Scribd
Upload
278 views2 pages

Payment of Retirement Benefit Application Form PDF

This document is an application form for payment of retirement benefits. It requests personal information about the beneficiary such as name, CNIC number, father/husband's name, last position held, date of birth, appointment, and retirement. It also asks for contribution history to retirement funds, present and permanent addresses, contact number, bank details, and required supporting documents. The form must be certified and signed by the head of the beneficiary's administrative department, and forwarded to the Board of Retirement Benefit and Death Compensation Fund for processing of retirement benefits.

Uploaded by

Wajahat_Raza_Qureshi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
278 views2 pages

Payment of Retirement Benefit Application Form PDF

This document is an application form for payment of retirement benefits. It requests personal information about the beneficiary such as name, CNIC number, father/husband's name, last position held, date of birth, appointment, and retirement. It also asks for contribution history to retirement funds, present and permanent addresses, contact number, bank details, and required supporting documents. The form must be certified and signed by the head of the beneficiary's administrative department, and forwarded to the Board of Retirement Benefit and Death Compensation Fund for processing of retirement benefits.

Uploaded by

Wajahat_Raza_Qureshi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

Application Form

PAYMENT OF RETIREMENT BENEFIT

PART - I

1 Personal # Paste passport


size photograph
2
a) Name of Beneficiary

b) CNIC No. - -

c) Father / Husband Name

d) Last Position held


alongwith BPS

e) Name of Department

f) Station/Place of last Posting


dd mm yyyy
3 Date of Birth - -

4 Date of Appointment - -

5
Date of Retirment OR removal from - -
service on account of

a) Superannuation / b) Dismissal from Service c) Removal


Qualifying service
d) Termination e) Resignation (Tick the relevant box)

6 Regular Contributions to
a) Group Insurance From To
b) RB&DC From To
c) Missing period in case of
leave without pay etc. i From To
ii From To
iii From To
7 Address
a) Present/Postal

b) Permenant
c) Contact No.

Signature or Thumb Impression


of Beneficiary

Page 1 of 2
Application Form

PAYMENT OF RETIREMENT BENEFIT

8 Bank Detail
a) Name of Bank b) Bank Code

c) Title of Account

d) Type of Account (i.e. PLS, Saving, Current)

d) Account No

Signature of Branch Manager Stamp with Branch Code

PART-II
CERTIFICATE

1 Certified that the information contained above in respect of Mr/Miss/Mrs ________________________________ is correct
and according to our record.
2 Certified that the above named employee was neither a contingency/work charged/adhoc/contract employee nor a
deputationist from any Provincial Government or Federal Government and he/she was a regular contributor of RB&DC &
Group Insurance Funds
3 Certified that the claim has been submitted for the first time and had never been sent previously from any office of this
department.
4 Certified that this department reserve the right to refund the amount of all grants sanctioned under RB&DC scheme, in case
of fake/fictitious documents / information in respect of the above named employee.

Seal and Signature


Dated_______________ Head of the office

Forwarded to the Board of Retirement Benefit & Death Compensation Fund, Finance Department Peshawar for grant
of retirement benefit

Dated_______________ Seal and Signature


Head of the Department

Required documents & Instructions for submission of Application Form


The application form must be countersinged by the concerned Head Administrative Department / Head of Attached
a)
Department
b) Attested Photocopy of Retirement Order / Notification
c) One Photograph of the beneficiary
d) Attested photocopy of CNIC of beneficiary
e) Photocopy of cheaque book leaf may be attached for confirmation of bank account
Last pay certificate/computerized pay slip, Pay stoppage certificate duly signed by the office of the
f)
DDO/AG/DCA/DAO/AAO(s)
Attested Photo copy of first and 2nd page of S/Book, In case of Gazzetted a Service Certificate be issued by the
g)
AG/DCA/DAO/AAO(s)
h) A copy of the Medical Board proceedings duly attested by the Head of Department.
i) The attached docments should be marked as Annexure A, B, C etc
j) Forward application form with covering Letter to:
Deputy Director (RB&DC), 1st Floor Directorate of Treasuries & Accounts, Khyber Pakhtunkhwa
Peshawar

Page 2 of 2

You might also like