Full Text
REGD. No. D. L.-33004/99
The Gazette of India
CG-DL-E-16072024-255464
EXTRAORDINARY
PART II—Section 3—Sub-section (i)
PUBLISHED BY AUTHORITY
No. 373]
NEW DELHI, TUESDAY, JULY 16, 2024/ASHADHA 25, 1946
MINISTRY OF PERSONNEL, PUBLIC GRIEVANCES AND PENSIONS
(Department of Pension and Pensioners' Welfare)
NOTIFICATION
New Delhi, the 16th July, 2024
G.S.R. 410(E).—In exercise of the powers conferred by the proviso to article 309, and clause (5) of article
148 of the Constitution and after consultation with the Comptroller and Auditor- General of India in relation to
persons serving in the Indian Audit and Accounts Department, the President hereby makes the following rules further
to amend the Central Civil Services (Pension) Rules, 2021, namely: -
1. Short title and commencement.-(1) These rules may be called the Central Civil Services (Pension)
Amendment Rules, 2024.
(2) They shall come into force after one hundred twenty days from the date of their publication in the Official
Gazette.
2. In the Central Civil Services (Pension) Rules, 2021, (hereinafter called the said rules), in rule 50, in sub-rule
(15), for clause (e), the following clause shall be substituted, namely:-
“(e) The Government servant shall submit the up to date details of the family again in Form 6-A at the time of
retirement from Government service.".
3. In the said rules, in rule 53,-
(a) for sub-rule (1), the following sub-rule shall be substituted, namely:-
"(1) Unless otherwise exempted by a general or special order of the Government, the pension case of a
Government servant shall be processed through online mode (Bhavishya/e-HRMS) and the retiring
officials, who are on e-HRMS, shall submit Form 6-A through e-HRMS (only superannuation cases).
Retiring Government servants, who are not on e-HRMS and for cases other than superannuation (i.e.
Voluntary retirement, Premature retirement, Permanent absorption in State Government/Public Sector
Undertaking/Autonomous Body, Invalidation, Compulsory retirement and Dismissal/Removal from
service), shall submit Form 6-A through Bhavishya.";
(b) in sub-rule (2), in clauses (a) and (b), for "Bhavishya", the following shall be substituted, namely:-
“online mode (Bhavishya/e-HRMS)”.
4. In the said rules, in rule 57, -
(a) in sub-rule (1), in clause (c) for sub-clause (iii), the following sub-clause shall be substituted,
namely:-
"(iii) advise the retiring Government servant to submit Form 6-A";
(b) in sub-rule (2), for clause (a), the following clauses hall be substituted, namely:-
"(a) The Government servant shall submit duly completed Form 6-A to the Head of the
Office, not later than six months prior to his date of retirement.";
(c) in sub-rule (3), in clauses (a) and (b), for "Form 4 and Form 6", shall respectively be substituted
"Form 6-A";
(d) for the proviso, the following proviso shall be substituted, namely:-
"Provided that where the said form is submitted by the spouse or any other member of the
family, the Government servant shall not be entitled to the benefit of commutation of a
percentage of pension until he himself subsequently applies for such commutation in
accordance with the Central Civil Services (Commutation of Pension) Rules, 1981."
5. In the said rules, in rule 58, -
(a) for sub-rule (1), the following sub-rule shall be substituted, namely:-
"(1) A Government servant, who is retiring or has retired for reasons other than
superannuation, shall submit Form 6-A to the Head of Office, immediately after the
competent authority has approved such retirement or the retirement has become effective,
as the case may be.";
(b) in sub-rule (2), in clauses (a) and (b), for "Form 4 and Form 6", "Form 6-A" shall respectively
be substituted.
(c) for the proviso, the following proviso shall be substituted, namely:-
"Provided that where the said form is submitted by the spouse or any other member of the
family, the Government servant shall not be entitled to the benefit of commutation of
pension until he himself subsequently applies for such commutation in accordance with
the Central Civil Services (Commutation of Pension) Rules, 1981."
6. In the said rules, in rule 59, -
(a) in sub-rule (1), for "Form 4 and Form 6", "Form 6-A” shall respectively be substituted;
(b) in sub-rule (2), for "rule 58 have", "rule 58 has" shall be substituted.
7. In the said rules, in rule 60, -
(a) in sub-rule (1), in clause (i), for "copies of Form 4, Form 6 and an undertaking to the Bank in
Format 9", "Form 6-A" shall be substituted;
(b) in sub-rule (3), for "a copy of each of the Forms", "copies of Form and Format" shall be
substituted;
(c) in sub-rule (4), for "Form 4 and Form 6", "Form 6-A" shall be substituted.
