PENSION PAPER IN RESPECT OF

ER. KRISHAN KUMAR KESHAV

SR. EXECUTIVE ENGINEER (ELECT.)
O/O CHIEF ENGINEER (P&M)

Mobile No. 9418451348

Date of Birth - 01.06.1961

Date of Retirement - 31.05.2019
 INDEX OF DOCUMENTS

Sr.No Document Page No

1. Form No.1 : Nomination for Death cum Retirement

Gratuity 1 -2

2. Form No. 1-A Commutation of pension without Medical 3-4

3. Form No 3 : Detail of Family Members 5

4. Form-5 Detail of Particulars 6

5. Slips containing Specimen Signature of the Retiree 7

6. Slips containing Height & Identification Marks 8

7. Form-5 See Rule-7 9

8. Form-7 Part-I for assessing pension & gratuity 10-11

9. Form-7 Part-II section I & II 12

10. Last emoluments due drawn 13

11. Annex “A”: Application for Drawl of Pension through

Designated Bank 14

12. Annexure “B” Undertaking for refund of excess payment 15

13. Annexure-C Option for Medical Reimbursement 16

14. 3 copies of Joint Photograph 17

15. Photo copy of Bank Pass Book 18

16. Photo copy of PAN Card / GPF account No. 19

17. Photo copy of Aadhaar Card of Self 20

18. Photo copy of Aadhaar card of wife 21

19. Photo copy of Aadhaar Card of Son 22

(Er. Krishan Kumar)

Sr. Executive Engineer (E)
 HIMACHAL PRADESH STATE ELECTRICITY BORAD LTD.
FORM-1
(SEE RULE 53 (1)

NOMINATION FOR DEATH- CUM-RETIREMENT GRATUITY

When the HPSEB Servant has a Family and Wishes to Nominate One Member, or
More than One Member thereof

I, Er. Krishan Kumar, Sr. Executive Engineer (Elect.) hereby nominate the person/ persons
mentioned below who is/ are members (s) of my family, and confer on him/ them the right to receive,
to the extent specified below, any gratuity the payment of which may be authorized by the HPSEB Ltd
in the event of my death while in service and the right to receive on my death while in service and the
right to receive on my death, to the extent specified below, any gratuity which having become
admissible to me on retirement may remain unpaid at my death:-

Original Nominee (s) Alternate Nominee(s)

Names and Address of Relationship Age Amount of Name, address, Amount or Share of
Nominee/ Nominees with the Share of relationship and age of Gratuity Payable
HPSEB Ltd Gratuity the person or persons, if to Each**.
Servant Payable any, to whom the right
to Each* conferred on the
nominee shall pass in
the
event of the nominee
predeceasing the HPSEB
Ltd. servant but before
receiving payment of
gratuity.
(1) (2) (3) (4) (5) (6)
Mrs. Suman Bala Wife 49 Full i) Ms. Kajal- 25 yrs. 33.3% each
years ii) Ms. Shreya-17 yrs.
iii) Ms. Antima-
14 yrs.

*This column should be filled in so as to cover the whole amount of the gratuity.

**The amount/ share of the gratuity shown in this column should cover the whole amount/share payable to
the original nominees(s)

Page…..1……..
 This nomination supersedes any and all nomination(s) made by me earlier which stand(s)
cancelled.
Note:- (i) The HPSEB Ltd servant shall draw lines across the blank space below the last entry to
prevent the insertion of any after he has signed.
(ii) Strike out which is not applicable.
Dated 30 th
Day of, 2019 at SHIMLA

Witness to signature

1……………………………
Er. Shishu Paul, Asstt. Engineer (E)
o/o Chief Engineer (P&M) , HPSEBL, Shimla-04 Signature of HPSEB Ltd.
Servant

2……………………………….
Sh. Ram Krishan, Supdt. Gr-II
o/o Chief Engineer (P&M) , HPSEBL, Shimla-04
(To be filled in by the Head of Office).
Nomination by………………………….. Signature of Head of Offic
Date……………………………... Date………………….

Designation……………………………

Page…..2……..
 FORM 1-A
FORM OF APPLICATION FOR COMMUTATION OF A FRACTION OF PENSION
WITHOUT MEDICAL EXAMINATION WHEN APPLICANT DESIRES THAT THE PAYMENT
OF THE COMMUTED VALUE OF PENSION SHOULD BE AUTHORISED THROUGH THE
PENSION.

