Common Nomination Forms for pensioners to avail various benefits

| November 4, 2013

No. 1/12/2013-P&PW (E)

Government of India
Ministry of Personnel, P.G. & Pensions
Department of Pension & Pensioners’ Welfare
Lok Nayak Bhawan,
Khan Market, New Delhi
Dated: 1st Nov, 2013
Circular

Sub: Introduction of Common Nomination Forms for Nominations under various Rules – inviting comments – regarding.

The undersigned is directed to state that as present separate Nomination Form are being filled for various benefits. With a view to simplifying the procedure, the Department of Pension &PW proposes to introduce Common Nomination Form 1 for making nomination for the following benefits:

1. Gratuity under CCS (Pension) Rules, 1972

2. General Provident Fund (Civil Services) Rules, 1960

3. Amount under Employees Group Insurance Scheme, 1980

2. It is also proposed to use Common Nomination Form 2 for making nomination under

1. CCS (Commutation of Pension) Rules, 1981

2. Payment of Arrears of Pension (Nomination) Rules, 1983

3. Comments are invited from all concerned, including pensioners and pensioners’ associations on the use of these Forms in place of the existing Forms. Any suggestions for making the proposed Forms more simple, user-friendly and compatible with the amended provisions of the Rules are also welcome.
4. You may forward your comments to Shri Harjit Singh, Deputy Secretary, Department of Pension & Pensioners’ Welfare, at his e-mail harjit.singh59@nic.in within 15 days of its updating on the website.
Encl – Common Nomination Forms 1 and 2
sd/-
(D.K. Solanki)
Under Secretary to the Govt. of India
Tel No. 24644632

Copy to: 1. O/o CGA, 7thFloor, Lok Nayak Bhawan, Khan Market.

2. CPAO, Trikoot – II, Bhikaji Kama Place, New Delhi – 66.

with the request to expeditiously look into the Forms and send comments, if any, before 15th November, 2013.

Common Nomination Form 1

for Gratuity, GPF and Employees’ Group Insurance Scheme
[See Rule 53 of CCS (Pension) Rules, 1972, Rule 5 of General Provident Fund (CS) Rules, 1960 and Para 19.7 of Employees’ Group Insurance Scheme, 1980]

Head of Office,

………………………………………

………………………………………

………………………………………

I, ………………………………………………………., hereby nominate the person/persons mentioned below and confer on him/her/them the right to receive in the event of my death, to the extent specified below, amount on account of the following:-

i. any gratuity the payment of which may be authorized under Rule 50 of CCS (Pension) Rules

ii. amount that may stand to my credit in the General Provident Fund

iii. any amount that may be sanctioned by the Central Government under the Central Government employees Group Insurance Scheme, 1980

Name, date of
birth (DOB) and
address of the
nominee
Relat-
ionship
with
employee/
pensioner
Share
to be
paid to
each
If nominee is
minor, name,
DOB and address
of person who
may receive the
amount on behalf
of minor
Name, DOB and
address of alternate
nominee in case the
nominee under
Column (1)
predeceases the
employee/ pensioner
Relat-
ionship
with empl-
oyee/ pensi-
oner
Name, DOB and
address of
person who may
receive the
amount if
alternate
nominee in Col.
(5) is a minor
Contin-
gencyon
happening
of which
nomination
shall
become
invalid
1 2 3 4 5 6 7 8

These nominations supersede any nominations made by me earlier.

Place and date:

Signature of Government servant
Telephone No.______________

Note1
Separate copies of this nomination Form may be used for nominating different persons for different benefits (i)] (ii) and (iii) above by ticking the intended benefits and striking out the benefits for which nomination is not intended to be made.
Note2
The Government servant shall draw lines across the blank space below the last entry to prevent the insertion of any name after he/she has signed. The nominee( s)/alternate nominee( s) shares together should cover the whole amount.

(To be filled in by the Head of Office/ authorized Gazetted Officer)
Received the nominations, dated …………………………., under the following Rules:-

1. CCS (Pension) Rules 1972 for Gratuity

2. General Provident Fund (CS), 1960

3. Central Government employees Group Insurance Scheme, 1980
made by Shri/Smt./Kumari……………………………………………

Designation …………………………………………………….

Office …………………………………………………………………………………………… .

(Strike out which nomination is not received)

Entry of receipt of nomination(s) has been made in page ………………….. Volume ……………….. of Service Book.

Name, Signature and Designation of Head of Office/authorized Gazetted Officer with seal
Date of receipt…………………………. .

The receiving Officer will fill the above information and return a duly signed copy of the complete Form to the Government servant who should keep it in safe custody so that it may come into the possession of the beneficiaries in the event of his/her death.
The receiving officer shall put his/her dated signature on both pages of this Form.

Common Nomination Form 2

for Arrears of Pension and Commutation of Pension
[See Rule 5 of Payment of Arrears of Pension (Nomination) Rules, 1983, Rule 7 of CCS (Commutation of Pension) Rules, 1981]

Pension Disbursing Authority,

……………………………………………….

……………………………………………….

……………………………………………….

I, ………………………………………………………., hereby nominate the person/persons mentioned below and confer on him/her/them the right to receive in the event of my death, to the extent specified below, amount on account of the following:-

i. Arrears of Pension

ii. Commuted Value of Pension

Narne, date of 

birth (DOB) and

address of the

nominee

Relat- 

ionship

with

employee/

pensioner

Share 

to be

paid to

each

If nominee is 

minor, name,

DOB and address

of person who

may receive the

amount on behalf

of minor

Name, DOB and 

address of alternate

nominee in case the

nominee under

Column (1)

predeceases the

employee/ pensioner

Relat- 

ionship

with

emplo-

yee/

pensi-

oner

Name,DOB 

and address of

person who

may receive the

amount if

alternate

nominee in Col.

(5) is a minor

Contin- 

gency on

happening

of which

nomination

shall

become

invalid

1 2 3 4 5 6 7 8

These nominations supersede any nominations made by me earlier.

Place and date:

Signature of Government servant
Telephone No.

Note1 Separate copies of nomination Form may be used for nominating different persons for benefits (i) and (ii) above by ticking the intended benefit and striking out the benefit which is not intended to be made.
Note2 ‘The Government servant shall draw lines across the blank space below the last entry to prevent the insertion of any name after he/she has signed. The nominee( s)/alternate nominee( s) shares together should cover the whole amount.

(To be filled in by the Head of Office/ authorized Gazetted Officer)

Received the nominations, dated ……………………………………….., under the following Rules:-

1. Payment of Arrears of Pension (Nomination) Rules, 1983

2. CCS (Commutation of Pension) Rules, 1981

made by Shri/Smt./Kumari…………………………………. .

Designation ………………………………………………………

Office ……………………………………………………………..

(Strike out which nomination is not received)

Entry of receipt of nomination(s) has been made in page …………….. Volume ……………………. of Service Book.

Name, Signature and Designation of Head of Office/authorized Gazetted Officer with seal
Date of receipt……………………….
The receiving Officer will fill the above information and return a duly signed copy of the complete Form to the Government servant who should keep it in safe custody so that it may come into the possession of the beneficiaries in the event of his/her death.

The receiving officer shall put his/her dated signature on both pages of this Form.

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Category: CSS, CSSS, DOPT, DOPT Circulars 2013, Dopt Orders 2013, Family Pension, Pensioners

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