PCDA(F) ALLAHABAD PHP-07/2017(Pre-2016 PBOR) (7th CPC)

LPC-CUM-DATA SHEET FOR REVISION OF PENSION IN RESPECT OF PRE-2016 PBORs AS PER CIRCULAR NO, 585

1 R 0 Code I I I 2 LPC Serial No 3 Original PPO No.

4 Latest Corr PPO No

5 PPO for Disability Element (if separately granted)

6. Latest Corr PPO No of Disability Pension, if any

7 Pension Type Being Drawn presently 8.DSC/TA Category

9,Name

10 Regimental Noj 14 j 11 Rank Last Held | j 12 Rank Pensioned for [ | 13 Group | | 13a Diploma (AICTE) | j

| |l 7.ACP/MACP Rank if any ["

Trade 15.Net Qualifying Service 16.Date of Birth

13 Date of Discharge 19 Date of Enrollment 20.Type of Pension

21 Date of Death 22.Aadhaar No

23 PAN No. 24 E-mail ID

25 Mobile No | +
26,Pay in Pay Scale (If Retired before 01.01,1986)

27 Pay scale (In which the personnel discharged Pre 86 cases) 1

28.Notional Pay/Actual Pay 29.Notional Pay /Actual Pay Code a 30.Notional Pay / Actual Pay as per 5th CPC
As per 4th CPC As per 4th CPC
31 Notional Pay/Actual Pay Code 32 Pay Band Corresponding to Notional Pay 33,Notional Pay / Actual Pay as per 6th CPC
As per 5th CPC AqnprfithCPn
As per 6th CPC I---- 1

34.Grade Pay as per 6th CPC 36.Notioal Pay Level

35.MSP (As per 6th CPC) 35a."X'1 Group Pay As per 7th CPC
(As per 6th CPC)
37.Notional Pay in Pay Level 38 Class
ss Pa
Pay 39.Gal. Award 1 40.Gal. Award 2 41.Gal. Award 3
(As per 7th CPC) (As pe r7thC PC)

42 Spouse/Family Pensioner s Name

43 Date of Birth of Family Pensioner 44.Relation [ | 45.PAN No.

46 Aadhaar No Of F P. 47.Mobile No OfFP.

48 E-mail ID
OfFP

49 Pensioner
Address

49a Pensioner Address 49b. Pensioner Address

District State

49c. Pensioner 50.War Injury Element % 51 .War Injury Pounded to 52. Disability Element %
Address Pin

53 Disability Rounded to (Other than WIE) 54.Composite Disability % 55.Disability From

56.Disability to 57.Service Element 58.LFP/SFP/OFP

59 Disability Element
As on 31 12 2015
62 Whether Pension Notified I [ As per
Court order (Y/N) I ___________ I
64 PPO No. (DSC/TA Service) |
As on 31 12 2015 As on 31 12 2015
60. Family Pension Share % 61.Enhanced Family Pen. Date upto
Which payable (if applicable) L
63.PPO issued in satisfaction Of
Court Order
65.Pension Recommended Code

66.Previous LPC SI. No (To be filled only in case of correction in 67.Whether National Pay Fixation method is
Previous 7th CPC PPO) More beneficial (Y/N) ’ ---- *

(PDA Details)

77 PDA Station

M
78. CPPC/Lsnk Bank Pin Code '' W
For PCDA(P) Use Only

CDR No.
i Date of Receipt
I
 Record Office

No.
Date
Signature & Seal of R.O.

CERTIFICATE

1. Certified that Col. Nos. 1 to 78 of LPC-Cum-Data Sheet in respect of Regt. No ............................ Rank ........................
Name................................................................ have been properly checked with reference to the entries in the Enrollment
Form, Discharge Roll, (Original) etc. and found correct.
2. Certified that qualifying service has been checked with reference to the Sheet Roll (Original).

Name & Signature of Name & Signature of Name & Signature of P.A.O. SEAL
Clk/Aud/SA SO/AAO AO/SAO

Claim Notified Vide ppo No.

Adr/Sr .Adr. SO(A)/AAO AO/SAO (P)