APPLICATION FOR SERVICE PENSION/FAMILY PENSION/RETIREMENT

1. G.O.Ms.No. 100. date: 6-4-2010 (RPS 2010)

2. G.O.Ms.No. 101. date: 6-4-2010 (RPS 2010)
Part I

INFORMATION TO BE FURNISHED BY THE GOVERNMENT SERVANT/APPLICANT

(The Pension Sanctioning Authority shall forward the Application duly processed to the AG(A &
E)/LF Authority within a period of 30 days)
1. a) Name of the Government Servant Sri. Shaik Pathe Ahmed,

b) Post held Record Assistant,

2. Name of the Applicant (in case of death of Government Not applicable
Servant)
3. Permanent Address H.NO.8-4-370/279, Rajnagar,
Borabanda,Hyderabad-18

4. Adress after retirement H.NO.8-4-370/279, Rajnagar,

Borabanda,Hyderabad-18

5. Commutation of Pension

Whether willing to commute 40% of monthly

pension, subject to AP Civil Pensions Yes
(Commutation) Rules, 1944 Vide G.O.Ms.No. 158
Dt. 16-9-1999.
If the answer is NO, Specify the fraction less than Not applicable
40%

6 a) Name of the Pension Payment Officer, M.J.Market

pension Disbursing Authority Road, Nampally, Hyderabad.

b) Name of the paying Bank from where pension payment

is desired by the pensioner/family pensioner/gratuitant. State Bank of India, MJJ Road,
Name of the Bank and Branch and S.B.Account No. Nampally, Hyderabad.
S.B.Account No. 20031654200
7. List of Family Members.

(a (b) (c) (d) Martial/Employment status of the children of

) the applicant/deceased Government servant
Sl. Relationship Married or unmarried Whether employed
No. Name of the family Date of with (Date of Marriage if or not?
member Birth government married) (Give details of
servant employment)
1. Smt.Be Be Jan 29-11-1962 Wife Married House Wife.

2. Smt..Hamedunnis 02-08-1984 Daughter Married House Wife.

11-07-1999
3. Smt. Pa Daughter Married House Wife.
11-07-1999
4. Daughter Married House Wife.
11-07-1999
5. Daughter Married House Wife.
11-07-1999
6. Son Unmarried Student

Instructions:

1. The Government servant is instructed to fill up the proforma very carefully as the
data furnished, is vital for sanction of family pension. He/She may note that alterations of
the data furnished at a later date is not permissible.

2. The family for the purpose mean wife or husband (as the case may be), sons
and unmarried daughters as laid down in Rule 50 (12), (for Family Pension) and Rule 46
(5), (for Gratuity) of AP Revised Pension Rules, 1980.

3. In case of death while service of the government servant, the answer Married, for the
daughter/Daughters will be understood that the daughter/the Daughters is/are already
married as on date of death of the Government servant
 DECLARATION

1) I undertake to refund the amount of pension, Gratuity and Communication, if it is found

subsequently to be in excess of the amount to which 1 was entitled under the rules.

2) I solemnly affirm that the particulars given by me in part-1 at item 7 are correct and
true to the best of my knowledge. If found false in future, I am liable for suitable action as
may be taken by the Government.

3) The particulars given above are correct and true to the best of my knowledge. If found
false in future I may be liable for any action that may be taken by the Government.

Place : Hyderabad.

Dated: Signature of the Applicant.

Signature of the Government Servant

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

TO BE FILLED IN BY HEAD OF THE OFFICE

Application for pension/gratuity etc. in part-1 is received on

(date to be recorded)

Certified that the person/persons mentioned by the Government servant/applicant in item

7 of part-1 is/are legally entitled to receive the Pension/share in Gratuity.

Guardianship certificate: (to be filled in wherever necessary)

This is to certify that the following minors of the deceased Government Servant Late

Sri/Smt...................is/are under guardianship of

Sri/Smt..

NAME Date of Birth

1) - -

2 -
 3) - -

Place : SIGNATURE OF THE HEAD OF THE OFFICE.

