instructions regarding grant of timely ex-gratia benefits...

53

For Office Use

INSTRUCTIONS REGARDING GRANT

OF TIMELY EX-GRATIA BENEFITS

TO THE FAMILY OF DECEASED

UNIVERISTY EMPLOYEES

CHAUDHARY CHARAN SINGH

HARYANA AGRICULTURAL UNIVERISTY

HISAR

2010

54

PREFACE

In order to make timely payment of ex-gratia benefits to the family of deceased

University employees, instructions have been issued from time to time by the

University. However, for sometime past, it was felt that these payments get delayed

due to one reason or the other and for want of readily available instructions. So, it

became necessary to have instructions as well as procedure to be adopted in this regard

may be compiled in a booklet form. Accordingly, the present booklet titled as

“Instructions regarding grant of timely Ex-gratia Benefits to the Family of Deceased

University Employees” has been brought out, which contains the time schedule as well

as procedure for releasing ex-gratia benefits such as; EWF, GSLIS, Ex-gratia, Death-

cum-Retirement Gratuity, Leave Encashment, Compassionate Financial Assistance,

Final Payment of CPF/GPF and Family Pension (if the deceased employee was in

pension scheme). This booklet will serve as a guide and handy reference book to the

Heads of the Departments/Offices as well as other concerned offices for releasing

timely payment of ex-gratia benefits to the family of deceased University employees.

I appreciate the efforts made by Sh. M. L. Munjal, Dy. Comptroller (Budget)

and the assistance of computer typing extended by Sh. Krishan Munjal, Sr. Scale

Stenographer and Mrs. Neelam Arora, Jr. Scale Stenographer in the compilation of

this important booklet.

June, 2010 (K. S. Khokhar)

Vice-Chancellor

55

INDEX

Sr.

No.

Particulars Page

No.

1. Details of payments to the bereaved families 1

2. Time Schedule for payments 1-3

3. Position and the attachments/documents required in each case of

assistance

3-8

4. Pre-requisites for payments 9-11

5. Application/proposal for release of assistance out of EWF 12-13

6. Application/proposal for release of payment of GSLIS 14-16

7. Application/proposal for Ex-gratia grant 17-20

8. Application for payment of Leave Encashment 21

9. Application/proposal for release of Death-cum-Retirement Gratuity 22-24

10. Application/proposal for Compassionate Financial Assistance 25-27

11. Application/proposal for Final Payment of CPF/GPF 28-31

12. Family Pension Form Set 32-52

1

Payments to bereaved families

It has been observed that the financial assistance to the families of the

employees dying while in service is not being provided in time. So to avoid

unnecessary delay and to render financial assistance to the bereaved family in

time, the University has been nominating/appointing Sr. Welfare Officer and

Welfare Officer every year amongst the teachers and the employees of the

University for the last several years. The job of the Welfare Officers is as

under : -

(i) To assist the bereaved families without any inhibition and in a spirit of

social service.

(ii) To ensure that all formalities regarding final payments due to the families

of the deceased employees are got completed and cases got processed

expeditiously.

(iii) To visit the families to render all possible help wherever feasible.

2. The Welfare Officers are required to be given intimation about the unfortunate

incident immediately so that all possible necessary assistance is rendered timely.

3. The bereaved family is provided the following assistance :-

I. Employees Welfare Fund (EWF)

II. Group Saving Linked Insurance (GSLI)

III. Ex-Gratia Grant

IV. Leave Encashment

V. Death-cum-Retirement Gratuity (DCRG)

VI. Compassionate Financial Assistance

VII. Final Payment of CPF/GPF

VIII. Family Pension (if the employee was in the Pension Scheme)

4. Time Schedule

(A) Head of Deptt./office/Section

To ensure the timely release of all payments on account of the above, the time

schedule has been laid down for the various Deptts./offices as under :-

Sr.

No.

Particulars Time prescribed

(i) Head of Deptt./Section, on the receipt of intimation

regarding the death of an employee, will inform the

Registrar, Comptroller, Controlling Officer and the Sr.

Welfare Officer/Welfare Officer

Same day

2

Sr.

No.


(ii) (a) He will obtain the ‘No Dues Certificate’ (NOC)

from all concerned.

(b) Simultaneously, he will obtain the

requests/applications except of family pension

(complete in all respect) from the nominee/legal

heir of the deceased employee in respect of the

above mentioned assistance. For this purpose, the

HOD/Incharge will depute an official to get the

necessary forms filled if the family of the

deceased employee is at headquarter. If the

family of the deceased employee is living at

outstation, he will send the necessary

applications/forms alongwith detail of the pre-

requisite documents, by post (Registered) for

furnishing the same.

(c) If there is any delay in submitting the application

and furnishing the desired information by the

family of the deceased employee, HOD/ Incharge

will also send the necessary information to the

Sr. Welfare Officer/Welfare Officer/Controlling

Officer/Comptroller/ Registrar

Within 15 days

(iii) Thereafter, he will submit all the cases (except of family

pension) with the service book/personal

file/NOCs/CR/SAR file with a single note to the

Controlling Officer for sanction/onward transmission to

the Comptroller & Registrar as under :-

Within 7 days

(a) EWF, GSLIS, Ex-gratia, DCRG, Final Payment of

CPF/GPF to the Comptroller.

(b) Compassionate Financial Assistance to the Registrar

(c) Leave encashment : to be sanctioned by the

HOD/Controlling Officer as per their competency)

(iv) He will make/ensure the payment of leave

encashment/DCRG after its sanction by the competent

authority

Within 7 days

3

Sr.

No.


(v) Before completion of admissible period of

Compassionate Financial Assistance, the HOD/Incharge

will process the case of Family Pension due to the

bereaved family

6 months prior to

the completion of

Compassionate

Financial

Assistance

(B) Controlling Officer

On receipt of the cases, he will scrutinize them and forward the

cases of EWF, GSLIS, Ex-gratia, DCRG, Final Payment of

CPF/GPF to the Comptroller while the case for grant of

Compassionate Financial Assistance to the Registrar. He will

forward the case of Compassionate Financial Assistance with an

attested copy of the service book of the deceased employee,

while the case of leave encashment, after sanction, will be

returned to the Deptt./office.

Within 15 days

(C) Comptroller

On receipt of the cases, he will deal/process all the cases and

will ensure the payments (except of GSLIS as in this case the

payment is to be released by the LIC).

Within 15 days

(D) Registrar

On receipt of the case of Compassionate Financial Assistance,

he will process and obtain the approval.

Within 15 days

(E) Sr. Welfare Officer/Welfare Officer

Sr. Welfare Officer/Welfare Officer will pursue and ensure the

release of all the payments/dues to the nominee/legal heir of the

deceased employee timely. He will report the delay, if any, in

release of the payments to the Registrar.

Within 15 days

5. In case of late payment of dues to the bereaved family, responsibility will be

fixed by the HOD/Officer concerned/Registrar. The defaulter will be fined @

Rs.100/- per day. If the delay is more than one month, disciplinary proceedings

will be initiated against the defaulter.

6. The position in brief and the attachments/documents required in each case of

assistance is as under :-

I. Employees Welfare Fund:

(a) Out of this fund, the Monetary aids are provided to the family of

deceased in case of his death. An amount of Rs. 7500/- is given

immediately within 15 days of occurrence of the death of the

employee out of this fund on the request of the legal heir/nominee.

4

(b) Financial assistance on the basis of rate of contribution by the

employees is given as under : -

(Amount in Rs.)

