SPECIMEN FILLED UP DATA SHEET

To

THE DIRECTOR AV – III

3^rd FLOOR

AFRO BUILDING

SUBROTO PARK

NEW DELHI-110010

INFORMATION REQUIRED TO BE F'ILLED BY PRE-01/01/2016 PENSIONERS EX-AIRMEN/NCs (E) AND THEIR ELIGIBLE FAMILY PENSIONERS

FOR REVISION OF PENSION UNDER 7^th CPC

Sl No	Details Required Details to be filled bv Pensioner
1	NAME OF AIRMEN/NC(E)	M B CHANDRAN MENON
2	SERVICE NUMBER	293512 T
3	RANK	SGT
4	TRADE	WPN/FIT
5	DATE OF BIRTH	00/00/0000
6	DATE OF DISCHARGE	30/09/1987
7	DATE OF DEATH (FOR FAMILY PENSIONER)	NA
8	AMOUNT OF PENSION DRAWN AT THE TIME OF DISCHARGE/DEATH (FOR FAMILY PENSIONER)	Rs 592
9	FULL POSTAL ADDRESSS  WITH PIN CODE	XXXXXXXXXXXXXXXXXX
10	AADHAR CARD NUMBER	0000 0000 0000
11	PAN CARD NUMBER(SELF)	XXXXXXXXXX
12	E-MAIL  ID	Vinodvihar31@gmail.com
13	MOBILE NUMBER	XXXXXXXX
14	BANK ACCOUNT NUMBER	XXXXXXXX
15	IFSC CODE OF PAYING BANK	SBIN0070517
16	BANK ADDRESS ( THROUGH DPDO ERNAKULAM HO NO  T09762)	STATE BANK OF INDIA SA ROAD NEAR JANATHA JN VYTTILA-PO
17	ORIGINAL PPO No.(ATTACH COPY IF AVAILABLE)	0814B1111887
18	CORRIGENDUM PPOS NO (ATTACH COPIES OF ALL)	08/14/CORR/10505/88
19	D ISABILITY PPO NO (IF GRANTED SEPARATELY) ATTACH COPY IF AVAILABLE	NA
20	LATEST CORR PPO No. OF DISABILITY IF NY(ATTACH COPY IF AVAILABLE	NA
21	WAR INJURY ELEMENT %	NA
22	DISABILITY ELEMENT% IF ANY	NA
23	SERVEICE ELEMENT AS ON 31 DEC 15	Rs 8778 (OROP)
24	DISABILITY ELEMENT AS ON 31 DEC 15	NA
25	LFP/SFP/OFP GRANTED( IN CASE OF FAMILY PENSIONER)	NA
26	WAR INJURY ELEMENT AS ON 31 DEC 15(IF ANY)	NA
27	FAMILY PENSION SHARE % (IN CASE OF DIVISION OF FAMILY PENSION%  SHARE)	NA
28	WHETHER PENSION NOTIFIED AS PER COURT ORDER (YES/NO).	NO
29	NAME OF SPOUSE/ FAMILY PENSIONER	XXXXXXXXXXXXXX
a)	DATE OF BERTH (spouse)	00/00/0000
b)	PAN NUMBER (spouse)	XXXXXXXXXX
c)	AADHAR CARD NUMBER(spouse)	0000 0000 0000
d)	MOBILE NUMBER	xxxxxxxxxxxx
e)	E-MAIL ID	Vinodvihar31@gmail.com

 Date:                                                          Signature of Pensioner