DATE:

PART-II -INFORMATION TO BE FILLED UP BY THE PENSION SANCTIONING AUTHORITY

1. Name of the Government Servant and Sri. Shaik Pathe Ahmed, Record Assistant.
post held.
2. Fathers Name/Husbands Name. Sri. Shaik Subhan Saheb.
3.Name of the Applicant (In case of death
of Government Servant). Not Applicable.
4. Date of Birth of Government Servant. 15-06-1955
5. Date of entering into service. 01-04-1994.
6.Date of retirement/death 30-06-2013
7. Designation and office from which the Record Assistant, New Govt. Junior College,Malkpet, Hyderabad
Government servant retires/retired/died.

8.The Rules Applicable Rule 33: Superannuation Pension (Rule 42)

A)The relevant Rules under the AP Revised
Pension Rules, 1980 applicable (tick the
rule number (s) applicable and strike out
the rest.)
B)Whether ANTICIPATORY PENSION
Is being Rule 51?
C) Whether PROVISIONAL PENSION
Is being Rule 9(4)
d) Any other rule applicable
9.Total Service (S.No.6 - S.No.5)
Rule 34: Retiring Pension (Rule 43/44).
Rule 35: Pension on absorption under a corporation.
Rule 37: Invalid Pension.
Rule 38: Compensation Pension.
Rule 39: Compulsary Retirement Pension.
Rule 40: Compassionate Allowance.
Rule 43: Retirement on completion of 20 years of qualifying
service.
Rule 44: Retirement on completion of 33 years of qualifying
service.
Rule 46: Retirement Gratuity.
Rule 50: Family Pension.
YES/NO.
YES/NO.
29 days 02 months 19 years

10.Periods of non-qualifying service

a) E.O.L. -NO-
b) Suspension period.
c) Dies non. -NO-
d) Boy service. -NO-
e) Any other service not qualifying for -NO-
pension. -NO-
Total non-qualifying service (a toe).
-NO-
29 days 02 months 19 years
11.Net qualifying service (S,No.9-S.No.10)

12. Weight age, if any. 05 years

13.Total qualifying service for calculation 24 Years

of Pension (S.No.11+S.No. 12)
14. Last pay drawn (Rule 31, 46 (4), 50(12) Rs. 14050-00
(c) of APRPRs.1980) para 4 of
G.O.Ms.No.87 Fin. & Plg. (FW-Pen.I) Dept.
dt. 25.5.1998.
15. Calculation of Service Pension/Service Rs.14050 X 24/66= Rs. 5109-00.
Gratuity (Rule 45 of APRPRs, 1980.
16. Calculation of Retirement Gratuity
(Rule 46 APRPRs, 1980) Rs.14050 + 7697 X X 24 = Rs 2,60,964-00.

17. Calculation of Family Pension.

a) Enhanced Family Pension. Rs. 5109-00
b) Normal Family Pension. Rs. 4215-00
18. Period of Payment of Pension. As applicable to the case under consideration

a) Service Pension
b) Enhanced Family Pension. From 01-07-2013 To Till death
c) Normal Family Pension From 01-07-2013 To 30-06-2020
01-07-2020 to till death.

19. Government dues to be recovered in respect of: Principal Amount Interest Total Amount
a) House Building Advance: - - -
b)Motor car/Cycle Advance - - -
c)Marriage Advance:
d) Advance Leave Salary: - - -
e.) Advance salary on Transfer - - -
f)Dues on Account of Government Quarters: - - -
g) Telephone/Trunk Call Charges: - - -
h) Festival Advance: - - -
I) Education Advance: - - -
j) Computer Advance: - - -
k) Other Government Dues: - - -
TOTAL - - -
Note: Information with conditions will not be accepted by Pension Issuing Authority. Amounts for recovery
should be specified and should be in whole Rupees. Absence of information will be understood as no dues for
recovery.
20.LPC I enclosed /LPC will be sent after retirement. :LPC will be sent after retirement.

