ADDITIONAL INFORMATION OF PENSIONER/FAMILY PENSIONER
1
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NAME OF THE PENSIONER/FAMILY PENSIONER
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2
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PPO NUMBER (COPY TO BE ATTACHED)
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3
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TYPE OF PENSIONER
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4
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FATHERS NAME/ SPOUSE NAME
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5
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DATE OF BIRTH OF THE PENSIONER(With Proof)
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6
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DATE OF DEATH OF PENSIONER(In case of Family Pensioner)
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7
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DATE OF JOINING SERVICE
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8
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DATE OF RETIREMENT
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9
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NAME OF THE FAMILY PENSIONER
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10
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DATE OF BIRTH OF FAMILY PENSIONER(WITH Proof)
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11
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RELATIONSHIP WITH THE PENSIONER
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12
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PRESENT ADDRESS WITH PIN CODE
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13
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PERMANENT ADDRESS
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14
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OTHER CONTACT DETAILS(PERSONAL Mobile No
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15
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NAME AND ADDRESS OF THE BANK BRANCH WHERE FROM PENSION IS DRAWN
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16
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PENSIONERS BANK ACCOUNT NUMBER
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17
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BSR CODE OF BANK
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18
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AADHAR NUMBER
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19
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PAN NUMBER (Self)
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20
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RATION CARD NUMBER
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21
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BLOOD GROUP “A” POSITIVE
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22
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DEPARTMENT FROM WHERE HE RETIRED
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23
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LAST POST HELD
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24
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LAST PAY SCALE
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25
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TOTAL QUALIFYING SERVICE
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Signature of the pensioner Signature of Branch Manager
Place Name
Date Designation