S.

No.

Rate of contribution per

month

Amount of financial

assistance admissible out

of EWF

1. 15/- 35,000/-

2. 30/- 70,000/-

3. 60/- 1,40,000/-

4. 90/- 2,00,000/-

The amount of Rs. 7500/- as mentioned in (a) above is reduced

from the quantum of financial assistance admissible as mentioned

above.

II. Group Saving Linked Insurance Scheme (GSLIS):

According to this scheme, a portion of premium charged is set aside for

insurance cover in the event of death and the balance is put into saving

bank account of each member with interest. Out of every Rs. 10/-

collected, about Rs. 3.75 are appropriated towards risk cover premium

and the balance amount of about Rs. 6.25 is credited to the saving

account. The monthly contribution payable by the employee and the

amount of the insurance cover is as under: -

S. No. Category of employee Monthly premium Maximum cover

1. Class-I 100 1,00,000/-

2. Class-II 60 60,000/-

3. Class-III 30 30,000/-

4. Class-IV 15 15,000/-

The above rates have been revised w.e.f. 7/09 payable in 8/09, the revised

rates of monthly contribution and the amount of insurance cover is as

under :-

S. No. Category Revised Monthly

premium

Maximum cover

1. Class-I 180 1,00,000/-

2. Class-II 108 60,000/-

3. Class-III 54 30,000/-

4. Class-IV 27 15,000/-

5

According to the above, the insurance cover & saving portion is on 50 :

50% basis which are payable in the event of the death of the employee

(i) In the event of death of an employee, the insurance cover as

applicable to respective category would be paid to his beneficiary.

In addition, amount accumulated in the savings with interest in

respect of the deceased employee upto the date of death would also

be paid to his beneficiary.

III. Ex-gratia grant/payment:

In the event of death of the employee, Ex-gratia grant maximum of

Rs. 25,000/- is given to the dependent of the deceased employee.

IV. Leave Encashment :

The payment in lieu of unutilized earned leave at the credit of the

employee on the day of death is granted. This leave encashment is paid in

lumpsum as a one time settlement and maximum of 300 days. This cash

payment for unutilized earned leave is made in the manner as under : -

Cash

Payment =

Pay+GP+DA as admissible

on date of death

30 x

Number of unutilized

days of earned leave

credit subject to a

maximum of 300 days

V. Death-cum-Retirement Gratuity : -

DCRG is granted to the dependent/nominated family member/legal heir

of the deceased employee. This gratuity is calculated as under: -

Last pay

drawn

(plus D.A.). x

4

1

x

Completed 6 monthly period subject to

maximum 66 times in case of Class-I, Class-II

and Class-III and 70 times in case of Class-IV

employees (Fraction of 3 months & more to be

counted half year).

Gratuity on death :

(i) 2 months emoluments If service is less than one year

(ii) 6 months emoluments If service is less than five years.

(iii) 12 months emoluments If service is five years to 24 years

period.

(iv) ¼ month emoluments for

each half year subject to a

maximum of 16½ months

(17½ months in case of Class

IV).

In excess of 24 years service.

6

The maximum limit of payable DCRG has been revised to

Rs. 10,00,000/- w.e.f. 1.1.2006.

VI. Compassionate Financial Assistance :-

The Govt. of Haryana has notified “Haryana Compassionate Assistance to

the dependents of deceased Government Employees Rules, 2006” to grant

compassionate assistance by way of ex-gratia financial assistance on

compassionate grounds to the members of the families of the deceased

Govt. employees who die while in regular service/missing. The Govt. of

Haryana instructions have been adopted by the University as such. The

object of the rules is to assist the family of a deceased/missing employee,

in tiding over the emergent situation, resulting from the loss of the bread-

earner while in regular service. On the death of an employee, the family

of the employee would continue to receive financial assistance a sum

equal to the pay and other allowances that was last drawn by the deceased

employee in the normal course without raising a specific claim as under :-

1 (a) for a period of fifteen years from the date of death of the employee,

if the employee at the time of his/her death had not attained the age

of thirty five years.

(b) for a period of twelve years or till the date the employee would

have retired from Government service on attaining the age of

superannuation, whichever is less, if the employee at the time of

his/her death had attained the age of thirty-five years but had not

attained the age of forty-eight years.

(c) for a period of seven years or till the date the employee would have

retired from Government service on attaining the age of

superannuation, whichever is less, if the employee had attained the

age of forty-eight years.

2. House Rent Allowance shall not be a part of allowance for the

purposes of calculation of assistance.

3. The family of a deceased Government employee who was in

occupation of a Government residence would continue to retain the

residence on payment of normal rent/license fee for a period of one

year from the date of death of the employee.

4. The eligibility to receive financial assistance under the rules shall

be as per the provision in the Pension/Family Pension Scheme –

1964.

5. The family shall be eligible to receive family pension as per the

normal rules only after the period during which he/she receives the

financial assistance as above is completed.

The request of the eligible nominee/legal heir of the deceased family will

7

be made in the prescribed Form as circulated by the Govt./University. On

the receipt of this form, the department shall prepare/send a case (after

getting the last salary drawn by the deceased employee duly verified from

the Audit) alongwith service book to the Registrar through Controlling

Officer for obtaining the necessary orders of the competent authority and

issuing the orders so that the payment shall be released by the department.

The payment will be released within one month by the department/office

concerned. In case of inordinate delay, the responsibility will be fixed and

necessary action will be initiated against the official at fault.

VII. Final payment of C.P.F./G.P.F. :-

When a subscriber dies, the amount standing to his credit in the General

Provident Fund/Contributory Provident Fund is paid to his dependents.

The interest shall be paid on the amount upto the end of twelve months

after the month in which the amount becomes payable.

As per the rules, the final payment of CPF/GPF can be drawn by the legal

heir/nominee of the deceased employee after producing No Objection

Certificate from all concerned. The request will be made in the prescribed

form. Thereafter, the HOD will send the case in the prescribed Form after

furnishing the complete information through the Controlling Officer to

the Comptroller for final payment. This case will be supported with the

service book and the copies of the NOC from all concerned. The service

book should also contain the entry of the death of the employee as well as

having obtained the NOC from all concerned. This entry should be duly

attested/verified by the DDO/HOD concerned and the Audit.

VIII. Family Pension (If the employee is/was in the Pension Scheme) :-

Under Haryana Civil Services (Revised Pension) Part-II Rules, 2009, in

case of death of an employee during service, if the service is more than

one year but less than seven years, then minimum Rs.3500/- p.m. pension

is admissible to his/her family w.e.f. 01.01.2006. If service is more than 7

years, the family would get Enhanced Family Pension at the rates of

pension what the employee would have drawn had he superannuated on

attaining the age of 60 years at the pay drawn on the date of death while

in service. This Enhanced Family Pension would be for 10 years after the

completion of period of Financial Assistance. After that, the family would

get normal family pension at the rate of 30% of basic pay of employee.

Definition of family for entitlement of family pension

(i) For the purposes of grant of family pension, the term ‘family’ shall

be categorized as under : -

Category-I

(a) widow or widower, upto re-marriage, or, as the case may be,

8

death if the recipient remains un-married till death;

(b) son/daughter (including widowed daughter), upto the date of

his/her marriage/re-marriage or till the date he/she starts

earning or till the date he/she attains an age of 25 years,

whichever is the earliest.