PART II (B) SANCTION OF PENSION

a) Certificate of competency to accord sanction (applicable in case of sanction of pension to non-

gazetted officers including Class-IV employees). i) I am declared by the Head of Department to be
the Head of an Office to accord sanction I in this case, under the powers delegated vide G.O.Ms.No.
262 Finance & Planning (FW-PSC) Department dated 23-11-1998. OR

II) I am the next Gazetted Authority in the heirchy to the Head of the Office, in this case, who is a
non-gazetted officer and hence, I am competent to accord sanction under the powers delegated
vide G.O.Ms.No. 262, Finance & Planning (FW-PSC) Department dated 23-11-1998.

(Strike off whichever is not applicable

b) Sanction Order:

Pensionary benefits including commutation found admissible under the rules may be authorized. It
is verified from the records in my custody and certify that no disciplinary or judicial proceedings are
pending/contemplated against retiring/retired Government servant to whom I am the authority for
sanction of pension.

i) Service Pension = Rs. 25,880-00.

ii) Retiring Gratuity = Rs. 8,00,000-00
iii) Commutation = Rs. 10,15,771-00.
iv) Family Pension :

a) Enhanced Family Pension : Rs. 25,880-00

b) Normal Family Pension : Rs. 15,528-00

PENSION SANCTIONING AUTORITY

Note 1 : This is to be prepared in duplicate by the Pension Sanctioning Authority. One for the
record of Pension Sanctioning Authority and the other one to be sent to Accountant General/Local
Fund Audit Officer.

Note 2: The Pension Sanctioning Authority should satisfy about the correctness of the particulars of
family, furnished by the Government servant/Applicant in Part-1.

Note 3: It the Pensionary benefits are not to be released Part-II-B (b) shall be struck off.
Note 4: If there is any likelihood of-delay, in Sanction of Pension. Anticipatory Pension/Anticipatory
Gratuity as per Rule 51 of A.P. Revised Pension Rules 1980 shall be drawn and p0aid by the Head of
Office to the beneficiary without any delay.

Note 5: Heads of Departments are those listed in Appendix-1, mentioned in Article 6 of A.P.
Financial Code Volume-I/Subsidary Rule 32 (ii) of FR 9.

ANNEXURE - I DESCRIPTIVE ROLLS

A. SPACE FOR PHOTOGRAPHS:

Single Photo Joint Photo

Service Pensioner/Family Pensioner Joint Photo of Service Pensioner

Gratuitant/Guardian of Minor of with Family Pension beneficiary

(Attestation has to be done across the Photographs by a Gazetted Officer of A P Government

Service)

B. SPECIMEN SIGNATURE OF:

Specimen Signature of Sri/Smt/Kum: Smt. T. Mohana.

Son/Wife/Daughter of: Sri. T. Devendernath

1.

2.

3..
(ii) Family Pensioner/Gratuitant/Guardian of Minor or Handicapped Child:

Specimen Signature of Sri/Smt/Kum. Sri. T. Devendernath

Wife/Husband/Son/Daughter/Guardian of Sri.T.Mohana
1.

2.

3.

C. PERSONAL IDENTIFICATION MARKS OF

(I) Service Pensioner : Sri/ Smt/ Kum Sri.T.Mohana.

1.A Mole on the

2. A Mole on the

2.A

(ii) Family Pensioner/ Gratuitant/ Guardian of Minor of Handicapped Child:

Smt. L.Nirmala

1. A Mole on the right elbow.

2. A Mole on the right palm.

D. LEFT HAND THUMB AND FINGER IMPRESSIONS OF SERVICE
PENSIONER/FAMILY PENSIONER/GRATUITANT/GUARDIAN OF MIONER OR
HANDICAPPED CHILD.(TO BE GIVEN BY THE ILLITERATE OR THJOSE UNABLE
TO SIGN AND FOR OTHERS IT IS OPTIONAL
Details Thumb Finger Fore Finger Middle Finger Ring Finger Little Finger

Service
Pensioner

Family
Pensioner

Gratuitant

Guardian of
Minor/
Handicapped
Child

Place: Attested by Signature

DATE: Name:

Office Seal: Designation:

(Attestation has to be done by a Gazetted Officer of AP State Government in Service)

Note: 3 Copies will be forwarded to Accountant General/Local Fund Audit Officer by Pension
Sanctioning Authority and one will be tetained by the Pension Sanctioning Authority.
 ANNEXURE II NOMINATION

(The Government servant may use separate forms, if he wishes to make different nominations for
each type of payment mentioned below)

I hereby nominate the person/persons mentioned below and confer on

him/her/them the right to receive life time Arrears of Pension, Retirement Gratuity that may be
sanctioned by Government, in the event of my death while in service and right to receive on my
death, Life time Arrears of Pension , Retirement Gratuity, Commuted value of Pension, Death Relief
which having become admissible to me on retirement which may remain unpaid at my death.

