JOINT NOTIFICATION OF FAMILY PENSION

DOCUMENTS REQUIRED FOR - POST-86 RETIREE

FOR ENDORSEMENT OF WIFE DETAILS IN CORRIGENDUM PPO

(All documents are to be forwarded to NAVPEN through Zilla Sainik Board)

1. For Endorsement of Wife’s Name of ESM.

SL DOCUMENTS REQUIRED

(a)

Appendix I form (All Columns i.e. Sl. 1 to 17 including Witness Signatures and

Part II pertaining to the PDA (Pension Disbursing Authority) Treasury / Bank, as

the case may be, to be completed)

(b) Original Self Declaration Affidavit attested by 1st Class Judicial Magistrate/Notary

stating correct name, date of birth and date of marriage of your wife

(c) Marriage Certificate issued by registrar.

(d) Details of your PDA (i.e. Bank/DPDO/Treasury Office) with full postal address.

(e) Attested Copy of Aadhaar and PAN Card of your wife.

In Case of Endorsement of 2nd Wife name: -

SL DOCUMENTS REQUIRED

(a)

Appendix I form (All Columns i.e. Sl. 1 to 17 including Witness Signatures and

Part II pertaining to the PDA (Pension Disbursing Authority) Treasury / Bank, as

the case may be, to be completed.) in Triplicate.

(b) Original Self Declaration Affidavit attested by 1st Class Judicial Magistrate/Notary

stating correct name, date of birth and date of marriage of your 2nd wife.

(c) Death Certificate/ Divorce Decree of 1st wife.

(d) Marriage Certificate of 2nd wife issued by registrar.

(e) Original Affidavit having details of children from 1st wife.

(f) Birth certificates of children from 1st wife

(g) Pension Disbursing Authority (i.e. Bank/ DPDO/Treasury Office) with full postal

address.

(h) Attested Copy of Aadhaar and PAN Card of 2nd wife.

2. For Change/ Correction of Wife’s Name of ESM (Pre-86/ Post-86 Retiree)

SL DOCUMENTS REQUIRED

(a)

Self-Declaration Original Affidavit attested by 1st Class Judicial

Magistrate/Notary for change/correction of name, mentioning correct Date of

Birth and Date of Marriage

(b) Two nationalised newspaper cutting publishing correct name (English/Local).

(c) Correct name published in state Gazette Notification/Govt. of India notification

(d) PDA (Pension Disbursing Authority) Details (i.e. Bank/DPDO/Treasury Office)

with full postal address.

(e) Attested Copy of Aadhaar and PAN Card of your wife

(f) Copy of Discharge Book/IN-271.

3. For Change/ Correction of Wife’s DOB of ESM (Pre-86/ Post-86 Retiree)

SL DOCUMENTS REQUIRED

(a)

Self Declaration Original Affidavit attested by 1st Class Judicial

Magistrate/Notary for change/correction of name, mentioning correct Date

of Birth and Date of Marriage.

(b) PDA (Pension Disbursing Authority) Details (i.e. Bank/DPDO/Treasury office)

with full postal address

(c) Attested Copy of Aadhaar and PAN Card of your wife

(d) Copy of Discharge Book/IN-271.

APPENDIX – A (To be submitted in Triplicate)

To,

The ______________________

__________________________

__________________________

__________________________

{Service Hqrs/ Record Office}

Subject :- Endorsement of family pension entitlement in the Pension Payment

Order of living Armed Forces Pensioners.

Sir,

With reference to Ministry of Defence letter N0. 1 (11)/2014-D (Pen/Pol) dated

………….…......... I hereby apply for endorsement of family pension in the PPO.

The requisite particulars are given below : -

(1) Name of Pensioner ……………………………………………….........

(2) Present Address ……………………………………………..

……………………………………………..

(3) Regt. No/ IC No. ……………………………………………..

(4) TS/PS N0. …………………………………………. …

(5) (i) Rank last held ……………………………………………..