PAYMENT ORDER
(See Rules 5(2),12,13(4),14(i)and 15(3)
To
The Chief Accounts officer,
F&A wing, HPSEB Ltd.,Shimla-4

Sub:- COMMUTATION OF PENSION WITHOUT MEDICAL EXAMINATION.

I desire to commute a fraction of my pension as indicated below in accordance with the

provision of the Central Civil Service (Commutation of Pension)Rules,1981 the necessary particulars
are furnished below:-
1. Name (In block letters) : ER. KRISHAN KUMAR
2. Father’s name :
3. Designation at the time of retirement : Sr. Executive Engineer
4. Name of office/Deptt/Ministry in which employed : HPSEB Ltd.
5. Date of birth (By Christian era) : 01.06.1961
6. Date of retirement : 31.05.2019
7. Amount of pension authorized (in case final
amount of pension has not been authorized, indicate the
amount of provisional pension sanctioned under rule 64
of the Central Civil Service (Pension)Rules-1972.
8. Fraction of pension proposed to be commuted. : 40 %
9. Designations of the accounts officer who authorized
the pension and the No. and date of the pension payment
Order, if issued.
10. Disbursing authority for payment of pension : Accounts Officer (Pension)
F&A wing, HPSEBL, Shimla
a)Treasuary/Sub Treasuary (Name & complete address of the
treasuary/sub treasuary to be indicated)
b)Branch of the Nationalised Bank with complete postal
address.

11. Bank account No. to which monthly pension is being credited Saving Bank A/C-
each month:-
12. Accounts Officer of the Ministry/Department/Office. Chief Accounts officer,
F&A wing, HPSEBL.Shimla-4

Place:- Shimla
Signature___________________
Dated:-.2019 Postal Address:- (Krishan Kumar)

Page…..3……..
 PART-II

(ACKNOWLEDGEMENT)
Received from Krishan Kumar, Sr. Executive Engineer (Elect.) application on
Part-I of Form-I for the commutation of a fraction of pension without medical examination .

Place:- Shimla
Date:- 30th April, 2019 Signature of Head of
office.

PART-III
Forwarded to the Accounts Officer / Chief Accounts officer, HPSEBL, F&A wing
Shimla-171004 herein indicate the address and designation with the remarks that:-

1. The particulars and address by the applicant in Part-I have been verified and are
correct.

2. The applicant is eligible to get a fraction of his pension commuted without medical
examination.

3. The commuted value of pension determined with reference to the table applicable
at present comes to ____________.

4. The amount of residuary pension after commutation will be ___________.

5 It is requested that further action to authorize the payment of the amount of

commuted value of pension may be taken as in rule 15 of the Central Civil
Services(Commutation of Pension Rules).

6 The receipt of the forms has been acknowledged the part-II which has been
forwarded separately to the applicant on_________.

7 The commuted value of pension is debatable to Head of Account 44.120

Place:- Shimla Signature of Head

of office.

Date:-

Page…4……..
 HIMACHAL PRADESH STATE ELECTRICITY BOARD LTD
FORM-3
{SEE RULE 54 (12)}

Details of Family Members:

Name of HPSEB Servant : Er. Krishan Kumar (Adhaar No. )

Designation : Sr. Executive Engineer (Elect.)
Date of Birth : 01.06.1961
Date of Appointment (D.O.J.) : 23.07.1984 (FN)
Details of the Members of my
Family *as on : 31.05.2019

S. Name of the Date of Relationshi Initials Remarks/

No. Members of Birth p with the of the Aadhar No.
Family Officer. Head of
Office
1. 2. 3 4 5 6

1. Smt. Suman Bala 25.12.19 Wife 848552952986

70
2. Ms. Kajal 02.03.19 Daughter 770752246394
93
3. Ms. Shreya 28.03.20 -do- 988880975472
02
4. Ms. Antima 08.11.20 -do- 701229871960
05

I hereby undertake to keep the above particulars up to date by notifying to the Head of Office any addition or
alteration.

Place: SHIMLA Signature of HPSEB Ltd.

Servant
Dated the 30th April, 2019

Family for this purpose means family as defined in Clause (b) of Sub- rule (14) of rule 54 of the
C.C.S. (Pension) Rules, 1972.