NAME AND Relation- Age Amount Contingencies Name and address, relationship and Amoun
ADDRESS Ship with Of Share On the happing age of the alternative nominee(s) to Of shar
OF Governme Payable of which the whom the right conferred on the payable
NOMINEE(s nt to each nomination shall nominee(s) in Col. 1 shall pass in the to eac
) Servant In Col. 1 become event of nomination to him/her/them in Col. 6
Invalid. (death becoming ineffective
need not be
mentioned)
(1) (2) (3) (4) (5) (6) (7)
Sri. T. Husband 100% -
Devender H.No.3-4-615, Mega City
nath Residency, Flat No. 601,
Narayanaguda, Hyderabad.
Dated:

Witnesses:-

1. Signature 2. Signature

Name and Address . Name and address

Signature of the Government Servant

COUNTERSIGNED

Signature of Head of Office/Department.

Signature of Head of Office/Departmennt. Designation

OFFICE SEAL
THIS NOMINATION SUPERSEDES THE NOMINATION MADE BY ME EARLIER ON------------

NB:- THE GOVERNMENT SERVANT SHALL DRAW LINES ACROSS THE BLANK SPACE BELOW THE
LAST ENTRY TO PREVENT THE ENSERTIONS OF ANY NAME AFTER HE/SHE HAS SIGNED

Note(1) :The Government Servant who has a family may nominate one member of more than one
member of the family as difined in Rule 46(5) of AP Revised Pension Rules, 1980.

Note(2): The Government Servant who has no family may nominate a person or persons, or a
body Of individuals, whether ;incorporated or not.

Note(3): The Government servant who has not submitted the nomination form with signature of
two Witnesses shall only have the legal validity of a WILL.

Note(4): This nomination form is to be submitted by the employee in triplicate. One for use of the
Pension sanctioning authority and two copies to be forwarded to the Accountant General Local
Fund Audit Office.

Note(5): For the purpose of Rules 46,47,48 and 49 of Revised Pension Rules 1980. Family of a
Government servant means:-

i) Wife or wives, in the case of a male Government servant.

Ii) Husband, in the case of a female Government Servant.

ii) Sons including step sons, posthumous sons, and adopted sons (Whose persona l law

permits such adoption)

iv) Unmarried daughters including step daughters, Posthumous daughters & adopted

daughters. (Whose personal law permits such adoption).

v) Widow daughters including step daughters and adopted daughters.

vi) Father & vii) Mother Including adoptive parents in the case of individuals, where whose
personal law Permits such adoption.

viii) Brothers below the age of 18 years including step brothers.

ix) Unmarried sisters and widow sisters including step sisters.

x) Married daughters, and

xi) Children of a pre-deceased Son.

FROM TO
The Principal, The Commissioner of Intermediate
M A M GovtModel Junior College for Girls, Education, Nampally, Hyderabad -1.

Nampally, Hyderabad - 500001. Dated: 2-1-2012.

(THROUGH PROPER CHANNEL)
Respected Sir,
Sub: Pension Sanction of Pension and other retiring benefits in respect of Sri/Smt . T.
Mohana, Junior Lecturer in Botany, Ramachandra Junior College, Adikmet,
Hyderabad, working on redeployment at Mahabubia Govt. Junior College for
Girls, Nampally, Hyderabad - Submission of Pension forms Request-Regd.

