Government of lndia Office of the Controller of

Ministry of Communicatioa Communication Accounts

Department of Telecommunications Punjab Telecom circle,
rel. No.Ol72-2641227 Madhya Marg
Fax OL72-264G)27 Sector 27A, Chandigarh160019
+{l.l cqa
Email - [email protected] www.ccapuniab.gov. in
[email protected] ISO: 9fi)1:201 5 CERTTFIED

Preparation of Pension Papers for Timely Pension after VRS

Dear YRS Optee of BSNL,

Please take care of following for timely settlement of your Pension/GPF
case:
1. Make efforts to get your Service Book (SB) completed with special
attention on:
a) Entry of details like Time-bound Promotion along with Promotion
Order
b) Entry of Training Period
c) Pay fixation memos form 1.10.2&)0 onwards are available in
Service Book
d) Up to date remarks regarding Pension Contribution duly attested
by BSNL Authority
e) Copy of Presidential Order is pasted in SB
f) Undertaking prescribed for post based increment is available
(wherever applicable)
g) Indemnity Bonds is available for Group B officers who opted for
IDA from date of promotion after 1.10.2000
h) TSM period should be mentioned in SB along with Regularization
orders
i) Strike Period has been regularized and entries are made in the
Service Book.
j) Leave Account is complete
k) Provide two copies of Aadhar Card, PAN Card, ECS Mandate
form of Pensioner and Pensioner letter of Authority and
Undertaking (Annexure l) for CCA Oflice.
l) Joint Bank Account with spouse. l" name should be of retiree.
m)Name in Bank Account and printed on cheque should be same

PaBe 1 of 4
Government of lndia Office of the Controller of
Ministry of Communication Communication Accounts
Department of Telecommunications Punjab Telecom circle,
Tel. No.0172-2641227 Madhya Marg
Fa,i0IT2-264/}927 Sector 27A, Chandiga.hl5o0l9
Rq4t nqi
Email - [email protected] www.ccapuniab.gov.in
ccapu n ia [email protected] ISO: 9fi)l:2015 CERTIFIEI)

2. Make sure that following Forms are ready and complete in all respect:
I Form -5 Application for Pension, showing Aadhar Number,
PAN Number, Mob. Number & email id. ( copies of
PAN Number & Aadhar Card to be enclosed)
, Form- I (A) Application for commutation.

3 Form -3 Details of Family mentioning Aadhar number, PAN

number, Mobile number and email id. ( copies of PAN
Number & Aadhar Card to be enclosed)

1 Form -7 Assessment of Pension & Gratuity) duly signed by the

Head of office. (to be done by BSNL tlnits)

5 Form-l Common Nomination Form for GPF, DCRG and

Commutation. (Copy enclosed)

6 Form-8 Forwarding the Pension Papers (to be sent by BSNL

Units)

7 Thrce Joint Photographs Less than 70B (passport Size) with wife/Husband, One
single photograph of pensioner and one singlc photograph of each family member
(Name should be written on the Back side of Photograph) duly attested hy the Head
of the olfice

8 Pension calculation sheet. (To be done by BSNL Units)

9 Disciplinary/Vigilance clearance certificate, (To be done by BSNL Units)

l0 Last Pay certificate (LPC). (To be done bv BSNL LInits)

ll Retirement order. (To be done by BSNL Units)

t2 VRS case - Copy of YRS Notice (To be done by BSNL Units)

l3 Three specimen signatures or left hand thumb impression marks in

duplicate duly attested.

Page 2 of 4
Government of lndia Orfice of the controller of
Ministry of Communication Communication Accounts
Department of Telecommunications Puniab Telecom circle,
Tel.No.Ol72-2 !227 Madhya Marg
lax OL72-264O927 *q4i cqi sector 27A, Chandigarh160019
Email - [email protected] www.cca pu n iab.gov. in
[email protected] ISO: 9001 12015 CERTIFIED

t4 Two slips showing the particulars of height and personal identification marks (not less lhan
two) duly attested by a Gazetted Govt. servant.

l5 ECS mandate form & Cancelled Cheque. l" page ofBank Pass Book showing Name, A/c No.
and IFSC Code mentioned in case of non issuance of cheque Book (To be submitted in
duplicate)

l6 Pay fixation Sheet: All Promotions and all Pay Commission etc. should be checked and
recorded in the Service Book duly attested, to avoid resuhmission/revision ofPension crse.

t7 Service Verification Sheet: Showing details & total period of non-qualifting service
spell and year wise breakup as per format below:

Sen'ice Vcrification Non qualifuing period

I rom To Service From To No. Type of non

Book Page davs Quali$ing
No

l8 Service Book duly completed as on date of submission and notifying the

date of superannuation.

