2. Father's name (and also husband's name in the case of female Government servant). 9. Rs. /- 10. Published on National Portal of India (india.gov.in) Government of Orissa Public Grievances & Pension Administration O.C.S.(PENSION) FORM 7 PARTICULARS FOR PREPARATING PENSION PAPERS [(See rule 58 (1) & 61, 62(1), 62(2)(I) AND 64] Schedule LIII-Form No.353 (New) (To be sent in duplicate if payment is desired in a different circle of accounting unit) PART-I 1. Name of the Government Servant Date of birth (by Christian era) 3. 4. Religion 5. Permanent Address Present or last appointment including name of establishment 6. 7. Class of Pension applicable (i) Total period of Military Service for which pension or gratuity was sanctioned. 8. From To (ii) Amount and nature of any pension/gratuity received for the Military Services. Rs. /- Amount and nature of any pension/gratuity received for previous civil service. Government under which service has been renedered in order of employment. Date of beginning of service 11. Date of ending of service 12. 13. Length of gross services (12-11) Periods of non-qualifying service (i+ii+iii+iv) 14. Interruption in service condoned. (i) (ii) Extraordinary leave not qualifying for pension. (iii) Period of suspension not treated as qualifying service. (iv) Any other service not treated on qualifying service. 15. Addition to qualifying service under rules 32, 41, 42. 16. Total qualifying service.(13 + 15 - 14) Emoluments in terms of rule 48. /- Rs. 17. (i) Proposed amount of Pension/service gratuity. Rs. /- 18. (ii) Amount of Provisional Pension sanctioned from. Rs. /- (i) Proposed amount of retirement gratuity. 19. Rs. /- (ii) Amount of Gratuity sanctioned previously, if any. Rs. /- 20. Proposed amount of family pension. Rs. (i)Before attaining 65 years. /- (ii) After attaining 65 years. Rs. /- Outstanding Government dues for recovery from gratuity 21. i.Licence fee for Government accommodation. Rs. /- ii.Balance of house building,conveyance or other advance with interest. Rs. Rs. /- /- iii. Over payment of pay and allowances including leave study. /- Rs. Rs. /- iv. Any other assessed dues and the nature thereof. Rs. /- Published on National Portal of India (india.gov.in) 22. Amount held from gratuity pending assessment of any of the above Government dues. Rs. /- 23. Date from which pension is to commence. 24. Place of payment (name of Treasury/Special Treasury/Sub-Treasury) 25. Head of account to which pension and gratuity are debitable. Signature of the Head of Office with designation PART II Sanction is hereby accorded in favour of Shri/Smt./Kumari (Name with designation) in the Department/Office for payment of pension/service gratuity/and in the event of death, family pension as admissible under rules. The amount of outstanding Government dues and the amount withheld as suggested in Part-I of this form shall be taken into account before authorizing pensionary benefits by the Accountant-General, Orissa. Signature of the Pension Sanctioning Authority and designation. Published on National Portal of India (india.gov.in) PART-III [ACCOUNT ENFACEMENT BY THE ACCOUNTANT GENERAL, ORISSA] Name of Government Servant. 1. 2. Class of Pension Gross Service Admitted 3. Admitted non-qualifying Service 4. Admitted qualifying Service 5. Addition to qualifying service 6. Rs. /- 7. Rs. /- Admitted amount of retirement gratuity 8. Admitted amount of family pension. 9. Before attaining 65 years Rs. /- (i) Rs. After attaining 65 years /- (ii) Amount of outstanding Government dues recovered from gratuity. Rs. /- Rs. /- Date of commencement of pension. 12. 13. Head of account to which pensionary benefits are debitable. Accounts Officer Published on National Portal of India (india.gov.in) Admitted amount of pension/service gratuity 10. Amount withheld from gratuity pending assessment of Government dues. 11.