8. In the said rules, in rule 62, in sub-rule (6), in clause (a) for "Form 4 and Form 6", "Form 6-A" shall be
substituted.
9. In the said rules, in rule 63, in sub-rule (4), in clauses (a) and (b), for "Format 9", "Form 6-A" shall be
substituted.
10. In the said rules, in rule 80, in sub-rule (5),
(i) for the proviso, the following proviso shall be substituted, namely:-
"Provided that if there is no member of the family eligible to receive family pension on death of Government
servant, a member of the family in whose favour a nomination was made by the Government servant for
payment of gratuity, shall be allowed to submit Form 6-A in place of Form 10 and the said member of the
family shall indicate, the details of his or her Bank Account in Form 6-A.";
(ii) for clause (c), the following clause shall be substituted, namely:-
"(c) The Head of Office shall send Form 4, Form 10, Format 9 and Format 13 (if applicable) or Form 6-
A, as the case may be, with Form 7 and a forwarding letter in Format 10, to the Accounts Officer for
authorisation of pension, retirement gratuity and family pension, if applicable.";
11. In the said rules, in Form 4, in para 1, for “along with Form 6”, “in Form 6-A” shall be substituted.
12. In the said rules, for "Form 6", "Form 6-A" shall be substituted.
13. In the said rules, in Form 7, under the sub-heading “ FORM – 7 CHECK LIST FOR HEAD OF OFFICE FOR
TIMELY PROCESSING OF RETIREMENT DUES", item 9 and item 10 shall be omitted.
14. In the said rules, in Format 10, under the sub-heading “Enclosures",-
(a) for item 2, the following item clause shall be substituted, namely:-
"2. Form 6-A or Form 10"
(b) for item 3, the following item clause shall be substituted, namely:-
"3. In case of Form 10, details of family in Form 4 and undertaking to the Bank in Format 9”
(c) for item 4, the following item clause shall be substituted, namely:-
"4. Form 7 or Form 11 duly completed, along with enclosures and checklists."
[F. No. 55/13/2023-P&PW(C)]
DHRUBAJYOTI SENGUPTA, Jt. Secy.
Form 6-A
[See rules 50, 53, 57, 58, 59, 60, 62, 63 and 80]
A. Particulars to be obtained by the Head of Office from the retiring/retired Government Servant
Photograph(s)
2.5cm x 3.5cm
1. Detail of Government servant:
+-------------------------+-----------------------------------+
| Name | Designation/ Rank |
+-------------------------+-----------------------------------+
| Date of birth | Date of retirement |
+-------------------------+-----------------------------------+
| Ministry/Department/Office| PAN No. |
+-------------------------+-----------------------------------+
| Aadhaar No | Nationality |
+-------------------------+-----------------------------------+
2. Address after retirement for future correspondence:
+-------------------------+-----------------------------------+
| Flat/House No./Bldg. Name | Street/Locality |
+-------------------------+-----------------------------------+
| Village & Post Office/Block | City &District |
+-------------------------+-----------------------------------+
| State | Pin Code |
+-------------------------+-----------------------------------+
| Mobile No | Telephone No.(If any) |
+-------------------------+-----------------------------------+
| E-mail ID | Alternate E-mail ID |
+-------------------------+-----------------------------------+
3. Details of Bank through which Pension is to be drawn:
+-------------------------+---------------------+-----------+
| Type of A/c | Single/ Joint with Spouse | A/c No. |
+-------------------------+---------------------+-----------+
| Bank's Name | Branch Address |
+-------------------------+---------------------------------+
| IFSC | |
+-------------------------+---------------------------------+
Note 1: Please attach a copy of the first page of passbook/cancelled cheque/document showing the name of Account
Holder. (The name should be the same in the bank account, this form and the office records.)
Note 2: Please ensure that the Government servant is the Primary Account holder in the Joint Account
Note 3: In case Head of Office is satisfied that it is not possible for the retiring Government servant to open a joint
account for reasons beyond his / her control, this requirement may be relaxed.
