Schedule LIII-Form No.352 (New) APPLICATION FORM FOR O.C.S.(PENSION) FORM 6 [(See rule 58 (2) and 62] PARTICULARS OF THE RETIRING GOVERNMENT SERVANT 1. Name and designation 2.(a) Date of birth(b) Date of retirement 3.Two specimen *signatures (to be furnished in a separate sheet) duly attested by a Gazetted Government servant. 4.Three** copies of passport size joint photographs with wife or husband (to be attested by the Head of Office). 5. slips showing the particulars of height and personnel identification marks duly attested by a Gazetted Government servant. 6.Present address 7.Address after retirement 8.Name of the Treasury through which the pension is to be drawn 9.Details of the family Published on National Portal of India (india.gov.in) Government of OrissaDepartment of Public Grievances & Pension Administration *Two slips each bearing the left hand thumb and finger impressions duly attested by Gazetted Government servant may be furnished by a person who is not literate enough to sign his name. If such a Government servant on account of physical disability is unable to give left hand thumb and finger impressions, he may give thumb and finger impressions of the right hand. Where a Government servant has lost both hands, he may give his impressions. Impression should be duly attested by a Gazetted Government servant. **Two copies of the passport size photograph of self only need be furnished - (i) If the Government servant is unmarried or a widower or a widows (ii) Where it is not possible for a Government servant to submit photograph with his wife or her husband, he or she may submit separate photographs. The photographs shall be attested by the Head of Office. Specify a few conspicuous marks, not less than two, if possible. Any subsequent change of address should be notified to the Head of office. Signature & Designation of the Head of Office Place Date 10. Indicate whether family pension is admissible from any other source - Military or other State Government / Government of India / or a Public Sector Undertaking / Autonomous Body / Local Fund under the State Government / Government of India or other State Government. Published on National Portal of India (india.gov.in)
