT. 1.Total period, of qualifying service which has been accepted for the grant of superannuation/retiring invalid/compensation/compulsory retirement pension gratuity with reasons for-disallowance if any (other than disallowance indicated in Part II of this Form). 2. Amount of superannuation/retiring/invalid/compensation/compulsory retirement pension/gratuity that has been admitted. 3. Amount of superannuation/retiring invalid/compensation/compulsory retirement pension/gratuity admissible after taking into account reduction if any in pension and gratuity made by the pension sanctioning authority. 4. The date from which superannuation/retiring/invalid/compensation/ compulsory retirement pension/gratuity is admissible. 5. Head of Account of which superannuation/retiring/invalid/ compensation/compulsory retirement pension and additional pension/gratuity is chargeable. 6. The amount of family pension becoming payable to the entitled members of the family in the event of death of the Government servant after retirement Section II I. Name of the Government servant. 2. Class of pension or gratuity. 3. Amount of pension sanctioned. 4. Amount of gratuity sanctioned. 5. Date of commencement of pension. 6. Amount of family pension admissible in the event of the death of the Government servant after retirement. 7. Amount recoverable from gratuity. 8. The amount of cash deposit or the amount of gratuity held over for adjustment of unassessed Government dues. Accounts Officer, Accountant General's Office.
