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Treasuries & Accounts Department Andhra Pradeh: Hyderabad

This document is an application for a multipurpose ID card for pensioners in Andhra Pradesh. It requests information about the pensioner and their dependents. Part 1 asks for details about the pensioner like their employee code, pension ID number, date of birth, retirement details, current address and contact information. Part 2 is for dependent details if the applicant is a service pensioner, requesting name, relationship to pensioner, date of birth, gender and other attributes. Descriptions or codes are provided on the back of the form to clarify response options for questions like retirement type, family pension type, designation grade, ailments, categories and more. A soft copy of passport photos for the pensioner and dependents is

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27 views3 pages

Treasuries & Accounts Department Andhra Pradeh: Hyderabad

This document is an application for a multipurpose ID card for pensioners in Andhra Pradesh. It requests information about the pensioner and their dependents. Part 1 asks for details about the pensioner like their employee code, pension ID number, date of birth, retirement details, current address and contact information. Part 2 is for dependent details if the applicant is a service pensioner, requesting name, relationship to pensioner, date of birth, gender and other attributes. Descriptions or codes are provided on the back of the form to clarify response options for questions like retirement type, family pension type, designation grade, ailments, categories and more. A soft copy of passport photos for the pensioner and dependents is

Uploaded by

kgn1
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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TREASURIES & ACCOUNTS DEPARTMENT

ANDHRA PRADEH: HYDERABAD


Application for Pensioner's(Service/Family) Multipurpose I.D Card
PART-I (Applicant Details)
1

Employee Code if available before


retirement

Pensioner I.D. No*

Name of the Treasury/PPO from


where pension is being drawn*

Pensioners Name & Surname Fathers


name/Husband name

Date of Birth (dd/mm/yyyy) *

Date of death of service Pensioner in


case of Family Pensioner *

Date of Retirement of Service


Pensioner*

Date of Commencement of
pension(Sp/Fp) *

Retirement type (See Overleaf) *

10

Type of Family pension (See


Overleaf) *

11

Name of the Department from


Where Service Pensioner Retired*

12

Designation at the time of


retirement of Service Pensioner*

13

Designation grade (See Overleaf) *

14

Gender(M/F) *

15

Marital status (See Overleaf) *

16

Blood Group(Overleaf)

17

Ailments if any (See Overleaf)

18

Pensioner Category (See Overleaf)

19

Pensioner Employment Category


(See Overleaf)

20
21

P.R.C. Year*

Present Basic pension*

22
PAN. No

23

Ration Card No.

24

Aadhar Card No.

25

Present Residential Address with


Pincode*

26

Residential Phone No.

27

Cell NO.

28

E-Mail Address

PART-II DEPENDENT DETAILS (In case of Service Pensioner only)


S.No
(1)

Dependent
Name* (2)

Gender*
(M/F) (3)

Date of birth*
(dd/mm/yyyy)
(4)

Marital Status
(See Overleaf)
* (5)

Relationship
with Pensioner
(See Overleaf) *
(6)

Employme
nt status*
(7)

Signature of the Service Pensioner/Family


Pensioner.

* In case of Pensioner's drawing more than one pension need to apply for
service pension only.
** In case of employment, no need to apply under this scheme by the Family
Pensioner.

Blood
Group
(8)

Part-1(Overleaf)
Sl.no Descriptions
09.
Service-Normal/Service-Provisional/Service-Voluntary/ServiceInvalid/Service- Prorata.
10.

Family-Normal/Family-Share/Family-Minor/Family-Pcmr/Direct Family.

13.

Gazetted/Non-Gazetted/Class-IV.

15.

Married/Unmarried/Widowed/Divorced/Remarried.

16.

A+ve, A-ve, B+ve, B-ve, AB+ve, AB-ve, O+ve and O-ve.

17.

B.P/Sugar/Cardiac Problems/Neurological Problems/Kidney Problems/Others.

18.

Civil/AST/FA/Political/Others

19. State Normal/UGC/AIS/Judicial officer/UGC-Doctors/AICTC/Other States /Others

Part-II(Overleaf)
Sl.no Descriptions
5.

Married/Unmarried/Widowed/Divorced/Remarried

6.
Father, Mother, Spouse, Son Including Adopted & step sons, Daughter
including step Daughter.

NOTE:
Pensioner shall carry a soft copy of passport size photos of self and
dependents which is not more than 100kb size, which is required to be uploaded.
The extension of photo should be .JPG or. JPEG or PNG.

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