Note: Wife and husband shall include respectively judicially separate wife and husband .

Page…..5……..
 HIMACHAL PRADESH STATE ELECTRICITY BOARD LTD
FORM 5
(See Rules 59 (1)(C) and 61 (1)

Particulars to be obtained by the Head of Office from the retiring HPSEB Ltd servant
eight months before the date of his retirement.

1. Name : Er. Krishan Kumar

2. (a) Date of Birth : 01.06.1961
(b) Date of retirement: : 31.05.2019
3. Two specimen Signature (to be : Attached
furnished in a separate (sheet)
duly attested by a gazette HPSEBL
4. Three copies of passport size joint: : Attached
Photograph with wife or husband
(To be attested by the Head of Office)
5. Two slips showing the particulars of : Attached
Height and personal identification marks
Duly attested by a gazette HPSEB servant
6. Present address :

7. Address after retirement : As above.

8. Name of the HPSEB Ltd Division/ : Chief Accounts Officer

Accounts Office. HPSEBL Ltd, Shimla-
4
9. Detail of the family in Form-3 : Attached

Place: SHIMLA
Dated: _______________ Signature…………………..
Designation: Sr. Executive
Engineer(E)

Page…..6……..

SPECIMEN SIGNATURES OF
 Er. Krishan Kumar, Sr. Executive Engineer (Elect.), o/o
Chief Engineer (P&M), Shimla-04, HPSEBL, Shimla-09

DATE OF BIRTH 01.06.1961 REITRED ON

31.05.2019

1._____________________________

2._______________________________

3._______________________________

Signature of Head of Deptt.

Page…..7……..

PARTICULAR OF HEIGHT AND IDENTIFICATION MARKS IN

RESPECT
 OF ER. KRISHAN KUMAR, SR. EXECUTIVE ENGINEER (ELECT).

(DOB-01.06.1961) {RETIRED ON
31.05.2019}

1. Height 5’3”
2. Identification Mark Cut mark on right eyebrow

(Er. KRISHAN KUMAR)

Sr. Executive Engineer (E)
O/o Chief Engineer (P&M),
HPSEBL Shimla-04

Signature of Head of Deptt.

Page…..8……..

FORM -5 (Subsidiary to Form-1 A)

To
 The Chief Accounts Officer,
F&A wing, HPSEBL,Shimla-4.

I, Er. Krishan Kumar, Sr. Executive Engineer (Elect.) hereby nominate the person named below,
under Rule-7of the Central Civil Services (Commutation of Pension) Rule 1981.

1. Name and address of nominee:- Smt. Suman Bala

Ward No. 3, Chaugan,
Nurpur,
Tehsil Nurpur, Distt.
Kangra (H.P.)-176202

2. Relationship with the pensioner:- Wife

(if nominee is minor)
3. Date of birth:-
4. Name & address of the person who may receive
the said commuted value during the nominee’s minority:-
5. Name of address of other nominee in case of the nominee under
Column (1) pre-deceases the pensioner. N.A.

Relationship with pensioner. N.A

Date of birth if the other nominee is minor. N.A.
6. Name and address of person who may receive the commuted value
of pension during the other nominee’s minority.
7. Contingency on happening of which nomination shall become invalid.

Place: Shimla (Er. Krishan Kumar)

Witness Signature:-

Name and address:-Er. Shishu Paul, Assistant Engineer,

o/o Chief Engineer (P&M)
Signature of Head of Deptt.

Acknowledgement to be sent by the Head of office

Certified that the nomination has been received from Er. Krishan Kumar
whose address is Ward No. 3, Chaugan, Nurpur, Tehsil Nurpur, Distt. Kangra, (H.P.)-176202

Place:- Signature of Head

of office
Date:- Full Address:-

Page…9…..