4. Details of member of the family of Government servant who has been authorized under Rule 57(3) to
submit this Form on behalf of the retiring/retired Government servant (if applicable):
+-------------------------+-----------------------------------+
| Name | Relationship with the |
| | Government servant |
+-------------------------+-----------------------------------+
| Aadhaar No. | Nationality |
+-------------------------+-----------------------------------+
| Flat/House No./Bldg. Name | Street/Locality |
+-------------------------+-----------------------------------+
| Village & Post Office/Block | City &District |
+-------------------------+-----------------------------------+
| State | Pin Code |
+-------------------------+-----------------------------------+
| Mobile No. | Telephone No.(If any) |
+-------------------------+-----------------------------------+
| E-mail ID | Reason(s) for non- |
| | submission of form by |
| | government servant |
+-------------------------+-----------------------------------+
5. I desire to commute % (in words) of my pension under Central Civil Services (Pension) Rules, 2021
in accordance with the provisions of the Central Civil Services (Commutation of Pension) Rules, 1981.
Note: A member of family who has been authorised under Rule 57(3) to submit this Form on behalf of the
retiring/retired Government servant shall not be eligible to apply for commutation of pension.
6. Indicate whether family pension is also admissible from any other source - Military or State Government or Public
sector undertaking/ autonomous body/ local fund under the Central or State Govt: Yes/No
7. Whether any departmental or judicial proceedings pending against the Government servant? If so, the details
thereof:
8. Whether the Government servant wants to receive Pension Payment Order (PPO) in Office through Head of
Office?: Yes/No
Declarations
(Tick the statement which is applicable)
(1) I am satisfied with the length of qualifying service to be reckoned for pension and gratuity, as intimated by the
Head of Office under Rule 57(1)(c)
OR
I am not satisfied with the length of qualifying service to be reckoned for pension and gratuity, as intimated by the
Head of Office under Rule 57(1)(c) and I have submitted a representation in this respect separately.
OR
I have not been intimated about the length of qualifying service to be reckoned for pension and gratuity.
(2) I am satisfied with the emoluments and average emoluments to be reckoned for pension and gratuity, as intimated
by the Head of Office under Rule 57(1)(c).
OR
I am not satisfied with the emoluments and average emoluments to be reckoned for pension and gratuity, as intimated
by the Head of Office under Rule 57(1)(c) and I have submitted a representation in this respect separately.
OR
I have not been intimated about the emoluments and average emoluments to be reckoned for pension and gratuity.
(3) I am aware that future good conduct of the pensioner/family pensioner shall be an implied condition for every
grant of pension/family pension and its continuance.
Enclosures: As per list attached
Note 1: Commutation of pension is optional. Item 5 may be struck off if the retiring Government servant does not
desire to commute pension.
Note 2: A separate application for commutation of superannuation pension in Form 1-A of Central Civil Services
(Commutation of Pension) Rules, 1981 is required to be submitted in case the retiring/retired Government servant
desires to apply for commutation of pension after submission of this form.
Note 3: Commutation of pension after one year or for commutation of pension in case of compulsory
retirementpension/invalidpension/compassionate allowance will be applied in Form-2 of Central Civil Services
(Commutation of Pension) Rules, 1981.
Note 4: Aadhaar Number. if provided, consent to link it to bank account and also for authentication of identity from
UIDAI for pension related purpose only, is presumed.
B.I Details of Family Members
[See rules 50 (15), 57, 58, 59, 60, 62 and 80]
1. The details of all members of family (whether eligible for family pension or not, who are alive as on date)
including spouse, all children, parents/parents in law and disabled siblings (brothers and sisters) may be given.
2. The fact regarding disability or change of marital status of a family member should also be indicated in the
'Remarks' column.
3. Wife and husband shall include judicially separated wife and husband.
+-----+---------------------+---------------+----------+-----------------------+----------+---------+
| S.N.| Name | Date of Birth | Aadhaar | Relationship with | Marital | Remarks |
| | | (DD/MM/YYYY) | No. | Govt. Servant | Status | |
+=====+=====================+===============+==========+=======================+==========+=========+
| 1 | | | | | | |
+-----+---------------------+---------------+----------+-----------------------+----------+---------+
| 2 | | | | | | |
+-----+---------------------+---------------+----------+-----------------------+----------+---------+
| 3 | | | | | | |
+-----+---------------------+---------------+----------+-----------------------+----------+---------+
| 4 | | | | | | |
+-----+---------------------+---------------+----------+-----------------------+----------+---------+
| 5 | | | | | | |
+-----+---------------------+---------------+----------+-----------------------+----------+---------+
| 6 | | | | | | |
+-----+---------------------+---------------+----------+-----------------------+----------+---------+
| 7 | | | | | | |
+-----+---------------------+---------------+----------+-----------------------+----------+---------+
| 8 | | | | | | |
+-----+---------------------+---------------+----------+-----------------------+----------+---------+
Note:
(i) In case of new addition of name, not included in service book, proof of date of birth is to be submitted.