Category-II

(a) unmarried/widowed/divorced daughter, not covered under

Category-I above, till the date of marriage/re-marriage or till

the date she starts earning or till the date of death, whichever

is earlier;

(b) parents who were wholly dependent on the Government

servant when he/she was alive provided the deceased

employee had left behind neither a widow nor a child.

(ii) Family pension to unmarried/widowed/divorced daughters in

Category II and dependent parents shall be payable only after the

other eligible family members in Category I have ceased to be

eligible to receive family pension and there is no other eligible

disabled child to receive the family pension. Grant of family

pension to children in respective categories shall be payable in

order of their date of birth and younger of them will not be eligible

for family pension unless the next above him/her has become

ineligible for grant of family pension in that category.

(iii) The dependency criteria for the purpose of family pension shall be

the minimum family pension of Rs. 3,500/- and dearness relief

thereon.

(iv) The childless widow of a deceased Government servant shall

continue to be paid family pension even after her remarriage

subject to the condition that the family pension shall cease once her

independent income from all other sources becomes equal to or

higher than the minimum prescribed family pension in the State

Government. In all such cases, the family pensioner would be

required to give a declaration regarding her income from all other

sources to the Pension Disbursing Authority every six months.

3. All the cases for grant of assistance as mentioned above will be prepared by the

concerned department/office where the employee was working and forwarded to

the competent authorities. All these cases will be initiated along with the request

of the dependent of the deceased family, death certificate, service book etc. of

the deceased employee. The pre-requisite for sanction of the above payments/

assistance out of various funds are detailed in the Annexure ‘A’.

9

ANNEXURE-A

PRE-REQUISITES FOR PAYMENTS

I. Employees Welfare Fund :

(i) Application from the nominated family member/legal heir.

(ii) Service book with entry of death of the employee duly attested/verified by

the DDO/HOD concerned and Audit.

(iii) Certificate from the DDO/HOD that the deceased was a regular subscriber

@ Rs.______ p.m. and when was the last deduction made duly verified by

the Audit.

(iv) Attested copies of the Death certificate and nomination form duly

accepted by the competent authority.

(v) Application with the recommendations of the HOD/Controlling Officer is

to be forwarded to the Comptroller for payment.

II. GSLIS :



the DDO/HOD and Audit

(iii) Original Death Certificate issued by the Registrar, Birth & Death

Registration Authority/competent authority.

(iv) Certificate from the DDO/HOD that the deceased was a regular

contributor towards GSLIS and that his name was sent to the

Comptroller’s office on 1st June while sending the list of employees to be

covered under GSLIS.

(v) Application in the prescribed proforma with the recommendations of the

HOD/ Controlling Officer is to be forwarded to the Comptroller for

payment.

(vi) Attested copy of the nomination form and the receipt of the nominee.

III. Ex-Gratia Grant :

(i) Application alongwith affidavit from the nominated family member/legal

heir.


the DDO/HOD & Audit.

(iii) Confidential Reports File alongwith gist of the CRs/SARs of the deceased

employee.

10

(iv) Application in the prescribed proforma with the recommendations of the

HOD/ Controlling Officer is to be forwarded to the Comptroller for

payment.

IV. Payment of Leave Encashment :



the DDO/HOD & Audit.

(iii) No dues certificates may be obtained from the DEO, Nehru Library,

Faculty Club/Community Centre, Appointing authority, Bank concerned

(if loanee) and the Department and the entries thereof are also to be made

in the service book duly attested/ verified by the DDO/HOD & Audit.

(iv) Case with the recommendations of the DDO is to submitted for sanction

to the competent authority.

V. Payment of Death-cum-Retirement Gratuity :


(ii) Service book with entry of death of the employee and all certificates

required for pension recorded in service book duly attested by the

DDO/HOD.



(if loanee) and entry thereof in the service book duly attested by the

DDO/HOD.

(iv) Original or attested copy of the death certificate and personal file.

(v) Recommendations of the HOD/Controlling Officer, if any deduction is

required to be made from the gratuity due to unsatisfactory work of the

official or any dues of the University made to the Comptroller for

sanction.

VI. Compassionate Financial Assistance :

(i) Application (alongwith death certificate) and an undertaking on affidavit

in view of employment/remarriage from the nominated family

member/legal heir.

(ii) Service book or attested photocopy thereof with entry of death of the

employee duly attested/verified by the DDO/HOD & Audit.



(if loanee) and the Department and the entries thereof are also to be made

in the service book duly attested/ verified by the DDO/HOD & Audit.

11

(iv) Detail of the last emoluments (Pay + GP + Allowances) drawn by the

deceased duly attested/verified by the DDO/HOD & Audit.

(v) Application, alongwith service book, No Objection Certificates from all

concerned alongwith recommendations of the Controlling Officer is to be

sent to the Registrar for necessary approval and issue of orders.

VII. Final payment of C.P.F./G.P.F. :-

(i) Application in the prescribed form (alongwith death certificate & two

attested photos, personal identification mark slip, two signatures duly

attested) from the nominated family member/legal heir.

(ii) Service book with entry of death of the employee duly

attested/verified by the DDO/HOD & Audit.


Faculty Club/Community Centre, Appointing authority, Bank

concerned (if loanee) and the Department and the entries thereof are

also to be made in the service book duly attested/ verified by the

DDO/HOD & Audit.

(iv) Applications in the prescribed form alongwith service book duly

attested photocopy of nomination form, No Objection Certificates

from all concerned with the recommendations of the Controlling

Officer is to be sent to the Comptroller for payment.

VIII. Family Pension

(i) Application in the prescribed form (pension set) with the affidavits,

photos and death certificate from the nominated family member/legal

heir.

(ii) Service book with entry of death of the employee and all required

certificates for pension to be recorded in the service book duly attested

by the DDO/HOD.


Faculty Club/Community Centre, Appointing authority, Bank

concerned (if loanee) and the Department and the entries thereof are

also to be made in the service book duly attested (verified by the

DDO/HOD & Audit).

(iv) Application, alongwith service book, No Objection Certificates from

all concerned alongwith recommendations of the Controlling Officer

is to be sent to the Comptroller for issue of PPO.

12

APPLICATION FOR RELEASE OF ASSISTANCE OUT OF

EMPLOYEES WELFARE FUND

1. Full information of the deceased University Employee :

(i) Name & Designation :

(ii) Deptt./office :

(iii) Date of Birth :

(iv) Date of joining of employee :

(v) Date of death (with proof) :

(vi) Pay scale :

2. Full information of Applicant/claimant

(i) Name :

(ii) Full Address :

(iii) Relationship with the deceased :

University employee

3. Any other information :

It is requested to release the assistance out of the Employees Welfare Fund as

per HAU rules.

Encl : Death Certificate

Place : Signature of the applicant

Date :

13

Subject : Grant of assistance out of Employees Welfare Fund (EWF) in respect of

Sh./Smt. ____________________________.

Sh./Smt. ____________________ S/o, W/o ______________________

was working as __________________________________ in this office/department.

Sh. Smt. ________________________ s/o, w/o late __________________________

has requested for grant of assistance out of Employees Welfare Fund (EWF). Late

Sh./Smt. ____________________ has expired on _____________ as per death

certificate issued by ___________________. As per nomination, the payment is to be

made to Sh./Smt._________ s/o, w/o of the deceased employee. The deceased

employee was contributing towards EWF @ Rs.___________ per month and last

deduction of EWF contribution was made from the salary in the month

of ___________ (to be got verified from the Audit). Therefore, the financial assistance

of Rs. _________ is admissible. An immediate assistance of Rs.__________ has

already been given to the family of the deceased employee. Therefore, full/balance

amount of Rs.___________ is payable to the nominee. The case is recommended and

forwarded to the Controlling Officer for onward transmission to the Comptroller.