19 No demand/No dues certificate by AGM (AyDE (Admin) of BSNL unit.

20 Form "A" Common Nomination for arrears of Pension and Communed

value of Pension. (Copy enclosed)

2l Pensioner's Letter of authority and Undertaking for refunding

any
excess payment made by the Pension Disbursing Authority ( Annexure -
A Pfoforma enclosed ) (To hc submitted in duplicare )

22 Declaration for non-employment after retirement in cases of Gr. 'A'

Pensioner.

23 Details of total income of the pensioner taxable under Income Tax Act during
current financial year along with the details of saving made by the pensioner for tax
rebate.

24 GPF Final Payment Application along with required documents.

Page 3 of 4
Government of lndia office ofthe controller of
Ministry of Communication Communication Accounts
Department of Telecommunications Punjab Telecom Circle,
Tel. No,0172-2641227 Madhya Mart
FexOLT2-26&927 qal Sector 27A, Chandigarhl6{X119
+&q4r
Email - [email protected] www.ccapuniab.sov.in
cca pu nia [email protected] ISO: 9001:2015 CERTIFIED

3. Always provide:
a) Permanent address after retiremetrt for future communication
b) Correct email id for future commutrication
c) Permanent mobile number for future communication
4. Make sure that that your Name in the Service Book is the same as in
your Aadhar Card, Bank Account and PAN Card.
5. Make sure that the Name and Date of Birth of family memberc is the
same as in their Aadhar Card, Bank Account and PAN Card.
6. Pl take care:
. not to provide your service connection number as contact
number
o not to give official email id for future communication
r not to provide your staff quarter address for future
communication

In case ofany further querT, please contact:

O/O Controller of Communication Accounts
Punjab Telecom Circle Sector 27A
Plot No.2C, Madhya Marg
Doorsanchar Bhawan Chandigarh 160019
o Toll Free- 1800-180-2089
a Email: Pen.ccaDun [email protected]
a Sh. Om Parkash PRO cum welfare Officer Mob No. 9464344437

Page 4 of 4
 Form I
Common Nomination Form for Gratuity, General Provident Fund and Central Government
Employees' Group Insurance Scheme
[See Ruie 53 ofCCS (Pension) Rules, 1972, Rule 5 ofGeneral Provident Fund (Central Services) Rules, 1960
and Para 19.7 ofCentral Govemment Employees, Group lnsurance Scheme, lggb]

I,.
bel ow and co ;;;;; ffi;;;;*";t;ili;;;;;i;; ;; ;i,: iiii,l'",,1,TT;jtli: ffi""".?1fi:T:il:,:,,J:?ffii
am ount on ac count ofthe following:
l. any gratuity the payment ofwhich may be authorised under rule 50 ofccs (pension)
Rules
ii. amount that may stand to my credit in the General provident Fund
iii. any amount that may be sanctioned by thc Central Govenlr)enI undcr thc Central
Govcrnrrcnt
Employees Group Insurance Scheme, 1980

Name, date ofbirth Relation-ship Shae lf nonlinee is Name, DOB, Share Name, DOB Contingellc),
(DOB) and address of with to be minor, name, relationship and
the nominee
to be and address of on happening
emploS,ee/ paid DOB and address of altemate paid person who ofwhich
pensioner to address of nominee in case the to may receive nomination
each person who noninee under each the amount if shall become
nray leccivc Column (l) altemalc invalid
i thc amount on predcceases the nominee in
bchalfof crnploycc/ Col. (5) is .r
ninor pcrsioncr minot'

I 2 3 4 5 6 7 8

These nominations supersede any nominations rnade by ntc earlier

Place and date:

Signature ol' Governnlcnt senr'ant

Telephone No.

