ABCDEFGHIJKL
1
2
FORM 7
[See Rules 58, 60, 61(1) and (3) and 65 (1)]
3
4
Form for assessing Pension / Family pension and Gratuity.
5
6
PART 1
7
1Name of the retiring Government employee:NAGENDRA RAM
8
2Father’s/ Husband’s name:Late Ram Sharan Ram
9
3Height:5.3"
10
4Marks of Identification:
11
5Date of Birth:04.02.1956
12
6Service to which belongs:General Central Services
13
7Particulars of post held at the time of retirement:
14
(a) Name of the office:O/o the Joint Commissioner of Income-tax,Range-1,Muzaffarpur
15
(b) Post held:Notice Server
16
(c) Whether the appointment mentioned above was under Government or outside the Government on foreign service terms?:
17
8Whether declared substantive in any post under the Central Government?:
18
9Date of beginning of service::21.05.1976
19
10Date of ending of service::29.02.1956
20
11Cause of ending of service
21
(a) Voluntary retirement on being declared Surplus (Rule 29):NO
22
(b) Permanent absorption in Public Sector
Undertaking / Autonomous body (Rule 37-A)		:NO
23
(c) Due to abolition of post (Rule 59):NO
24
(d) Superannuation (Rule 35):
25
(e) Invalidment on medical ground (Rule 38):
26
(f) Voluntary / premature retirement at the
Initiative of the Government servant
[under Rules 48, 48-A or FR 56 (k)]		:
27
(g) Premature retirement at the initiative of the Government [Rule 48 or FR 56 (j)]:
28
(h) Compulsory retirement (Rule 40):
29
(i) Removal / dismissal from service
(Rule 24 and 41)		:
30
(j) Death:
31
12In the case of compulsory retirement, the orders of the competent authority, whether pension may be allowed at full rates or at reduced rates and, in case of reduced rates the percentage at which it is to be allowed.:
32
13In case of removal / dismissal from service whether orders of competent authority have been obtained for grant of compassionate allowance and if so, at what rate.:
33
14Particulars relating to military service, if any
34
(a) Period of military service:
35
(b) Terminal benefits drawn / being drawn for Military service:
36
(c) Whether opted for counting of military service towards civil pension?:
37
(d) If answer to (c ) above is in the affirmative whether the terminal benefits have been refunded.:
38
(e) In case of ex-servicemen who are eligible for
Family pension under the Armed Forces Rules,
whether opted to retain family pension under the Armed Forces Rules or to draw family pension
under the Civil rules.
:
39
15 Particulars relating to service in Autonomous body, if any:
40
(a) Whether the above service is to be counted for pension:
41
(b) Whether the Autonomous organization has discharged its pensionary liability to the Central Government?
:
42
16Whether any departmental or judicial proceedings are pending against the retiring employee:
43
17 Qualifying service:
44
(a) Detail of omission, imperfection or deficiencies in the Service Book which have ignored [under Rule 59 (1) (b) (ii)]
:
45
(b) Period not counting as qualifying service.:
46
(i) Boy Service (2nd proviso to Rule 13).:
47
(ii) Extraordinary Leave not counting as qualifying service (Rule 21).:
48
(iii) Periods of suspension not treated as qualifying service (Rule 23).:
49
(iv) Interruptions in service [Rule 27 (1) (b) and Rule 28 (c)]:
50
(v) Periods of foreign service with United Nations bodies for which United Nations pension has been availed.:
51
(vi) Any other period not treated as qualifying service (give details).:
52
(c) Additions to qualifying service----:
53
(i) Military service (Rule 19):
54
(ii) War service (Rule 20):
55
(iii) Weightage on voluntary retirement on being declared surplus (Rule 29):
56
(iv) Weightage under Rule 30:
57
(v) Benefit of service in an Autonomous Body (Rule 37):
58
(vi) Weightage under Rule 48-B:
59
(c) Net Qualifying service:
60
(d)
 Qualifying service expressed in terms of completed six monthly periods (Period of three months and over is treated as completed
six monthly period)		:
61
18Emoluments---:
62
(a)
Emoluments drawn during 10 months preceding retirement—
63
FromToRate of PayAmount
64
65
(b) If the officer was on foreign service immediately preceding retirement, the notional emoluments which he would have drawn under Government but for being on foreign service:
66
(c) Average emoluments reckoned for pension:
67
(d) Emoluments reckoned for retirement gratuity/death gratuity:
68
(e) Emoluments reckoned for family pension:
69
19Date on which the retiring employee submitted his
application for pension in Form 5.		:
70
20Complete and up to date details of the family as given in Form 3
71
Sl.No. Name of the Member of the FamilyDate of BirthRelationship with the Govt. Servant
72
1Sumit Kumar18.01.1989Son
73
2Amit Kumar
74
75
76
77
78
21Whether Nomination made for death gratuity/retirement gratuity:
79
22The date on which action initiated to:
80
23(a) Obtain the ‘No demand’ certificate from theDirectorate of Estates as provided in Rule 57.:
81
(b)
 Assess the service and emoluments qualifying for pension as provided in Rule 59:
82
(c) Assess the Government dues other than the dues relating to the allotment of Government accommodation as provided in Rule 73(1):
83
23 Details of Government dues recoverable out of Gratuity :--
84
(a) Licence fee for Government accommodation:
85
(b) Dues referred to in Rule 73:
86
24 (a)

Proposed pension / service gratuity:
87
(b)Proposed dearness relief on pension (as on date of retirement):
88
(c) Date from which pension is to commence:
89
25Rate of Family pension :--:
90
(a)Enhanced rate:
91
(b) Period for which family pension will be payable at enhance rate.:
92
( C) Ordinary rate:
93
(d) Date from which ordinary rate of family pension will be payable:
94
26Amount of retirement gratuity / death gratuity.:
95
27Commutation of Pension:
96
(a) Period for which family pension will be payable
at enhance rate Whether simultaneously applied for commutation of pension with the pension application (applicable only in the case of those who retire on Superannuation pension.)		:
97
(b) The portion of pension commuted:
98
(c) Commuted value of pension:
99
(d) Amount of residuary pension after deducting commuted portion.:
100
(e) Date from which reduced pension is payable.: