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Form 14

This document appears to be a form for applying for family pension benefits upon the death of a government servant or pensioner. It requests information such as the name and relationship of the applicant and deceased, date and place of death of the deceased, the office where they last served, details of any surviving children, addresses and identification documents of the applicant, and signatures/thumbprints to verify the applicant's identity. The form also provides instructions on attestation requirements for documents.

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Purushothaman Poopparambil
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96 views2 pages

Form 14

This document appears to be a form for applying for family pension benefits upon the death of a government servant or pensioner. It requests information such as the name and relationship of the applicant and deceased, date and place of death of the deceased, the office where they last served, details of any surviving children, addresses and identification documents of the applicant, and signatures/thumbprints to verify the applicant's identity. The form also provides instructions on attestation requirements for documents.

Uploaded by

Purushothaman Poopparambil
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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FORM 14

(See rule 77(4), 79(3) and 61(2)

FAMILY PENSION ON THE DEATH OF A GOVERNMENT SERVANT/PENSIONER


1. Name of the applicant: (i) Widow/ Widower: (ii) Guardian if the deseased Pension is survived by Child or children. Name and age of surveying: Widow/widower and children Of the diseased Government Servant/Pensioner. _______________________________________________________________________________ Sl.No. NAME Relationship Date of birth With the deceby children age Sed Govt. Christian era.__________ 2.

________________________________________________________________________________ 3. Date of death of the: Government servant Pensioner. 4. Office/Department/Ministry: In which the deceased Government servant Pensioner served last. If the applicant is guardian: His date of birth and relaIonship with the deceased Government servant/Pensioner. Full address of the applicant: Name of the Treasury or SubTreasury at which payment is Desired. Enclosures: (i) Two specimen signature of the applicant, duly attested (To be furnished in two separate sheets) (ii) Two copies of passport size Photograph of the applicant, duly attested.

5.

6. 7.

8.

(iii)

(iv)

(v)

Two splis each bearing left Hand thumb and finger Impression of the applicant, duly attested. Descriptive Roll of the applicant duly attested, indicating (a) height and (b) personal marks, if any, on the hand, face etc. Certificate(s) of age (in original with two attested copies) showing the date of birth of the children. The certificate should be from the Municipal Authorities or from the local Panchayat or from the local Panchayat or from the head of a studying in such school. (This information should be furnished in respect of such child or children the particulars of whose date of birth are not available with the Audit Officer/Head of Office.)

5. Signature or left hand thumb impression of the applicant. 6. Attested by: Name Full Address (i) (ii)

Signature

7. Witness: (i) (ii) NOTE:Attestation should be done by two gazetted Government servants or two or more persons of responsibility in the town, village or pargana in which the applicant resides. *To be furnished in case the applicant is not literate enough to sign. his name.

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