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PENSION DATA INPUT SHEET
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110 Digit DDO Code:
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2Date of Submission of Pension Papers:
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3Adhaar Card Number:
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First NameMiddle NameSur Name
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4Full Name of the Retiring Government Servant:
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5Date of Birth:
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6Date of Appointment:
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7Date of Regularization:
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8Date of Retirement/Death:
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9Designation:( 24 Characters only)
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10Last Place of Working: ( 22 Characters only)
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11Parent Department:( 22 Characters only)
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12GPF Account No:
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13KGID No.
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Address before retirement
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14Flat/ Door/ Block No.( 28 Characters only)
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15Name of Premises/ Building/ Village( 28 Characters only)
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16Road/ Street/ Lane/ Post Office( 28 Characters only)
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17Area/ Locality/ Taluka/ Sub-Division( 28 Characters only)
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18Town/ City/ District( 22 Characters only)
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19Pin Code( 06 Characters only)
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Address After retirement
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20Flat/ Door/ Block No.( 28 Characters only)
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21Name of Premises/ Building/ Village( 28 Characters only)
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22Road/ Street/ Lane/ Post Office( 28 Characters only)
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23Area/ Locality/ Taluka/ Sub-Division( 28 Characters only)
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24Town/ City/ District( 22 Characters only)
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25Pin Code( 06 Characters only)
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26Phone Number / Landline
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27Mobile Number
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28Email Id:
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29Place of payment (treasury/sub-treasury):
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30Bank Account No
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31Name of the Bank
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32Type of retirement [Please select tick mark in dropdown menu]
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1. Superannuation 0
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2.Voluntary 0
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3.Compulsory0
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4. Invalid0
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If Invalid please specify
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33Rules applicable [Please select tick mark in dropdown menu]
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1. KCSR0
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2. TBS0
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3. FNJPC0
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4. UGC0
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5. ICAR0
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6. AICTE0
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34Name of Wife/Husband:
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35Date of Birth of Spouse (Wife/Husband):
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36 LIST OF FAMILY MEMBERS
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Sl. No.NameRelationshipDate of BirthMarital StatusPhysically /Mentally Challenged
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1
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2
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3
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4
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37Details of Previous service, if any:FromTo
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(i)Daily Wage service:
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(ii)MRE service:
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(iii)Local Candidate service:
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(iv)Stipendiary service:
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(v)Any others(Specify):
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38Details of Additions to Service (Specify the rules)(Sanction order to be enclosed)
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Rule of KCRSs
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39Details of Non-Qualifying Service (Mention the types: dies-non, LWA, Suspension etc.)
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TypeType
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40Pay Drawn on Last Day of Service STATE SCALE
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(a)Basic Pay :Rs./per month
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(b)Grade Pay/ADA/IR:Rs./per month
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(c)Personal Pay/Special Pay:Rs./per month
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(d) Average Emoluments:Rs./per month
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41Scale of Pay Admissible:
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42Details of Outstanding Government Dues
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1)HBA / HPA
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2)MCA
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3)Computer Advance
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4)Others (Specify):
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43Father Name (Husband's name in case of women Government servent)
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44Permanent or last appointment including name of establishment.
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45Class of Pension or Service Gratuity applied for and cause of application
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46Class of Pension or service Gratuity applied for and cause of application. SUPERANNUATION