With reference to the subject cited I am submitting Pension/Family Pension

application form of Sri/Smt. T. Mohana, Junior Lecturer in Botany, Ramachandra Junior College,
Adikmet, Hyderabad, working on redeployment at Mahabubia Govt. Junior College for
Girls, Gunfoundry, Abids, Hyderabad is to be retired from service on attaining the age of
superannuation attaining the age of 58 years on31-6-2012. I am also herewith submitting Original
Service Book and (4) sets of Pension Papers for sanction of pension and other retirement benefits.
Therefore I request you sir , kindly forward the Pension Forms to the Director
of Intermediate Education, Nampally, Hyderabad for sanction the pension and retirement benefits
in respect of Sri/Smt. T. Mohana, Junior Lecturer in Botany, Ramachandra Junior College, Adikmet,
Hyderabad, working on redeployment at Mahabubia Govt. Junior College for Girls,
Gunfoundry, Abids, Hyderabad.

Thanking you sir, Yours faithfully,

Enclosers:

1. Original Service Book. PRINCIPAL

2.(5) sets of Pension papers.

M A M GOVERNMENT MODEL JUNIOR COLLEGE FOR GIRLS, NAMPALLY, HYDERABAD -1.

LAST PAY CERTIFICATE

Last pay certificate of Sri L.Madhava Reddy, Junior Lecturer in Zoology, Chanakya Junior College,
Punjagutta, Hyderabad working on redeployment in M.A.M.Government Junior College for Girls ,
Nampally, Hyderabad to be retired on 29-2-2012.

2. He/She has been paid up to December, 2011 a t the following rates.

PARTICULARS Rs. DEDUCTIONS Rs.

1. BASIC PAY =51760-00 DEDUCTIONS Rs.
2. PERSONAL PAY 1. G.P.F.
3. SPECIAL PAY 2. A P L I F
4. D.A. (47.936%) =18609-00 3. G.I.
5. H.R.A.(30%) = 15528-00
6. C. C. A. = 525-00 4. P.TAX. =200-00
7. OTHERS. 5.
TOTAL =86,422-00 TOTAL =200-00
NET AMOUNT = Rs. 86,222-00

3. He/She made over charge of the Office of the Mahabubia Govt. Junior College for
Girls, Gunfoundry, Abids, Hyderabad is to be retired from service on 30-06-2012 A.N. on
superannuation of attaining the ae of 58 years.

4. Recoveres are to be made from the pay of Government Servant as detailed on the reverse.

5. He/She has been paid leave salary as detailed above deductions have been made as noted on the
reverse PERIOD RATE AMOUNT

From.to..at Rs.. a month.

Fromtoat Rs..a
month.

6. He/She is entitled to draw the following.

7. He/She is also entitled to joining time for

..

8.The details of the income tax recovered from him/her up to the date from the beginning of the
current year are noted on the reverse.

SIGNATURE OF THE PRINCIPAL.

M A M GOVERNMENT MODEL JUNIOR COLLEGE FOR GIRLS , NAMPALLY, HYDERABAD-1.

DETAILS OF RECOVERIES

Nature of Recovery Amount Rs

To be recovered in .Installment.
 DEDUCTIONS MADE FROM LEAVES SALARY

From .toon account of ..Rs..

From.to.on account ofRs..

From.to.on account ofRs

Pay Gratuity Fee Fund and other Amount of Income Tax Remarks
etc. deductions recovered
Name of
month Rs/Ps Rs./Ps.
Rs./Ps. Rs./Ps.

April
May
June
July
August
September
October Nil Nil Nil
November Nil
December
January
February
March

Date:.. Signature

Name..
 NO ALLEGATIONS CERTIFICATGE

Certified that no allegations are pending against Sri. Shaik Pathe Ahmed, Record Assistant, Chanakya
Junior College, Hyderabad working on redeployment at MAM Govt.Model Junior College for Girls
Urdu Medium, Nampally, Hyderabad is to be retired from service on attaining the age of
superannuation attaining the age of 58 years on30-6-2013.