Head of Department

(alongwith signature & stamp)

Controlling Officer

The above case has been checked and is in order. So the case of the nominee

of late Sh./Smt.__________ for making the payment of Rs._____________ on account

of financial assistance out of EWF is recommended and forwarded to the Comptroller.

Controlling Officer

(alongwith signature & stamp)

The case of __________ in respect of late Sh./Smt. _____________ for

making the payment of Rs. ____________ on account of financial assistance out of

EWF is in order and is submitted to the Comptroller for sanction/approval please.

14

APPLICATION FOR RELEASE OF PAYMENT OF GSLIS







(vi) Pay scale :


(i) Name :

(ii) Full Address :

(iii) Relationship with the deceased/ :

University employee


It is requested to release the payment of GSLIS as per HAU rules.


Signature of the applicant

Place :

Date :

15

ANNEXURE-II

LIFE INSURANCE CORPORATION OF INDIA

Divisional Office KARNAL

GSLI CLAIM FORM B

(To be completed by the Master policy holder for claiming benefits under the Group

Savings Linked Insurance Scheme on death of a member)

1. Name of the Master Policy Holder COMPTROLLER,

CCSHAU, HISAR

2. Master Policy No. GSLI 67086

Date of commencement 20.08.1987

3. Full name of the deceased employee

4. Employee No./Sr. No. in the list of members

5. Date of birth

6. Date of joining service

7. Date of joining the scheme

8. Category/Salary Grade

9. Date of death

10. Amount of life insurance cover on the date of death

11. Amount of monthly contribution

Risk Portion

Savings Portion

12. If there has been any change/s in the monthly

contribution during his membership indicate the date of

change/s and the revised contribution/s

13. Amount of last monthly contribution

14. Due date for payment of the last monthly contribution

(indicate day-month & year)

15. The date on which the last contribution was paid to the

Corporation

16. Are there any gaps in premium and if so, give full

particulars thereof.

17. Cause of Death

18. Nature of proof of death (please enclose original death

registration certificate)

19. Was the member in the service of the employer on the

date of death

16

20. Name of the beneficiary and relationship with the

member

21. Additional information in case death has taken place within 3 years of date of

joining the scheme

(a) Was the member absent on the date of entry into the

scheme (if so, give details of leave i.e. period of absence.

Cause of absence, how the absence was treated by the

employer and date of resuming duties)

(b) Whether the contribution of the member was included in

the monthly remittance for the scheme as a whole in the

first month. Give details of amount and date of payment

to LIC

(c) The date of the Authority-cum-declaration form signed

by the employee

(d) Was the member alive on the date the salary was

disbursed and out of which the deduction of contribution

to the GSLI scheme to cover the first premium was made

by the employer.

We hereby declare that the answers to the above questions are true in every

respect and the deceased member was eligible for the above benefits as per the rules of

our GSLI Scheme and contributions were paid in respect of him strictly as per the rules

of the scheme.

Head of department

Controlling Officer

Dated at ________________ this _________ day of _____________________

WITNESS Signature of the

Master policyholder

Signature ___________

Name ______________

Address ____________

___________________

Detail of premium

17

CCS HARYANA AGRICULTURAL UNIVERSITY, HISAR

FORM OF APPLICATION FOR EX-GRATIA GRANT

PART-A

Application from the family of Late Dr./Sh./Smt._____________________

employed as _________________ in the office/deptt. of _______________________.

1. Name and full address of the applicant

2. Relationship to the deceased employee

3. Date of birth of the HAU employee

4. Name and age of surviving relation of deceased

a) Widow/husband

b) Sons Name Age

c) Unmarried daughters

d) Widow daughters

e) Parents wholly dependent on the deceased HAU

employee

f) Widowed/unmarried sisters

5. General financial condition of the family

(to be indicated in affidavit proforma A/I)

6. Any other source of income

7. In case the widow/or any member of the deceased

is employed, give detail of employment indicating

the monthly emoluments drawn in each case.

8. Any other relevant information

Place :

Date : Signature of applicant

18

ASSISTANCE OUT OF EX-GRATIA GRANT

AFFIDAVIT

I, _____________________ W/o /S/o _____________ R/o _____________________

solemnly affirm and declare as under :-

That the following property was with my husband/father and with the members

of his family at the time of death.

(a) Detail of deposit in bank/post office.

(b) Amount of General Life Insurance & income on other investments.

(c) Detail of cash/jewellery.

(d) Details of movable/immovable property and other investments.

(e) If any amount is received from ex-gratia policy, details of the same.

2. Family members who are in Government/University service

(Income in each case be mentioned)

Sr.

No.

Name of member and

relationship with

deceased

Age Whether

married or

unmarried

Detail of job

& monthly

income

1.

2.

3.

4.

5.

3. The following are the sources of income of family members :-

(a)

(b)

(c)

4. I was fully dependent on the deceased/University employee.

DEPONENT

VERIFICATION

I further hereby declare that the information given in the application form under

the ex-gratia scheme and in the affidavit is correct and true to the best of my

knowledge and belief and nothing has been concealed therein.

DEPONENT

19

PART-B

(To be filled by the Head of office/department)

1. Name of the deceased employee

2. Circumstances under which the employee

died

3. Length of service

4. Date of birth

5. Details of monthly emoluments drawn at

the time of death (with pay scale)

6. Financial conditions of the family

alongwith exceptional features, if any.

7. Record of service alongwith exceptional

features, if any

8. Property owned by the deceased employee

(copy of property declaration be attached)

9. Period between date of retirement and date

of death.

10. a) Benefits which would have been accrued

to the deceased by way of GPF/CPF,

gratuity, if he had retired in the normal

course.

b) Benefits which his family will not

receive as CPF/GPF/Gratuity

11. Amount of CPF/GPF at the credit of the

deceased employee at the time of death.

12. Where are the sons of the deceased settled

and what are their monthly income

13. Amount of ex-gratia grant recommended

Note : Lump-sum grant equal to 10 times the last emoluments drawn before the

employee’s death subject to a minimum Rs.10,000/- and a maximum of Rs.25,000/-

provided the record of service of the deceased is not exceedingly adverse, say in the

matter of integrity.

Place : Signature of the Head of office/deptt.

Dated :

20

PART-C

(For use of Administrative Department/Head of Deptt.)

1. Recommendations by the Head of the Department

2. Recommendations by the Controlling Officer

PART – D

Forwarded to the Comptroller for sanction and payment of ex-gratia grant as

per HAU rules.

(ii) The CR/SAR file, service book and personal file of Dr./Sh./Smt.

___________________________________ are enclosed herewith.

21

APPLICATION FOR PAYMENT OF LEAVE ENCASHMENT







(vi) Pay scale :


(i) Name :

(ii) Full Address :


University employee


It is requested to release the payment of Leave Encashment as per HAU rules.



Date :

22

APPLICATION FOR RELEASE OF

DEATH-CUM-RETIREMENT GRATUITY







(vi) Pay scale :


(i) Name :

(ii) Full Address :


University employee


It is requested to release the Death-cum-Retirement Gratuity as per HAU rules.