FORM-7
FORM FOR ASSESSING PENSION AND GRATUITY
(See Rules 58,60,61(1) and (3) and 65(1)
(To be sent in duplicate if payment is desired in a different Circle of accounting unit)
 PART-1
1. Name of the HPSEB Ltd. Servant : Er. Krishan Kumar
2. Father’s Name :
3. Date of Birth (by Christian Era) 01.06.1961
4. Religion : Hindu
5. Permanent residential address showing :
Ward No. 3, Chaugan, Nurpur
Tehsil Nurpur, Distt. Kangra
(H.P.)-176202

6. Present last appointment including the name : O/O Chief Engineer (P&M), HPSEBL,
of the establishment Shimla-04.
(i) Substantive :
(ii) Officiating, if any :
7. Date of beginning of Service : (FN)
8. Date of ending of service : 31.05.2019
9. (i) Total period of military service for which
Pension or gratuity was sanctioned. : Not applicable.
(ii)Amount and nature of any pension/gratuity
received from the military service : Not applicable.
10. Amount and nature of any pension/gratuity
received for previous civil service : Not applicable
11. HPSEB Ltd. under which service has been
rendered in order of employment : 34 Years 05 Months 08 days
12. Class of pension applicable : Superannuation Pension
13. The date on which action initiated to:
(i) Obtain the No Demand Certificate from the Directorate of Estates as provided in Rule 57.
(ii) Assess the HPSEB Ltd. dues other than the dues relating to the allotment of HPSEBL
accommodation as provided in Rule 73 (1)
(iii) Assess the service and emoluments qualifying for pension as provided in Rule 59 and
(iv) Assess the HPSEBL dues other than the dues relating to the allotment of HPSEB Ltd.
accommodation as provided in Rule 73 (1)
14. Details of omissions, imperfections or deficiencies in the service book which have been ignored under
Rule 59 (1) (b) (ii)
15. Total length of qualifying service for the purpose of adding towards broken period (a month is reckoned
as thirty days.)
16. Period of non-qualifying service:- From To
(i) Interruption in service condoned under Rule 28.
(ii) Extra ordinary leave not qualifying for pension
(iii) Period of suspension not treated as qualifying. -------NIL-----
(iv)Any other service not treated as qualifying
17. Emoluments reckoning for gratuity Pay in Band:- Rs. + Rs. 8500
(Grade Pay)
18. Last Drawn emoluments:- Rs. /-

Page…..10……..

Post Held From To Pay in Pay Band Last Drawn

+ Grade Pay. Emoluments
Sr. Executive 03.12.2018 31.05.201 Rs. 30,700/- + Rs. 36,500/-
Engineer (Elect.) 8,500/-(Grade Pay)
9

19. Date on which Form 5 has been obtained from the HPSEB Ltd, servant (To be obtained eight months
before the date of retirement of HPSEB Ltd. servant)
20. (i) Proposed Pension. Rs.__________________________________/-
(ii)Proposed Graded relief. Rs.__________________________________/-
21. Proposed death-cum-Retirement gratuity. Rs.___________________________________/-

*(i) In a case where the last ten months include some period not to be reckoned for calculating average
emoluments as equal period backward has to be taken for calculating average emoluments.
(ii) The calculation of average emoluments should be based on actual member of days contained
in each
month.
22. Date from which pension is to commence :- 01.06.2019
23. Proposed amount of provisional pension. If departmental or judicial proceedings are instituted against
the HPSEB Ltd servant before retirement. N.A.
24 . Details of HPSEB Ltd. dues recoverable out of gratuity
(i)License fee for the allotment of HPSEB Ltd. accommodation. N.A.
(See sub-rules (2),(3) & (4) of Rules 72)
(ii)Dues referred to Rule 73
25 Whether nomination made for:-
(i) Death-cum-retirement gratuity
(ii)Family Pension 1950, if applicable
26. Whether family Pension 1964 applies to the HPSEB Ltd. servant , and if so.
(i) Emoluments reckoning for the family pension
(ii) The amount of the family pension becoming payable to the family of the HPSEB Ltd. servant, if
death
takes place after retirement.
(a) Before attaining the age of 65 years or Rs………………………………
(b) After attaining the age of 65 years Rs…………………………….
(iii) Complete and upto date details of the family as given in Form 3:-

Sr.No Name of the member of the Date of Relationship with the HPSEB
. family birth Servant
1. 2 3 4
1. Smt. Suman Bala 25.12.19 Wife
70
2. Ms. Kajal 02.03.19 Daughter
93
Ms. Shreya 28.03.20 -do-
02
Ms. Antima 08.11.20 -do-
05

27. Height. 5’3”

28. Identification marks. Cut mark on right eyebrow
29. Place of payment of pension HPSEB Ltd. Divisions & Accounts office Chief Accounts
Officer, Shimla
30. Head of Accounts to which pension & gratuity are debatable : 46.120

Signature of the Head of

office
 Page…..11……..