PRINCIPAL

NO DUES CERTIFICATE

Certified that no Govt. dues are recoverable from Sri. Shaik Pathe Ahmed, Record Assistant,
Chanakya Junior College, Hyderabad working on redeployment at MAM Govt.Model Junior College
for Girls Urdu Medium, Nampally, Hyderabad. 1. Sales proceedings of A.P. Trading Corporation.
2..Nationalised Text books and notebooks as they are not supplied / supplied to him

PRINCIPAL

AUDIT OBJECTIONS CERTIFICATE

Certified that are no audit objections are pending in respect of Sri. Shaik Pathe Ahmed, Record
Assistant, Chanakya Junior College, Hyderabad working on redeployment at MAM Govt.Model
Junior College for Girls Urdu Medium, Nampally, Hyderabad.

PRINCIPAL

RECOVERIES UNDER ACT 14 OF 1992

Certified that Sri. Shaik Pathe Ahmed, Record Assistant, Chanakya Junior College, Hyderabad
working on redeployment at MAM Govt.Model Junior College for Girls Urdu Medium, Nampally,
Hyderabad (Arts Gradunles) was sanctioned 130-250/150-300 grade W.E.F. though he/she was
untrained graduals by virture of Court order/Department order claim amount is recoverable from
him as per act 14 of 1992.

a) The amount has been recovered and recorded in the SB at page No.(Nil)

b) The amount has not been recovered

c) Not applicable. PRINCIPAL

CERTIFICATE UNDER ACT 14 OF 1992

Certified that Sri. Shaik Pathe Ahmed, Record Assistant, Chanakya Junior College, Hyderabad
working on redeployment at MAM Govt.Model Junior College for Girls Urdu Medium, Nampally,
Hyderabad. SGT. Asst was not sanctioned 130-250/150-300 grade under trained graduate teacher
and no amount is to be recoverable from her/his under act 14 0f 1992.

PRINCIPAL

LEAVE CERTIFICATE

Certified that Sri. Shaik Pathe Ahmed, Record Assistant, Chanakya Junior College, Hyderabad
working on redeployment at MAM Govt.Model Junior College for Girls Urdu Medium, Nampally,
Hyderabad has not availed any leave/ has availed the following kind of leave during the period of
his/her service.

1. Leave on Loss of Pay.

2. E.O.L. on Loss of Pay.

PRINCIPAL

SUSPENSION CERTIFICATE

Certified that Sri. Shaik Pathe Ahmed, Record Assistant, Chanakya Junior College, Hyderabad
working on redeployment at MAM Govt.Model Junior College for Girls Urdu Medium, Nampally,
Hyderabad has not been suspended any time during his/her service.

Principal
 RESPONSIBILITY CERTIFICATE

I Sri. Shaik Pathe Ahmed, Record Assistant, Chanakya Junior College, Hyderabad working on
redeployment at MAM Govt.Model Junior College for Girls Urdu Medium, Nampally, Hyderabad. Do
here by declare that, if any amount found to be excess paid, due to erroneous calculation, noticed
at a later date, I shall be ready to refund the same without any objection in the matter.

Station:

Dated: Drawing Officer

PENSIONER

ATTESTED

SERVICE REGISTER CLOSURE CERTIFICATE

Certified that all entries are made in Service Register of Sri. Shaik Pathe Ahmed, Record Assistant,
hanakya Junior College, Hyderabad working on redeployment at NMAM Govt.Model Junior College
for Girls Urdu Medium, Nampally, Hyderabad.

PRINCIPAL.

DISCHARGE CERTIFICATE

Sri. Shaik Pathe Ahmed, Record Assistant, Chanakya Junior College, Hyderabad working on
redeployment at MAM Govt.Model Junior College for Girls Urdu Medium, Nampally, Hyderabad is
to be retired from service on the after noon of 30-06-2013. He has been paid all allowance due to
him up to date and that no Government dues are recoverable from him.

PRINCIPAL

GAP CERTIFICATE

Certified that Sri. Shaik Pathe Ahmed, Record Assistant, Chanakya Junior College, Hyderabad
working on redeployment at MAM Govt.Model Junior College for Girls Urdu Medium, Nampally,
Hyderabad is to be retired from service on the after noon of 30-06-2012 has no gap period from
her entire service from 1-4-1994 to 30-06-2013.

