FORM - I (See Clause 6) Application for Pension Benefits to the Journalists and Families ameapant nat ateoWiapat atnal Wheapstantienat atatmu ive ivets hNic lp(e icDlp dhuuc ffrooohtPer ityPntrese o hteerfP htio DiesgND(N : and hte fo n io : h&Aeoeapant ic lp fht g itr B f 2 )ihtrBfoe : 3 : 4 by er ybyBho ritr / nc e deires be ic fCiter fU.Tntnunc ouse. idRiees oCo ) hde : es dr d A5 : : manent : : : : : : o reseis ghta r epnt neet n deameies Ns 'htoer Pierodr FM dofrncei 8 ades at hidtorze iewsppouse lhhto f io hwolre N(N ameoeseo m famiypnssau atn t ame ofte Nap anthas / s Jour/er nal )ide fispec be:lde i fhtein n io fShitttoryo ) iirgy Agehe/iervceJourbe oe/er Newsp atapnalncauat dinal acno hteby ids ue Jouriifhttcyoe nAgekdwore Pidero ncyinal ic lp hichw hteap Ns 'her ame htngfic Le(Citer : erveic lployee h e hteel it fu Whrteapantsdasa memp 6 7 9 1. 11. at ac : Whrtanting eapsranynsn/noarntalateGnmentndany mefyasefniht Whrtantial eapsPandapuf ngncabedasnabetoprpes ntoni-hrify cialfany atneapauat dinal acno he yfes, hee lyf e ) Whrtapantr (iceiieceviauerurshiyscierursue c ouI.iirgideceve itrerefmtroany,fyl,paseselfhttesoe lespe,lrnihtanddaintamoicI icIshelpiclpicHoicoame lpmal s(atesis) lpoverlespe,lpht,ut) lsioiseewspbehehsourceepdisourte lhIhdpe /.lTitehteePeStrls hteeicfrol hitttoryohteehseftandfamiantncmeoeapbof teoroeDnuarfankahoarhWhtanteerapdrehs hscedaiteurhitehcrooReveCeHiforfursIfrobrfur Ac dJnalt(fyasnihtedai from 16. DECLARATION I, ........................Hereby solemnly affirm and declare that the particulars furnished above are true and I have not suppressed any materialfactthatwilldisentitle me to grantof Pension Benefits. Signature of the A pplicant Place : D ate : . : : from or u /esan on io al icdeM hte : ids ue e ic fCiter ment htoer and atmonearybne,I fits fe ituytGr . meremp loyer : d hlou ic fCiter an rom aid f ne heleo mentnotbw t : an is hte asni () atentmehs furficCiterfitorere/ eRteporlpe nalnc y Age/ Jour/er ateDby FORM - II [See Clause 6(c)] SERVICE CERTIFICATE (Tobeissued bytheEmployer) Certified that Thiru/Tmt/Selvi................... . S/o,W /o,D/o ......................has worked from ....... to .......... as Full Time Editor / Sub-Editor / Reporter/ Correspondent of the Newspaper/Journal/Agency viz., .............. registered with the Registrar of Newspapers for India,Ministry of Information and Broadcasting, GovernmentofIndia,New DelhivideNo........................... Place : S ignature : Date : Name : D esignation : FORM - III [See Clause 7(1)] VERIFICATION CERTIFICATE (Tobeverified andCertifiedbytheAssistantDirector, Directorate of Inform ation and Publicity) Certified thattheapplicationofThiru/Tmt................... . S/o, W /o, D/o ................................ for providing Pension Benefits to the Journalists of Union Territory of Pondicherry has been scrutinized and the particulars furnished by him /her therein are found to be correct. Place: S ignature : Date : Name : D esignation : FORM - IV [See Clause 7(2)] GOVERNMENTOF PUDUCHERRY DIRECTORATEOF INFORMATIONANDPUBLICITY -oooOooo- N o. DIP/PRESS/ /200 Puducherry,dated ORDER Sub: DIP-PaymentofPensionundertheschemefor grantof Pension Benefitsto Journalistsand theirfamilies,2006-Sanctionconveyed -Reg. Ref: His/Herapplicationdated............. -oooO ooo- In pursuance of Clause 7(2) of the schem e for grant of Pension Benefits to Journalists and to their families in the Union Territory of Puducherry ,2006 sanction of the Selection Committee is hereby conveyed for payment of Rs. 2,000/-(Rupees two thousand only) per month to Thiru / Tmt / Selvi.......................with effectfrom .............. ThePensionNumberallotted tohim/heris............. DIRECTOROFINFORMATION ANDPUBLICITY To Thiru/Tmt/Selvi.............. . ........................... .......................... .