Note I : Completcly strike out the benefits for which nornination is not intended to
be rnadc. Scparate copics
of this nomination Form may be used for nominating cliffclcnr pcrsons 1'or benefits (i), (ii)
arr6 1,ii1 above
Note 2 : The Govemment servant shall draw lines across the blank space below the
last entry to prevent tlre
insertion of any name after he/she has signed. The nominee(s)/altcrnate nomineels);
shrres'iog"ttrer strouta
cover the whole amount.
 (To be filled in by the Head of Office/aurhorised Gazetted Officer)

Received the nominations, dated . .. ... ... .. .., under the following Rules :-
l. Central Civil Services (Pension) Rules, 1972 for Gratuity

2. General Provident Fund (Central Services) Rules, 1960

3. Central Govemment employees Group Insurance Schenrc, l9ij0

made by Shri/Smt./Kumari.......................

Designation.-............

Office.................

(Strike out which nomination is not received)

Entry ofreceipt of nomination(s) has been made in page ....Volume..........of Service Book

Name, Signature and Designation ofHead of offioe/aurhorised Gazetted officer rvith seal

Date of receipt.............

The receiving officer will fill the above information and retum a duly signed copy ofthe complete
Form to the Government servant who should keep it in safe custody so that it may come into the
possession of the beneficiaries in the event of his/hcr dcatir.

The receiving officer shall put his/her dated signature on both pages of this Form.
 FORM 3
[See rule 54 (12)]
Details of Family

I Name of the Government servant

) Designation
-) Date of birth
4 Details of the members of family as on-----------------------:

S Names of the Date of Relationship Marital Remarks Dated

No members of family birth with the status signature
ofEcer of Head
of Office
(1) (2) (3) (4) (s) (6) (7\
1.
2
J
4
5.
6.
7
8
9
l0

I hereby undertake to keep the above particulars upto-datc by notifuing to the Head ofthe
Office any addition or alteration.

Signature of Govemment servant

Place: Date :

Note I . -The original Form submitted by the Government. servant is to be retained. All
additions/alterations are to be recorded in this Form under the signature ofHead of Office in Col
7. No new Form will substitute the original Form. However, the retiring Govemment. servant
should submit the details of family afresh along with Form 5.

Note 2. - The detarJs of spouse, all children and parents (whether eligible for family pension or
not) and disabled siblings (brothers and sisters) may be given.

Note 3. - The Head of Office shall indicate the date ofreceipt of communication regarding addition
or alteration in the family in. the 'Remarks' column. The fact regarding disability or ihange of
marital status of a family member should also be indicated in the 'Remarks' column.

Note 4. - Wife and husband shall include judicially separated wife and husband.
 a
Form A
(conrmon Nomination Form for Arrears of pension and commutation pension)
.-.- of
lSce Rule 5 of Payment of Arrears of Pension (Nomination) Rules, 1983 and Rule 7 of Central
Civil
Services (Commutation of pension) Rules, I 9g ll
I, hereby nominate the person/persons
mentioned below and confer on him/her/them the right to receive in the
event of my death, to ttre extent
specified below, amount on account ofthe following:

i. Arrears of Pension

ii. Commuted Value of Pension payable under Central Civil Services (Commutation of pension)
Rules, l98l

Nalnc, datc of Relationship Share Ifnominee Name, DOB and Relationship Name, DOB Contingency
biah (DOB) and with to be is minor, address of altemate with empl- and address on
addrcss ofthe employee/ paid to name, DOB nominee in case the oyee/ pensi- ofperson happening of
nominee pensioner each and address nominee under oner who may which
ofperson Column (l ) receive the nomimtion
who may predecoases the amount if shall become
receive the employee/ altemat€ invalid
amount on pensioner nomitee in
I
behalfof Col. (5) is a
minor minor
I 2 3 4 5 6 7 8

l-hese norninations supersede any nominations made by me earlier.

Place and date:

Signarure of Govemment servant/Pensioner

Telephone No.

Note I : Completely strike out the benefit for which nomination is not intended to be made. Separate
copies of this nomination Form may be used for nominating different persons for benefits (i) and (ii)
above.