Date :

23

DEPARTMENT OF ____________________________

CCS HAU, HISAR

Subject : Death-cum-Retirement Gratuity (DCRG) in respect of late

Dr./Sh./Smt. ______________________________.

Dr./Sh./Smt. __________________ (designation) _________________ has

expired on ____________. Legal heir/nominee of Dr./Sh./Smt._________________

has made a request for release of Death-cum- Retirement Gratuity in respect of

him/her. He/she joined HAU service on ______________. He/she was on EOL from

___________ to _____________ (total period = _______________). He/she has thus

rendered total qualifying service in HAU for _________ years, ________ months and

_______ days. He/she has satisfactory record of service to his/her credit under Rule

6.16-A of Pb. CSR Vol.II. Death-cum-Retirement Gratuity is payable to him/her/his

family/ legal heirs as per calculations below :-

Last Basic Pay +

Grade Pay +

DA @ _______%

Total emoluments = Rs._________

Gratuity =

No Dues Certificates have been obtained from all concerned i.e. DEO,

Nehru Library, Faculty Club/Community Centre, and the Departments Funds are

available in the Department.

It is proposed that above gratuity may be recommended in favour of

Sh./Smt./Dr. __________________ and the case may be sent to the Comptroller

through Controlling Officer for according financial sanction.

Head of Department

24

CONTROLLING OFFICE

The information/particulars as furnished above has/have been checked with

reference to the service book/record is/are correct. The case is recommended to the

Comptroller for according sanction of Rs.______________ as Death-cum-Retirement-

Gratuity to the claimant - Dr./Sh./Smt.______________.

COMPTROLLER OFFICE

This is a Death-cum-Retirement gratuity case in respect of

Dr./Sh./Smt._______________ which may kindly be perused.

2. The service has already been verified in service book. No Dues Certificates

from all concerned have been obtained and entry made in the service book. The Head,

Deptt. of _______________ and _____________________ (Controlling Officer) have

recommended gratuity amounting to Rs.___________. Funds are available in the

concerned department/office. The case has been examined and found in order.

3. The gratuity has been calculated as under :-

Last Basic Pay + GP+DA ( ) X completed half years

4

4. The case is submitted for sanctioning a retirement gratuity of

Rs._______________ (Rupees _______________________________________

____________________________ only) in favour of Dr./Sh./Smt. ___________,

Department/office of ____________________________ please.

25

APPLICATION FOR COMPASSIONATE FINANCIAL ASSISTANCE







(vi) Date of missing :

(vii) Pay scale :


(i) Name :

(ii) Full Address :


missing Government employee

(iv) Detailed information regarding :

Dependents of deceased/missing

Government employee

Sr.

No.

Name Relationship Age/date

of birth

Occupation Married/unmarried

1. 2. 3. 4. 5. 6.

3. Monthly income of family from all sources :


Encl : (i) Death Certificate

(ii) An undertaking on affidavit in view of employment/remarriage


Date :

26

DEPARTMENT OF ____________________________

CCS HAU, HISAR

Subject : Compassionate Financial Assistance in respect of late

Dr./Sh./Smt. ______________________________.

Dr./Sh./Smt. ___________________ (designation) _____________ has

expired on ______________. Legal heir/nominee - he/she______________ of

Dr./Sh./Smt._________________ has made a request for payment of Compassionate

Financial Assistance. The date of birth of the deceased employee is ____________ and

he/she has joined the University service on ____________. He/she was due for normal

retirement on attaining the superannuation on ___________.

2. As per Sr. No. 5(1) (b) & 5 (2) of State Govt. Notification dated 1.8.06

adopted in the University vide Endst. No. 5434-5583 dated 11.8.06 and clarification

received from the Govt. vide letter dated 18.12.07 and adopted by the University vide

Endst. No. Admn.E.3/08/1345-1494 dated 22.2.08, on the death of any employee, the

family of the employee would continue to receive as financial assistance, a sum equal

to the pay and other allowances that was last drawn by the deceased employee in the

normal course without raising a specific claim for a period of 7 years or till the date the

employee would have retired from Govt. service on attaining the age of

superannuation whichever is less, if the employee had attained the age of 48 years and

above. The family shall also be eligible to receive family pension as per normal rules

(if the deceased employee has opted pension) after the period of financial assistance is

over.

3. The detail of the last salary drawn by the deceased employee is as under :-

(i) Basic Pay

(ii) Grade Pay

(iii) NPA

(iv) Special Pay

(v) ADA

(vi) FMA (if opted) _______________

Total : _______________

4. No Dues Certificates have been obtained from all concerned i.e. DEO, Nehru

Library, Faculty Club, Community Centre, Bank (if loanee) and the departments.

Nothing is due against him. The legal heir/nominee – he/she _____________ of the

deceased employee is entitled for Compassionate Financial Assistance for a period

w.e.f. _______ to _________ @ Rs.________ p.m. (BP+GP+SP+NPA+FMA+ADA).

27

Increase in ADA from time to time will also be admissible. Thereafter, he/she will be

entitled to family pension (if the deceased employee was in pension scheme), as per

rules. It is proposed that the above case may be recommended to the Registrar through

Controlling Officer for issuing the necessary orders of Compassionate Financial

Assistance as per rules.

CONTROLLING OFFICER

The above case has been checked and is in order. So, the case of the nominee

of Late Sh./Smt./Dr.________________________ for making the payment of

Rs.___________ p.m. w.e.f.___________ to ___________ on account of financial

assistance is recommended and forwarded to the Registrar for obtaining the sanction of

the Vice-Chancellor and issuing necessary orders.

REGISTRAR OFFICE

This is a case of Compassionate Financial Assistance in respect of

Sh./Smt./Dr.________________________ which may kindly be perused.

The information furnished above is correct. In view of the same, may

submit the case to the Vice-Chancellor for approval of Compassionate Financial

Assistance of Rs.__________________ p.m.(BP+GP+ NPA+SP+ADA+FMA) w.e.f.

_______ to _________ in respect of Late Sh./Smt./Dr.___________ to

Sh./Smt.________ legal heir of the deceased family whereafter the necessary

administrative orders will be issued. The increase in ADA from time to time will also

be admissible. Thereafter, the family of the deceased employee (if pension opted) will

be entitled to the family pension as per HAU Pension Rules please.

28

To

The Comptroller,

CCS HAU, Hisar.

(Through Proper Channel)

Sub :- Final payment of CPF/GPF.

Sir,

It is requested that arrangements may kindly be made for payment of the

accumulation in the Contributory Provident Fund/General Provident Fund account No.

of Sh/Smt……………………………. . Necessary particulars required in this

connection are given below :

1. Name of University employee.

2. Date of joining .

3. Date of birth.

4. Date of death.

5. Post held by University employee at the time of death.

6. Proof of death in the form of death Certificate issued by

the Municipal Authority etc.

7. (a) GPF account No.

(b) CPF account No.

8. The amount of CPF/GPF money standing to the credit of the subscriber at the

time of his/her death is Rs…………….. as per annual statement.

9. Details of nominee(s) alive on the date of death of the subscriber (if nomination

subsists) are as under :

Name of nominee Relationship with

Subscriber

Date of birth

of Nominee

Share of the nominee

1 2 3 4

10. In case no nomination subsists the details of surviving member(s) of the family

on the date of death of the Subscriber as under:

(i) Name

(ii) Relationship with the subscriber

(iii) Date of birth

29

Note (for para 9 and 10 above)

In case of minor nominee the claim should be supported by indemnity bond or

guardianship certificate, as the case may be.