(ii) In the case, Form 6-A is being submitted by any person other than Government servant and spouse, the family
member details already submitted by the Government servant shall be added in the details and no change in the family
member details shall be allowed.
B.II Whether any member of the family (other than spouse), as above, is proposed to be co- authorized for family
pension i.e permanently disabled child/Dependent Parents/Permanently disabled siblings [Rule 63(1) and 79(2)]:
Yes/No
If yes, the details regarding co-authorised family member (s) may be given as under:
+---------------------------------------+-------------+-------------+-------------+
| Name of the family members to be co | | | |
| authorized | | | |
+---------------------------------------+-------------+-------------+-------------+
| Photograph | | | |
+---------------------------------------+-------------+-------------+-------------+
+-----+-------------+-------+------------------+--------------+------------+---------+---------+------------+----------+
| S.N.| Name of the | PAN | Signature/ | Personal | Details of | Address | Tel/Mob | Details of | Branch |
| | family | | left hand | mark of | pension/ | | No. and | Bank | Address |
| | member | | thumb | identification | family | | email ID| Account | (If Bank |
| | co- | | impression | | pension | | | (optional) | Account |
| | authorised | | | | from other | | | | details |
| | | | | | sources (if| | | | are given)|
| | | | | | any) | | | | |
+=====+=============+=======+==================+==============+============+=========+=========+============+==========+
| 1 | | | | | | | | A/c No- | |
| | | | | | | | | IFSC- | |
+-----+-------------+-------+------------------+--------------+------------+---------+---------+------------+----------+
| 2 | | | | | | | | A/c No- | |
| | | | | | | | | IFSC- | |
+-----+-------------+-------+------------------+--------------+------------+---------+---------+------------+----------+
| 3 | | | | | | | | A/c No- | |
| | | | | | | | | IFSC- | |
+-----+-------------+-------+------------------+--------------+------------+---------+---------+------------+----------+
B.III In case the family member(s) to be co-authorised, suffering from disorder or disability of mind, including mental
retardation, details of guardian/ nominee, wherever applicable:
+-----+--------------+--------------------+--------------------+----------+-------+--------------------+--------------------+----------+----------+
| S.N.| Name of the | Name of | Date of Birth of | Aadhaar | PAN | Relationship with | Relationship with | Tel/Mob | Address |
| | family | guardian/nominee | guardian/nominee | No. | | the Govt | mentally disabled | No. and | |
| | member | | | | | Servant | family member | email | |
| | co-authorised| | | | | | | ID | |
+=====+==============+====================+====================+==========+=======+====================+================----+==========+==========+
| 1 | | | | | | | | | |
+-----+--------------+--------------------+--------------------+----------+-------+--------------------+--------------------+----------+----------+
| 2 | | | | | | | | | |
+-----+--------------+--------------------+--------------------+----------+-------+--------------------+--------------------+----------+----------+
| 3 | | | | | | | | | |
+-----+--------------+--------------------+--------------------+----------+-------+--------------------+--------------------+----------+----------+
Note:-
(i) The name(s) of permanently disabled child/children/siblings and/or dependent parents shall be added in the PPO
only if there is no other eligible prior claimant for family pension
(ii) The co-authorisation shall become invalid in case any other member of family becomes entitled to family pension
prior to the co-authorised family member.
List of Documents to be submitted/enclosed.
1. Two specimen signatures (to be furnished in a separate sheet). If the member of the family cannot sign his /her
name then he/she is required to put the impression of his/her left/right thumb etc. on the document in lieu of specimen
signature.
2. Proof of identity.
3. Proof of relationship with the pensioner.
4. Certificate of age showing date of birth.
5. A copy of Photo ID proof of the guardian along with proof of Permanent Address.
6. Two specimen signatures of guardian (to be furnished in a separate sheet if the member of the family is minor or
suffering from mental disability)
7. If the guardian cannot sign his/her name then he/she is required to put the impression of his/her left/right thumb etc.
on the document in lieu of specimen signature.
8. Last Income Tax Return failing which Certificate from SDM failing which any other document regarding income in
support of the claim for family pension.