Notc 2 : The Govemment servant shall draw lines across the blank space below the last entry to prevent
lhc inseftion of any name after helshe has signed. The nominee(s)/alternate nominee(s)' shares together
.;lrorrld cor cr the whole amount.
.* (To be filled in by the Head of Office/ authorised Gazetted Officer)

. Received the nominations, dated ....... .. ...., under the following Rules:

I . Payment of Arrears of Pension Q.,lomination) Rules, I 983

2. Central Civil Services (Commutation of pension) Rules, l9g1

made by Shri/Smt./Kumari...................

Designation........

(Strike out which nomination is not received)

Entry of receipt of nomination(s) has been made in page ............Volume..........of Service Book.

Name, Signature and Designation of Head of office/authorised Gazetted officer with seal

Date of receipt

The receiving Oflicer will fill the above information and return a duly signed copy of the complete
Form to the Government servant who should keep it in safe custody so that it may come into the
possession ofthe beneficiaries in the event ofhis/her death.

The receiving officer shall put his/her dated signature on both pages of this Form.
 MANDATE FORM

l, Beneficiary Name

2 Beneficiary/Address &Telephone No.

I

3 Beneficiary Account No

4. Account t e S avl n tc U rre nt lot c a S h Credi 1

Nine digit code number of the Bank & branch

5 appearing on the MICR Cheque issued by the bank (if
available)
I

6 Bank Name
7 B ranch Name & Address with T one No
B IFSC (lndian Financial Services Code)
Photo copy of th e cancelled cheque to confirm
correctness of IFSC code and Account N o ven

I' hereby declare that the particulars given above are correct and complete. lf the
transaction is delayed or
not effected at all for reasons of incompleteness or incorrectness
of information given by me as above, I would not
hold the user institution responsible.

Dated .................

(Signature of Spouse) (Signature of the Beneficiary)

ified th e rs fu a c s

Bank Stamp (Signature of the Authorised officer

)
Dated
 ANNEXURE 1

er' Au rit nd e rta kin

Pen n

To,

PT.CCA/CCA

sir' B:1r<1"::T:::1::t::,ti:":1"1J'3:l'.",$"::"ifi""T'
herebv opt to draw mv Pension throush 3
I pension on my beharf
oensron by DOT through cpMS. ,'#;;;'ffi;;ihe
bank to-rec€rve my monthry
as lollows
I"l ii"ortin".rre tJmy account as per particulars given the bank as per detail given below:-
1) I have to draw my p""ti"i;;;il;
;"niLi tnl,o'gn

a. Name of the Bank

b Branch
c Account No'
d. IFSC Code
payment of pension it credlted to my
2r I herebv undertake that any amount of excess/wrong
Bank Account will be refunded on your instructlons
3)lundertake'no"g'"""i;ii;i;y""-n'no'yheirs'successors'toindemnifytheBank/PDA
tn" scheme and to forthwith pay the same to
p"|-ititnio' n1v''"icount
in so crediting
the Bank/pDA and 'v ,,JilJilil;;lioiiie 'ni"'
ine eanr.lpoA to recover the amount due bv debit
to me in possession of the bank'
to my said o. iny"Jil5il"*"vJ"p"rnr uetpnging
"""oun,
Signature of Pensioner

'1. Pe onal deta i ls:-

2 Designation
3. Date of retirement
4. Address of the Pensibner :

Familv Pensioners onlv:'

6. Name of the Family Pensioner :

2. Eank Details :'

1. Saving /Current Account No :

2 Name of the Bank :

t JXT,3o"llli,i!"331* 0o,,, (2 above) n *"

.. tf'"
lT
"",'""1-.11" il:"-::::1":'",?1,":,::iJ:'ff;"''if*"
excess amount credited in the account
spe"irneniiitl"t"" i"io'" ou'.f":o.'d: Any PDA
of the
overleaf agrees witn
immeoiativ as and when called ror bv the
;;ffi;';il;iunaea
Signature of the Bank Manager
Place (Bank Accounts Seal)
Date

pensioner and Part 3 by Bank'

Note - Part 1 & 2 to be filled in by the