11. If the subscriber has left no family and no nomination subsists (the names of

persons to whom the CPF/GPF money is payable should be supported by letter

of probate or succession certificate etc):

(i) Name

(ii) Relationship with subscriber

(iii) Date of birth

(iv) Address

(v) Religion of the claimants

12. The following documents duly attested by the Gazetted Officer/Magistrate are

also attached.

(i) Personal marks of identification

(ii) Left/right hand thumb and finger impression

(in case of illiterate claimants).

(iii) Specimen signatures in duplicate

(in case of literate claimants).

(iv) Photograph in duplicate.

Yours faithfully,

Signature of Claimant

Place : …………………… Name :

Date : …………………… Address :

Office of ………………Deptt./office

Endst. No.

Forwarded to the Comptroller for necessary payment.

2. Certified that the claimant is the rightful nominee/ legal heir to receive the

outstanding amount of CPF/GPF Account No………… in the name of

Sh………………. for Rs……………..

3. Signatures and photographs of the claimant are duly verified.

4. The entry of death has been made in the service book on page ……….

and duly verified by the Head of Deptt.

30

5. Has the above entry been got verified from RSA under full signatures ?

6. The date of bill from which last GPF/CPF deduction was made is …………

7. Details of recoveries, if any, duly verified from Audit are as under :

8. No Dues Certificate from others concerned (i.e. Librarian, DEO, Secretary,

Faculty Club/Community Centre) are at Pages …………. of personal file.

9. It is certified that nothing is due against the subscriber except Rs……………..

as mentioned above.

10. The following documents are sent herewith :

(i) Service Book.

(ii) Personal file (Page 1……to……).

(iii) Death Certificate

(iv) Nomination

(v) Documents as mentioned under para-12 of the applicant.

Signature of HOD/Office

Deptt./Office

Date

Note : Details whatever is inapplicable.

31

Sub: Final payment of GPF/CPF

PUC is an application of Dr./Sh./Smt. ________________________________

______________________________ Ex _____________________________ office of

the _______________________________________________ received through proper

channel for the refund of Contributory Provident Fund/General Provident Fund.

2. The total amount of Rs. ________________ + Interest Rs.________________

upto ___________ is standing to his/her credit under CPF/GPF A/c

No.___________.

Orders of acceptance of resignation/termination/retirement/voluntary retirement

may kindly be perused at __________. He/she joined University service on

regular basis on _____________ and left on ___________.

3. His/her service in the University since commencement of subscription of CPF is

not/is less than three years. He/she is not entitled to get University share of CPF.

4. As per ‘No Dues Certificate from Librarian ( ). Dy. Estate Officer ( ),

Secretary, Community Centre/Faculty Club ( ) and Head of

Deptt./Office ( ) and service-book page No. ______, recovery of

Rs.____________________ is due.

5. Consent of the subscriber for effecting this recovery out of his/her CPF/GPF is

at ____________. Audit verification of recoverable amount is at

______________.

6. May refund the payment of CPF/GPF of Rs. ____________________________

(Rupees ______________________________________________________) as

per details given overleaf, please.

7. Payee’s A/c Cheque in f/o _______________________________________.

Asstt.

32

CHAUDHARY CHARAN SINGH HARYANA AGRIL. UNIVERSITY , HISAR

FAMILY PENSION

1. Name & Designation of the deceased

2. Father/Husband's name

3. Date of birth

4. Date of entry into University service

5. Date of Death

6. Nature of claim

7. Relationship with the deceased

8. Postal Address

9. Permanent Address

10. Name of the family pensioner

33

FORM PEN 18

Form of letter to Controlling Officer for forwarding papers for the grant of

family pension

From

HOD concerned,

CCS HAU, Hisar.

To

The ………………. (Controlling Officer)

CCS HAU, Hisar.

Memo No. Dated :

Sub :- Grant of Family Pension.

It is to point out that Sh. ……………………………………………………..

Designation ……………………………died on ………………………………………

His family has become eligible for the grant of family pension. Form PEN 17 duly

completed is forwarded herewith for further necessary action.

1. University dues in respect of the deceased University employee will be

recovered out of Death-cum-retirement gratuity as indicated in section II of

Part-I of form PEN 17.

2. Your attention is invited to the list of enclosures which is forwarded herewith.

Yours faithfully

Head of Office

List of enclosures :-

Sr.No. Particulars

1. PEN 17 Application form duly completed (Rules 9.12(1), 9.24(1) (3) and (5)

and 9.26 (1) and (5).

2. Service Book indicating date of death.

3. Specimen signatures/left hand thumb and finger impression of the claimant

or guardian duly attested.

4. Three copies of passport size photograph of the claimant or guardian duly

attested.

5. Two copies of descriptive roll of the claimant or guardian duly attested

indicating height and personal marks.

34

6. Postal address of the claimant or guardian.

7. Annexure-I - Form of letter from HOD concerned to the widow/ Widower of

the deceased employee for grant of family pension.

8. Annexure-II - Form of application for the grant of family Pension on the

death of the employee - also see PEN 19 & 20.

9. Annexure-III - Form for sanctioning Family Pension.

10. Calculation sheet of Family pension.

11. No Dues Certificate in respect of long term advances & other Recoveries, if

any, by HOD, Librarian, DEO, Faculty Club, Community Centre.

12. No. complaint/Enquiry Certificate.

13. L.P.C.

14. Consent of the legal heir of the deceased University employee to recover the

amount of advances, if any, alongwith interest taken out of University share

of CPF alongwith interest taken out of own share of the employee and if

there is still any short-fall, the consent to recover the balance out of other

retiral benefits, if he/she opts for family pension.

15. Statement indicating reason for delay for not forwarding Application within

prescribed time, as per PCSR Vol. II Rules.

16. Employment/Non-employment Certificate from spouse claiming Family

pension.

17. Certificate of correctness of particulars/calculations by A&AO of the

Controlling Officer.

Endst. No. Dated :

Forwarded herewith the pension papers in respect of ……………….of the

Deptt. of ……………..…….. to the Comptroller, CCS HAU, Hisar. It is certified that

the particulars furnished in the application and its enclosures including Commutation

application are in order. Further necessary action to release the P.P.O. may be taken at

his end.

Signature

(Designation of Controlling Officer)

35

(FORM PEN 17) See rules 9.22(1), 9.24(1), (3) and (5) and 9.26 (1) and (5)

FORM FOR ASSESSING AND AUTHORISING THE PAYMENT OF FAMILY

PENSION WHEN A UNIVERSITY EMPLOYEE DIES WHILE IN SERVICE

To be sent in duplicate.

PART I

SECTION I

1. Name of the deceased University employee.

2. Father's name and also husband's name in

the case of female Univ. employee.

3. Date of birth (by Christian era).

4. Date of death (by Christian era).

5. Religion and Nationality.

6. Office/department in which last employed.

7. Appointment held last

(1) Substantive (2) Officiating

8. Date of beginning of service

9. Date of ending of service.

10 (i) Total period of military service for which pension/gratuity was sanctioned; and

(ii) Amount and nature of any pension/gratuity received for military service

11. Amount and nature of any pension received for previous civil service, if any.

12. Deptt./office under which service has been rendered in order of employment.

13. The date on which intimation regarding the death of a Univ. employee was

received by the Head of office.

14. The date on which action initiated to :

(i) Obtain claim or claims from the

Claimants in the appropriate form

death -cum-retirement gratuity and family

Pension as provided in rule 9.21.

