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APPLICATION FOR GRANT OF ADDITIONAL GRATUITY TO PRE -1996 RETIREES

1. No and Name of Pensioner 2. No and Name of deceased in case of family pension 3. Rank of pensioner 4. Date of retirement 5. Record office (or CDA) 6. Original PPO Number 7. Latest Corrigendum PPO if any 8. Previous reference of correspondence if any 9. Postal address, email ID and tele number 10. Bankers through which pension is being received At the time of my retirement I have been paid Gratuity only based on Basic Pay. Additional Gratuity may please be paid to me for the DA being drawn by me at the time of my retirement, as admissible vide Government of India Letter No 45/86/97 P&PW(A) dated 04 Dec 2004. signatures name date

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