(ii) Rank for pension ……………………………………………..

(6) Date for retirement/ discharge ……………………………………………..

(7) Name of Record Office ……………………………………………...

(in the case of Personnel Below Officer Rank)

(8) Original PC/PPO No. & year ……………………………………………...

(in case of pension circular(PC) quote Pension Circular No. Part and

Descriptive Sl No.) ……………………....................................

(9) Details of Family Pension from other sources ………………………………………..

(10) Name of handicapped children, if any ……………………………………………….

(11) Particulars of pension Disbursing Authority :-

(a) Station ……………………………………………...

(b) Treasury/DPDO/PAO/BANK/Post Office ……………………………………...

(c) SB A/c No . …………………………………………...

(d) Bank Branch with full address and …………………………………………….

……………………………………………...

(12) Particulars of pay last drawn at the time of retirement ………………………………

(13) E-mail ID ……………………………………………...

(14) Aadhaar No. ……………………………………………...

(15) Mobile No. ……………………………………………...

Joint Photograph of husband and

wife (attested)

(16) Details of family, eligible for family pension in terms of Pension Regulation.

Sl Name(s) and address of members of family

Relation-ship with

the pensioner

Date of marriage

Aadhar No. Marital

Status

Date of Birth

(17) Attested joint photograph of Smt/Shri___________________________________

is pasted above (Attestation can be done by any Gazetted officer, pension Disbursing Officer

such as Manager of the Bank, Record Officer, Village Sarpanch, SDM, Block Development

Officer, MLA/MLC etc.)

(18) (a) Signature or thumb impression of Spouse

(b) Marks of Identification __________________________________________

Signature or left hand thumb Impression of the pensioner

(in case of female right hand thumb Impression)

Name, address & signature of witnesses :-

Name Full Address Signature

Part (II) The particulars furnished above have been verified from available records. Column No. Column not to be verified at your end. Signature of PDA (With Office Stamp)

Part – (III) The particulars furnished above have been verified with reference to Service records. Station Signature of RO Service Headquarters

Part – (IV) Ordinary family pension @ …………………………. p.m. sanctioned vide PCDA (P) Corr. PPO No. …………………………… ………….dated ………………….. . Signature of AO/RO

(To be filled in Duplicate) FINAL KINDERED ROLL FORM (No further amendments will be accepted) Ex- Name ____________________________________________ Rank ___________________ No. _______________ Mobile No_______________________ Aadhaar No. _________________________ (Attach photo copy) Email. ID _____________________________ Note: (a) Particulars of all living/dependent relatives shown in column of the form should be filled in. A fresh form is to be prepared whenever any changes in the particulars already submitted occurs as Marriage, Divorce, Births and Deaths. Copy of Documentary proof for name, date of birth and marriage. e.g. Birth Certificate / PAN Card /Aadhaar Card / Passport / Voter ID/Passport to be attached. Otherwise the form will be considered null and void. (b) This Kindred Roll will be considered as the Final Kindred Roll before retirement and details mentioned in this will be used for verification of Pension / ECHS and all other Release Formalities. (c) The form is to be prepared in duplicate, ink signed with the date by the claimant and countersigned by Zilla Sainik Welfare Officer. The form is to be sent along with the Pension forms and audited SDs to the LOIC, NAVPEN / Pension Section along with all documents mentioned at Para (a). Relationship Name Date of

Birth Aadhaar Card No

(Attach photo copy)

Residence Address Village, Post Office, Tehsil,

District & Pin code)

Name of heir estate name of persons to whom estate should

be made over on behalf of heir.

Percentage (%)

Wife

1.

Father

Mother Son/ Daughter

1 2.

2 Brother /Sister

1

2 Date & Form of Marriage

COUNTERSIGNED Record Office Sign Claimant's Sig. _____________________ (NAVPEN) Name ____________________________ Rank _____________________________ Service No. ________________________ (Zilla Sainik Welfare Officer) Date _____________________________ Dated : _______________ Date: - _________