(ii) Obtain the "No Dues certificate" from

the HOD, DEO, Library, F.Club, Community Centre.

(iii) Assess the Univ. dues other than the

dues pertaining to occupation of Univ.

36

Accommodation as provided in rule

9.24(2).

(iv) Assess the service and emoluments

qualifying for death-cum-retirement

Gratuity and family pension as provided

in rules 9.22 and 9.23.

15. Whether nomination made for Death-cum-

Retirement gratuity.

16. Length of service qualifying for Death-cum-

Retirement gratuity/pension.

17. Period of non-qualifying service.

(i) Interruption in service condoned under rule 3.17A.

(ii) Extra-ordinary leave not qualifying for Gratuity.

(iii) Period of suspension treated as non-qualifying

From……………….. to ………………….

(iv) Any other service not treated as qualifying Service.

Total period of non-qualifying service.

18. (a) Emoluments reckoning for Death-cum Retirement gratuity.

(b) Amount of Death-cum-Retirement Gratuity.

19. If Family Pension Scheme 1964 applies.

(i) Proposed family pension at :

(a) Enhanced rates (if service rendered at the time of death is more

than seven years) as in para 2 of Appendix I to these Rules )

(b) Ordinary rates (as in para 1 of Appendix 1 to these rules).

(ii) Period of tenability of Family Pension Scheme, 1964.

(a) Enhanced rates From To

(b) Ordinary rates

20. Person to whom family pension is payable.

Name : (Relationship with the deceased University employee)

Full postal address

37

21. Details of University dues recoverable out of gratuity:

(i) Licence fee for occupation of Univ. accommodation (see rule 9.27)

(ii) Amount of Death-cum-Retirement Gratuity to be held over pending

receipt of information from the D.E.O.

(iii) Dues referred to in rule 9.27(2).

22. Date on which claim received from the Claimant(s).

23. Name of guardian who will receive payment of Death-cum-Retirement

Gratuity and family pension in the case of minors.

24. Place of payment(branch of public sector Bank)

25. Head of Account to which family pension is debitable

Place

Dated the Signature of Head of Office

--------------------------------------------------------------------------------------------------------

38

SECTION II

Details of provisional family pension and gratuity to be sanctioned by the

pension sanctioning authority in accordance with rule 9.25.

Provisional family pension Rs. ……………………………………..

Gratuity (the amount mentioned in Item

18(b) of Part-I)

Rs. ...…………………………………...

Less

(a) Licence fee recoverable from

Gratuity for occupation of

University accommodation (as in

item 21(i) of part-I)

Rs. ……………………………………

(b) Amount of gratuity to be held over

pending receipt of information from

the DEO as item 21(ii) of part-I)

Rs……………………….…………..

(c) Other University dues as mentioned

in item 21(iii) of part-I

Rs………………………………………

(d) Other University dues as mentioned

in item 21(iii) of part -I

Rs……………………………………..

Place :

Dated, the Signature of Head of Office

39

SPECIMEN SIGNATURES

Specimen Signatures of Sh./Smt. ………………..…………………….…….

Designation ……………………….……………………………… Attested

1. ……………………………….

2. ……………………………….

3. ……………………………….

(Signature)

Designation with stamp

--------------------------------------------------------------------------------------------------------

PARTICULARS OF HEIGHT IDENTIFICATION MARKS

Sh./Smt………………………………….……….Designation…………..…………….

Particulars of Height …………………………..

Personal Marks of Identification ……………………………………………..…………

Attested ……………………………

(Signature)


Sh./Smt……………………………………….……….Designation…………..………

……. Particulars of Height …………………………..

Personal Marks of Identification ……………………………………………..…………

Attested ……………………………

(Signature)


40

FORM OF LETTER TO THE WIDOW/WIDOWER OF A DECEASED

UNIVERSITY EMPLOYEE FOR THE GRANT OF A FAMILY PENSION

No…………………………..

Deptt./office of …………….

Dated, the :

To

…………………………..

………………………….

………………………….

Sub :- Payment of Family Pension Scheme, 1964 in respect of Late

Sh./Smt……………………….

Sir/Madam,

I am directed to say that in terms of Appendix I of Punjab Civil Services

Rules, Volume-II, a family pension is payable to you as widow/widower of late

Sh./Smt. ………………………..……………… (Designation in the office/Department

of ……………………………….).

1 You are advised that a claim for the grant of family pension may be submitted

in the enclosed Annexure-II.

2 The family pension will be payable till your death or re-marriage, whichever

event occurs earlier. In the event of your death or re-marriage the family pension shall

be granted to the child or children, if any, through the guardian.

Yours faithfully,

(Head of Office)

--------------------------------------------------------------------------------------------------------

Attestation should be done by two Gazetted University employees or two or more

persons of respectability in the town, village or pargana in which the applicant resides.

41

Attested Photograph

of the applicant

ANNEXURE-II

FORM OF APPLICATION FOR THE GRANT OF FAMILY PENSION ON

THE DEATH OF THE UNIVERSITY EMPLOYEE/PENSIONER

1. Name of the applicant

(i) Widow/widower

(ii) Guardian, if the deceased person is survived by

child or children

2. Name and age of surviving widow/ widower and

children of the deceased university

employee/pensioner.

S.

No.

Name Relationship

with the

deceased person

Date of birth by Christian

era (to be attested by Head

of Office)

1.

2.

3.

4.

5.

3. Date of death of the Univ. employee/

pensioner

4. Office/Deptt. in which the deceased Univ.

Employee/pensioner served last.

5. If the applicant is guardian, his date of birth

and relationship with the deceased Univ.

employee/pensioner.

6.A If the applicant is a widow/widower the

amount of service pension which she/he may

be in receipt on the date of death of the

husband/wife.

6. Full address of the applicant :

7. Place of payment of pension and gratuity

(Public Sector Bank Branch)

8. Enclosures :

42

(i) Two specimen signatures of the applicant, duly attested (To be furnished

in two separate sheets).

(ii) Two copies of passport size photograph of the applicant, duly attested.

(iii) Two slips each bearing left hand thumb and finger impressions of the

applicant, duly attested.

(iv) Descriptive Roll of the applicant, duly attested, indicating (a) height and

(b) personal marks, if any, on the hand, face etc. (To be furnished in

duplicate).

(v) Certificate(s) of age (in original with two attested copies) showing the

dates of birth of the children. The certificate should be from the

Municipal Authorities or from the Local Panchayat or from the Head of

a recognized school if the child is studying in such school (This

information should be furnished in respect of such child or children the

particulars of whose date of birth are not available with the Head of

Office).

(vi) Death Certificate.

9. Signature of left-hand thumb impression of the applicant.

10. Attested by :

Name Full Address Signature

_____________________________________________________________________

11. Witnesses :

(i) …………………………………………………………………………….

(ii) ……………………………………………………………………………

Note : Attestation should be done by two gazetted Univ. employees or two or more

persons of respectability in the town village or Paragana in which the applicant

resides. To be furnished in case the applicant is not literate enough to sign his

name.

In the case of re-marriage of the widow while applying the family pension on

behalf of the minor child, the widow should furnish (i) the date of her re-marriage, (ii)

Name of the public sector Bank branch at which payment is desired and (iii) her full

address in the application for family pension. It is not necessary to furnish a fresh

application nor the documents as they are already available with the pension papers on

which family pension was originally admitted to her.