C. Common Nomination Form for Gratuity, General Provident Fund and Central Government Employees'
Group Insurance Scheme
[See Rule 46 of Central Civil Services (Pension) Rules, 2021, Rule 5 of General Provident Fund (Central Services)
Rules, 1960 and Para 19.7 of Central Government Employees' Group Insurance Scheme, 1980]
i. any amount of gratuity, the payment of which may be authorised under rule 44 and Rule 45 of CCS (Pension)
Rules, 2021
ii. amount that may stand to my credit in the General Provident Fund
iii. any amount that may be sanctioned by the Central Government under the Central Government Employees Group
Insurance Scheme, 1980
+------------+-------------------------+------------+------------+-------------------------+-------------------------+------------+-------------------------+-------------------------+
| Type of | Name, date of | Relationship | Share to | If nominee is | Name, | Share to | Name, | Contingency on |
| Benefits | birth (DOB) | with | be paid | minor, name, | DOB, | be paid | DOB and | happening of |
| | and address of | employee/ | to each | DOB and | relationship and | to each | address of | which |
| | the nominee | pensioner | | address of | address of | | person who | nomination |
| | | | | person who may | alternate | | may receive | shall |
| | | | | receive the | nominee in | | the amount | become invalid |
| | | | | amount on | case the | | if alternate | |
| | | | | behalf of minor | nominee under | | nominee in | |
| | | | | | Column(2) | | Column(6) | |
| | | | | | predeceases the | | is minor | |
| | | | | | employee | | | |
+============+=========================+============+============+=========================+=========================+============+=========================+=========================+
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
+============+=========================+============+============+=========================+=========================+============+=========================+=========================+
| Gratuity | | | | | | | | |
+------------+-------------------------+------------+------------+-------------------------+-------------------------+------------+-------------------------+-------------------------+
| GPF | | | | | | | | |
+------------+-------------------------+------------+------------+-------------------------+-------------------------+------------+-------------------------+-------------------------+
| GIS | | | | | | | | |
+------------+-------------------------+------------+------------+-------------------------+-------------------------+------------+-------------------------+-------------------------+
These nominations supersede any nominations made by me earlier.
Note:-
(i) In the case, Form 6-A is being submitted by any person other than Government servant, the nomination already
submitted by the Government servant shall be added in the details and no change in the nomination shall be allowed.
(ii) The nominee(s)/alternate nominee(s)' shares together should cover the whole amount.
D. (Common Nomination Form for Arrears of Pension and Commutation of Pension)
[See Rule 5 of Payment of Arrears of Pension (Nomination) Rules, 1983 and Rule 7 of Central Civil Services
(Commutation of Pension) Rules, 1981]
i. Arrears of Pension
ii. Commuted Value of Pension payable under Central Civil Services (Commutation of Pension) Rules, 1981
+-------------------------+-------------------------+------------+------------+-------------------------+-------------------------+------------+-------------------------+-------------------------+
| Type of | Name, | Relationship | Share to | If nominee is | Name, | Share to | Name, | Contingency on |
| Benefits | date of | with | be paid | minor, name, | DOB, | be paid | DOB and | happening of |
| | birth | employee/ | to each | DOB and | relationship and | to each | address of | which |
| | (DOB) | pensioner | | address of | address of | | person who | nomination |
| | and | | | person who may | alternate | | may | shall |
| | address | | | receive the | nominee in | | receive | become |
| | of the | | | amount on | case the | | the amount | invalid |
| | nominee | | | behalf of | nominee under | | if alternate | |
| | | | | minor | Column(2) | | nominee in | |
| | | | | | predeceases the | | Column(6) | |
| | | | | | employee | | is minor | |
+=========================+=========================+============+============+=========================+=========================+============+=========================+=========================+
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 |
+=========================+=========================+============+============+=========================+=========================+============+=========================+=========================+
| Commuted | | | | | | | | |
| Value of | | | | | | | | |
| Pension | | | | | | | | |
+-------------------------+-------------------------+------------+------------+-------------------------+-------------------------+------------+-------------------------+-------------------------+
| Arrears of | | | | | | | | |
| Pension | | | | | | | | |
+-------------------------+-------------------------+------------+------------+-------------------------+-------------------------+------------+-------------------------+-------------------------+
These nominations supersede any nominations made by me earlier.
Note: The nominee(s)/alternate nominee(s)' shares together should cover the whole amount.
