Application Form for Pre-2006 Pensioner/Family Pensioner

Application Form for Pre-2006 Pensioner/Family Pensioner

To........................
.........................
(Pension Sanctioning Authority)
(i.e. CPO/Sr.DPOs/WPOs etc.)
Sub: - Revision of Pension/Family Pension of Pre-2006
Pensioners/Family Pensioners in terms of the recommendation of
6th CPC.
Sir,
Kindly revise my Pension/Family Pension entitlement shown in my PPO
(photocopy enclosed) in terms of recommendation of 6th CPC. The
requisite particulars are given below:1. Name of the Applicant (in Block Letters with Full Postal Address,
PIN Code No. & Phone No. : ..............................................................
...................................................
2. Designation/Dept./Office: ...................................................
3. Name of Railway Servant/Deceased Railway Servant with
designation/Dept.: ...................................................

4. Date of Retirement/Death of the Railway servant (Death Certificate of

the Pensioner to be attached, if application is made by Family
Pensioner): ....................................................
5. Last Pay drawn & Scale: ....................................................
6. PPO No. & Date: ....................................................
7. Name of the office which issued PPO:
.....................................................
8. Name of the Bank & Branch/Post Office/Treasury:
.....................................................
9. Full Postal Address of the Linked Bank:
.....................................................
.....................................................
10. Pension Account Number (Photocopy of the first page of Pass Book
containing SB A/c No. to be attached): .....................................................
11. Pension/Family Pension consolidated/revised by Bank/Post
Office/Treasury as on 01.01.2006 (for Pre-2006 Pensioners/Family
Pensioners): ......................................................
12. (a) Name of the Spouse & Date of Birth with proof:
......................................................
(b)Name of dependent & DOB with proof:
......................................................
(c)Relation of dependent with deceased pensioner:
......................................................

13. Date of Birth of the Spouse/widow (proof of Date of Birth * must be

enclosed): ......................................................
14. Documentary evidences such as photo copies of
(i) Service Certificate, (ii) PPO Book,
(iii) Death Certificate, if applicable, (iv) Photocopy of 1st page of Pass
Book & (v) Age proof certificate: ....................................................
Date: .................................

Yours faithfully,

Place: .................................

______________
(Signature)

N.B.
* Attested copy of any one of the following documents in support of
Date of Birth of the
Spouse/Widow may be submitted- (a) Birth Certificate (b) School
Leaving Certificate
(c) Identify Card issued by Railways (d) Medical Card issued by
Railways (e) Pan Card
(f) Passport (g) Voter ID.
Copy to: Pension Disbursing Authority (i.e. Bank/Post Office/Treasury
etc.)