43

ANNEXURE-III

FORM FOR SACNTIONING FAMILY PENSION

1. Name of the University employee

2. Father's name and also husband's name in the case of

woman (Univ. employee)

3. Relationship and Nationality

4. Last appointment held including name of establishment

5. Date of beginning of service

6. Date of ending service.

7. Substantive appointment held

8. Pension Rules opted/eligible

9. Length of continuous qualifying service prior to death

10. Pay as per paragraph 2 of the Punjab Govt. Finance

Deptt.'s letter No.7856 (7) FRI/64/9691 dated the 16th

October, 1964 Annexure 1 to Punjab CSR Vol.II 1969

Edition as applicable to Haryana State).

11. Amount of family pension admissible

12. Date from which pension is to commence

13. Place of payment (Branch of public sector Bank)

The undersigned having satisfied himself of the above particulars of late

Shri/Smt………………………………………….… hereby orders the grant of family

pension of Rs……………………. p.m. to Sh./Smt. ……………………………………

which may be accepted by the Comptroller, CCSHAU, Hisar as admissible under the

rules.

Signature and Designation

of the sanctioning authority

44

CALCULATION SHEETS OF FAMILY PENSION/DCRG

1. Name & Designation ………………………………

2. Date of birth ………………………………

3. Date of joining service ..……………………………..

4. Date of death ...…………………………….

5. Gross service ………………………………

6. Less non-qualifying service ………………………………

7. Net qualifying service ………………………………

(In term of six monthly period)

8. Pay including S.P. or P.P. on the date of death ………………………………

9. Normal family pension admissible ...…………………………….

10. Enhanced rate of Family pension ................……………………

11. Amount of D.C. R.G. ..…………………………….

Last pay drawn X multiply by six

Monthly Period (limited to 66/70)

45

NO DUES CERTIFICATE

Certified that there is no long term advances and other advances outstanding :

pending against Sh./Smt. ………………………………..……………………………..

Designation ……………………………..…….…………………………………………

Date of death ………………………………...………………………………… ……….

Date of Birth ……………………………………………….……………………………

(Signature of Head of Office)

_____________________________________________________________________

NO COMPLAINT/ENQUIRY CERTIFICATE

Certified that there is no complaint/Enquiry pending

against Sh./Smt. ………………………………………………………………………

Designation ………………………………………………………………………

Date of death ……………………………………………………………………..

_____________________________________________________________________

(Signature of Head of office)

1 In case any complaint/Enquiry pending against the applicant detail thereof.

2 In case he was suspended any time, brief statement leading to reinstatement

after having been either suspended, compulsorily retired, removed or

dismissed from service.

(Signature of Head of office)

46

Office of the ……………………………………………………………………………..

No. ………………………………………………………………………………………

office case ….……………………………………………………………………………

Provincial LAST PAY CERTIFICATE OF Mr./Mrs. …………….………………… ..

of the ……………………………………………………………………………..… …..

proceeding……………………….………….… RETIREMENT (Nature of retirement).

w.e.f………………………………. .

2. He has been paid upto …………………………………………………… at the

following rates :

Particulars Amount (in Rs.)

1 Pay

2 SP/PP

3 DA/ADA

4 HRA

5 CCA

6 FIXED MEDICAL ALLOWANCE

7 CONVEYANCE ALLOWANCE/

MEDICAL REIMBURSEMENT

8. DEDUCTIONS

1 GPF/CPF Monthly Subscription

2 GPF/CPF Advance

3 HRA

4 Car/Scooter Advance

5 G.I.S.

6 E.W.F.

7 House Rent dues

8 PLI

9 Any other deduction

3. He has made over charge of the office of ……………………………… on the

…………………………….. Noon of the ………………………

4. Recoveries are to be made from the pay of the University employee as detailed

on the reverse.

47

5. He has been paid leave salary as detailed below. Deductions have been made as

noted on the reverse.

Period…………….…….rate………………amount…………from………..to…………

at……………… Rs……………. A month.

Head of office/deptt.

DETAILS OF RECOVERIES

Name of recovery ……………………………………………

Amount : Rupees ……………………………………………

To be received in ……………………… instalments.

SALARY DEDUCTIONS MADE FROM LEAVE SALARY

From ……………. To ……………………. On account of ………………………



Head of Office/Deptt.

Signature with Stamp

Name of Pay Gratuity Fee Funds and other Amount of Income-tax Remarks

Months Deductions recovered

April

May

June

July

Aug.

Sept.

Oct.

Nov.

Dec.

Jan.

Feb.

March

He took over/assumed charge of the office of …………………..………………. on the

………………………………………………….. noon of ……………………………..

Signature Designation

48

CERTIFICATE REGARDING EMPLOYMENT

Certified that I, …………………………..………………………. Widow/widower of

Late Sh./Smt. …………………………………………. , am not in employment of any

Govt. or any other organization.

(Signature of claimant)

…………………………………………………………………………………………

CERTIFICATE

It is certified that the particulars/calculations filled up in the application form

and its enclosures of Sh. ………………………… Designation ………………………

Department/Office of ………………………………….. have been duly verified and

found correct.

Controlling Officer

49

D

M

Net qualifying

service

Y

6

Reasons for

non-

qualifying

service

5

D

M

Less -

Non-qualifying

service

Y

4

D

M

Total period

Y

3

Period from

------------------

------------------

2

Sr. No. Page No. of

Service Verification

Certificate as per

service Book

1

Signature Head of Office/Deptt.

DETAILS OF QUALIFYING SERVICE

(as defined to in Col. 15 of Form Pen 1)

To be filled up department-wise/designation-wise where the official worked from time to time)

50

FORM OF CERTIFICATE OF VERIFICATION OF SERVICE FOR PENSION

(as given in FORM PI 15)

CERTIFICATE

It is certified that Sh./Smt. …………………………………… has completed a

qualifying service of ………………years………….. months and ………. days which

has been verified on the basis of his service documents and in accordance with the

rules regarding qualifying service in force at present. The verification done under sub-

rules (1) and (2), of rule 5.34-A shall be treated as final and shall not be re-opened

except when necessitated by a subsequent change in the rules and orders governing the

conditions under which the service qualifies for pension.

Signature Head of Office/Deptt.

51

Period of qualifying service are as under : -

(i) Period and details of earlier/past services other than HAU proposed to

be counted after obtaining information from previous employer as per

statutory provisions.

(ii) Amount and nature of pension/gratuity or any other terminal benefits

received for service of the above period.

(iii) Period of war/military service.

(iv) Amount and nature of pension/gratuity and other terminal benefits

received for above service.

(v) Details of break in service, if any.

(vi) Details of extra-ordinary leave or any other non-qualifying service not

counted for pension.

(vii) Details of service on deputation/foreign service.

(viii) Certified that the leave salary and pension contributions of the above

service have been received by the University and deposited in University

account and the entries thereof have been made in the Service Book.

Signature of Head of Office/Dept

52

DESCRIPTIVE ROLL

Submitted by the ____________________________

1. Name and residence showing

Village, Tehsil and District

_______________________________

Description of the claimant

2. Age _______________________________

3. Height _______________________________

4. Race, caste or tribe _______________________________

5. Marks for identification _______________________________

6. Present occupation and pecuniary

circumstances

_______________________________

7. Degree of relationship to deceased. _______________________________

Description of the deceased

8. Name _______________________________

9. Occupation _______________________________

10. Income of the deceased _______________________________

11. Nature of injury causing death _______________________________

Signature of the Applicant