E. Undertaking by Government servants who have worked in any Intelligence or Security-related
organization(s)
(See Clause (b) of Sub-rule (4) of Rule 7)
І..............................who have worked in ..............................(Name of Organization(s)) on the post
of.........................,for the period from............................to...........do here by solemnly declare that, save with
prior approval of the Competent Authority, I shall not publish in any manner, while in service or after my
retirement, any information or material or knowledge which is related to the domain of the organisation and
obtained by virtue of my working in the said Organization. This declaration is notwithstanding my
responsibilities and liability, in terms of the relevant conduct rules, pension rules, laws dealing with offences
relating to official secrets or national security and Intelligent Organisations (Restriction of Rights) Act, 1985 (58
of 1985), as the case may be. I further agree that in the event of any failure of the above undertaking by me, the
decision of the Government as to whether it was likely to prejudicially affect the aspects stated above shall be
binding on me.
2. I am aware that the pension which may be granted to me after retirement, in terms of the relevant pension rules,
can be withheld or withdrawn, in full or part, for any failure of this undertaking given.
Note:-
(i) Write not applicable for other Ministry/Department/Organization
(ii) In case, the form is being filled on behalf of government servant, this section may be striked down.
F. Option for availing Medical Facilities under Central Government Health Scheme or Fixed Medical Allowance after
retirement.
+--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------+
| I opt the following facility |
+--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------+
| i. I will be residing in a CGHS area and would be availing CGHS facility |
+--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------+
| ii. I will be residing in a CGHS area but would not be availing CGHS facility. I understand that I will not be |
| eligible for Fixed Medical Allowance (FMA) |
+--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------+
| iii. I will be residing in non-CGHS area but would be availing CGHS facility for In-patient Department |
| (IPD) and Out-patient Department (OPD) treatment. I will not be eligible for FMA |
+--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------+
| iv. I will be residing in a non-CGHS area but would be availing CGHS facility for IPD treatment only by |
| payment of CGHS contributions. I will also avail FMA for OPD treatment. |
+--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------+
| v. I will be residing in a non-CGHS area and would not be availing CGHS facility for both IPD treatment |
| and OPD treatment. I will avail FMA. |
+--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------+
| vi. I will avail medical facilities available to spouse/family members who is an employee/ pensioner of |
| Government/PSU/Autonomous Body. I will not avail CGHS facility and FMA |
+--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------+
| vii. Avail Medical facility of previous Organization. I will not avail CGHS facility and FMA |
+--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------+
| viii. Avail Medical Facility of Previous Organization/ ECHS facility/other Health facility. I will not avail |
| CGHS facility and FMA |
+--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------+
G. Undertaking
(See Rules 57, 58, 60, 63 and 80)
To
The Branch Manager
In consideration of your having, at my request, agreed to make payment of pension due to me every month by
credit to my account with you. I the undersigned agree and undertake to refund or make good any amount to
which I am not entitled or any amount which may be credited to my account in excess of the amount to which
I am or would been titled. I further here by undertake and agree to bind myself and my heirs, successor,
executors and administrators to indemnify the bank from and against any loss, suffered or incurred by the
bank in so crediting my pension to my account under the scheme and to forthwith pay the same to the bank
and also irrevocably authorise the bank (mentioned at the S.No. 3 of Part A) to recover the amount due by
debit to my said account or any other account/ deposits belonging to me in the possession of the bank.
2. The date of birth of spouse is ___________ and her mark of identification is __________
H - Verification
I certify that the particulars and declarations given by me in points A to G of this form is true to the best of my
knowledge.
Date:
Place:
Signature of Government servant/Family member
(with name) authorised to submit this Form
The details of the Government Servant given above are verified and found to be in the order.
Date:
Place:
Signature of HOO
List of additional Documents to be attached with Form 6-A
1. Two specimen signatures (to be furnished in a separate sheet). If the claimant cannot sign his/her name then he/she
is required to put the impression of his/her left/right thumb on the document in lieu of specimen signature.
2. Three copies of Joint photograph with spouse or, if it is not possible to submit joint photograph with spouse,
separate photographs of self and spouse, along with three copies of photograph of the member or members of the
family whose names are to be included in the Pension Payment Order as a co-authorised family pensioner.
(Photographs to be attested by Head of Office).
3. Form for submitting details under Anubhav (optional).
4. Copy of PAN Card
Note: The principal rules were published in the Gazette of India, Extraordinary, Part II, Section 3, Sub-section (i),
vide number G.S.R. 868 (E), dated the 20th December, 2021 and were subsequently amended vide number
G.S.R. 770 (E), dated the 7th October, 2022.
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