PART-II
SECTION-I
ACCOUNTS ENFACEMENT:-

1 Total period of qualifying service, which has been accepted for the grand of superannuation
or retiring or invalid or compensation or compulsory retirement pension and gratuity, with
reasons for disallowance, if any (other than disallowance indicated in Part-I of this Form)

2 Amount of superannuation or retiring or invalid or compensation or compulsory retirement

pension or gratuity that has been admitted.

3. The date from which superannuation or retiring or invalid compensation or compulsory

retirement pension or gratuity is admissible

4. Head of Account to which superannuation of retiring pension or gratuity is chargeable.

5. The amount of the Family Pension 1964 becoming payable to the entitled members of the
family in the event of death of the Govt. Servant after retirement.

SECTION-II

1. Name of the HPSEB Ltd. Servant. Er. Krishan Kumar

2. Class of pension or gratuity. _________________________
3. Amount of pension authorized. _________________________
4. Amount of gratuity authorized. _________________________
5. Date of commencement of pension. 01.06.2019
6. Amount of Family pension in the event of death after retirement.
(i)If death takes place before 65 years of age or _________________________
(ii) If death takes place after 65 years of age. _________________________
7. The amount of graded relief admissible on pension.
_________________________
8. The HPSEB Ltd. dues recoverable out of gratuity before authorizing the payment.____________
1. The amount of cash deposit or the amount of gratuity held over for adjustment of
un-assessed HPSEB Ltd. dues. _________________________
2. Date on which the pension papers received by the Accounts Officer___________________

Accounts officer
(Pension)
For Chief Accounts officer
F&A wing, HPSEB,Shimla-
4

Page…..12…..
 LAST EMOLUMENTS DUE/DRAWN BY ER. KRISHAN KUMAR, SR. EXECUTIVE
ENGINEER (E)

(D.O.B. 01.06.1961) RETIRING ON 31.05.2019

LAST BASIC PAY DRAWN/TO BE DRAWN
Sr. No Month Basic +Grade Dearness I.R @ Total Monthly
Pay Rs. Allowance 21% Pay
39,840+8500 @ 140 %
1. Feb. 2019 Rs. 48,340/- Rs. 67,676/- Rs. Rs. 1,26,167/-
10,151/-

Last Pay Drawn. Rs. 48,340/-

Total Service :- 34 Years 04 Months 18 days
Qualifying Service :- Entitled for full pensionery
benefit i.e. 50% of last pay
drawn.
PROPOSED PENSION ________
50% of Last Pay Drawn Rs. 48,340 x1/2 = Rs.
24,170/-
A.D.A. @ 140 % Rs. 24,170 x 140 % = Rs.
33,838/- I.R @ 21% Rs. 18,250 x 21%
= Rs. 5,076/-
Total = Rs.
63,084/-
Commutation of Pension 40% of Rs. 24,170/- =
Rs. 9,668/-
Amount of Commuted Pay Rs. 9,668 x12 x 8.71 =
Rs. 10,10,499/-
Pension Due :- = Rs.
53,416/-

The calculations are provisional and final figures to be given by the F&A wing

PROPOSED LEAVE ENCASHMENT

Earned Leave due 300 days or 10

months
Emoluments drawn in last Basic pay + DA + IR = (Rs. 48,340 + Rs. 67,676+ Rs. 10,151) =Rs.
1,26,167/-
Total amount of Leave encashment:- Rs. 1,26,167/- x 10 months = Rs.
12,61,670/-

PROPOSED GRATUITY Calculation of retirement gratuity -Basic+G.Pay+I.R+ ADA x 33

2
(39,840+8500+10,151+67,676)x33/2 = Rs. 15,71,873/-

Basic pay as on 31.03.2019 Rs.

36,500/-
DA as per present rate i.e. 140% Rs.
51,100/-
I.R. @ 21% Rs. 7,665/-
Total Rs.
95,265/-

Total Service 34 years 04 months 18

days
 Total amount of gratuity Rs. 20,81,756/-
Maximum limit is Rs,
10,00,000/-

SUMMARY:-
Total amount of Leave Encashment Rs.
12,61,670/-
Total amount of Gratuity Rs.
10,00,000/-
Total amount of commutation Rs. 10,10,499/-

Grand Total: Rs.

