Download Pension Nomination Form

FORM -5 (See Rule 7) To, Head of Office (Place) ....................................... I, .................................................. hereby nominate the person named below, under (Name of the pensioner in capital letters) Rule 7 of the Rajasthan Civil Services (Commutation of Pension) Rules, 1996. Name and address of Relationship with the If nominee is minor the nominee pensioner Date of birth Name and address of person who may receive the said commuted value during the nominee's minority 1 2 3 4 Name and address of other nominee in case the nominee under column (1) predeceases the pensioner 5 Relationship with pensioner 6 Date of birth if the other nominee is minor 7 Name and address of person who may receive the commuted value of pension during the other nominee's minority 8 Contingency on happening of which nomination shall become invalid 9 Place........................................ Signature (or thumb­impr ess ion if illiterate) Date......................................... and name of Pensioner. Witness : Signature : Address : Name & Address : Signature of Head of Offi ce STAMP Acknowledgement to be sent by the Head of Office Certified that the nomination has been received from ...................................... (Name of Pensioner) whose address is................................................ Place :................................. Date :................................. Signature of Head of Office