PRINCIPAL

RETIREMENT CERTIFICATE

Certified that Sri. Shaik Pathe Ahmed, Record Assistant, Chanakya Junior College, Hyderabad
working on redeployment at MAM Govt.Model Junior College for Girls Urdu Medium, Nampally,
Hyderabad is to be retired from service on superannuation attaining the age of 58 years on the
after noon of 30-06-2013.

PRINCIPAL

GRANT IN AID CERTIFICATE

This is to certify that Sri. Shaik Pathe Ahmed, Record Assistant, Chanakya Junior College, Hyderabad
working on redeployment at MAM Govt.Model Junior College for Girls Urdu Medium, Nampally,
Hyderabad has admitted in to Grant in aid with effect from 1-4-1994 vide G.O.Ms.No. 120
Education Department dated 06-02-1981. He has been paid the salaries from the Government
funds during the period from 1-4-1994 to 31-06-2013.

PRINCIPAL

AUDIT DECLARATION

I Sri. Shaik Pathe Ahmed, Record Assistant, Chanakya Junior College, Hyderabad working on
redeployment at MAM Govt.Model Junior College for Girls Urdu Medium, Nampally, Hyderabad
retired from the service on attaining the age of superannuation of 58 years on the afternoon of
30-06-2013 in this College. In this connection I declare that during audit if it is found any excess
amount paid time the same can be recovered from me.
IDENTIFICATION MARKS OF PERNSIONMER AS PER GOVERNMENT FINANCE (PSC) DEPARTMENT
CIRCULALR MEMO.NO. 13910/90/a1/PSC/04 DATED 21-6-2004 WITH REFERENCE TO A.G.s
LR.NO.PM/1/7-7/2004/05/U-IV/10 DATED: 4-6-2004.

Certified that the following are the identification marks of Sri. Shaik Pathe Ahmed, Record
Assistant, Chanakya Junior College, Hyderabad working on redeployment at NewGovt.Model Junior
College, Hyderabad retired from the service on bad is to be retired from the service on attaining
the age of superannuation on attaining the age of 58 years on the afternoon of 30-06-2013 in this
College. 1. A Mole near the
Left arm pit.

2. A Mole 3 cm above the left wrist.

PRINCIPAL

PHOTOS AS PER GOVT FINANCE (PS) DEPARTMENT CIRCULAR MEMO NO. 13910/90/A1/PSC/04
DATED 21-6-2004 ISSUED WITHREFERENCE TO A.G.s Lr. No. PM/1/7-7/2004-05/IV/10 dt.4-6-2004.

1. Photos of pensioner : Sri. Shaik Pathe Ahmed, Record Assistant

2 . Designation : Record Assistant

3. Office : New Govt. Junior College, Malakpet,

Hyderabad .

4. Date of Retirement :30-06-2013.

Photos: 4 photos to be enclosed with write the name of PHOTO

The pensioner in back side and attested on photo by the

Competent authority.
 CERTIFICATES TO BE ENTERED IN THE SERVICE BOOK

1. This is to certify that there is no gap in the service of Sri Shaik Pathe Ahmed , Record Assistant.

2. This is to certify that there is no allegations and no court cases are pending against of Sri Shaik
Pathe Ahmed , Record Assistant.

3. This is to certify that the Service Book of Sri Shaik Pathe Ahmed , Record Assistant, have been
verified along with Pay Bill Register and Acquaintance Register and entries are made in updated.

4. This is to certify that Sri Shaik Pathe Ahmed , Record Assistant, has not availed any Extra
ordinary Leave on loss of pay during his entire period.

5. This is to certify that Sri Shaik Pathe Ahmed , Record Assistant. is governed by AP Revised
Pension Rules of 1980 as per G.O.Ms.No. 88 Fin. & Plg (FW PSC-IV) Department Dated 26.3.1980.

6. This is to certify that Sri Shaik Pathe Ahmed , Record Assistant. has not been re-employment
after retirement of his service.

7. This is to certify that the services of Shaik Pathe Ahmed , have not been extended after
Superannuation attaining the age of 58 years on 30-06-2013 A.N.