32,72,169/-
Residuary Pension after commutation. Rs.
53,416/-

Accounts Officer (Pay Gazetted)

F&A wing, HPSEBL,Shimla-171004

Page….13……..

Annex “A”

DECLARATION FOR DRAWL OF PENSION THROUGH DESIGNATED BANK

(To be submitted in Duplicate)
To

The Chief Accounts Officer,

HPSEB, Vidyut Bhawan,
Shimla.

I opt. to draw my pension through Designated Bank are given below necessary
particulars to enable you to make arrangement in this regard.

1. Particulars of Pensioners:
(a) Name: Er. Krishan Kumar
(b) PPO No. ___________________________
Present Address: Ward No. 3, Chaugan, Nurpur, Tehsil Nurpur, Distt. Kangra
(H.P.)-176202

Name of Designated Banks.

i) State Bank of India, Shimla.
ii) Punjab National Bank, Shimla.
iii) United Commercial Bank, Shimla.
iv) State Bank of Patiala, Shimla.
v) H.P. Co.-Operative Bank, Dalan Branch.
vi) K.C.C. Bank Dharamshala.
2. Particulars of Designated Bank.
(a) Name: K.C.C. Bank Sadwan Branch (IFSC code KACE0000069)
(b) Branch where payment desired :- Sadwan Pensioner’s saving Bank a/c
No. at the Branch to which pension is to be credited to:-
Saving Bank A/C No. 20069030196

Place: SHIMLA

Date: 30.04.2019 (Er. Krishan Kumar)

 Pensioner

PENSIONER’S SPECIMEN SIGNATURE

1.________________________________

Page…..14……..
Note: Joint or Either or Survivor Account.

Annexure “B”

Undertaking of Excess payment in respect Er. Krishan Kumar,

Sr. Executive Engineer (Elect.) o/o Chief Engineer (P&M),
HPSEBL, Shimla-04

Date of Birth:- 01.06.1961 Date of Retirement:-31.05.2019

I hereby undertake to refund excess payment, it any, noticed

after my retirement either pertaining to service period or any pensioner benefits

to the Board.

(Er. Krishan Kumar)

Sr. Executive Engineer
(Elect.)
O/o Chief Engineer (P&M),
HPSEBL, Shimla-04
 Page…..15……..

Annexure”C”

OPTION FOR MEDICAL REIMBURSEMENT IN RESPECT OF

ER. KRISHAN KUMAR, SR. EXECUTIVE ENGINEER
(ELECT.), O/O Chief Engineer (P&M), HPSEBL, Shimla-04
(D.O.B. 01.06.1961 ) (Date of Retirement. 31.05.2019)

I, Er. Krishan Kumar, presently working as Sr. Executive Engineer (E), o/o Chief

Engineer (P&M), HPSEBL, Shimla-04 hereby opt to get open Medical Re-imbursement claim

for own and other dependent members of my family after my retirement from Sr. Executive

Engineer, Electrical Division, HPSEBL, Nurpur, Distt. Kangra (H.P.)

(Er. Krishan Kumar)

Sr. Executive Engineer
(Elect.)
O/o Chief Engineer (P&M),
HPSEBL, Shimla-04
Page…..16……..
 PROFORMA FOR ACKNOWLEDGING THE RECEIPT OF THE
NOMINATION FORM BY THE HEAD OF OFFICE/ AUDIT OFFICER

To
Er. Krishan Kumar
Sr. Executive Engineer,
o/o Chief Engineer (P&M),
HPSEBL, HPSEBL, SHIMLA-171004
Sir,

In acknowledging the receipt of your nomination, dated the _________March, 2018 and
cancellation of any and all the nomination(s) made earlier in respect of gratuity, I am to state that
it has been duly placed on record.

Place:_______________ Signature of Head

of Office
Date:_________________
Designation………………

Note: The HPSEB Ltd servant is advised that it would be in the interest of these nominees if copies
of the nominations and the related notices and acknowledgements are kept in safe custody
so that they may come into the possession of the beneficiaries in the event of his death.

Page…..3……..