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Get Form 14 See Rule 77 3 And 81 2

FORM 14 See Rule 77 3 and 81 2 Form of application for the grant of Family pension 1964 on the death of a Government servant / pensioner. 1. Name of the applicant i Widow / Widower ii Guardian if the deceased person is survived by child or children* 2. Name and age of surviving widow/widower and children of the deceased Government servant / pensioner Sr. Name Relationship with deceased person Date of birth 3. Name and PPO no. of the deceased pensioner 4. Date of death of the Government servant/pensioner 5. Office/Department/Ministry in which the deceased 6. If the applicant is guardian his date of birth and of service pension which she/he may be in receipt on the date of death of the husband/wife 7. Full address of the applicant 8. Place of payment of pension and gratuity 9. Enclosures I. Two specimen signatures of the applicant duly attested to be furnished in two separate sheets. II. Two copies of passport size photographs of the applicant duly attested* III. Two slips each bearing left hand thumb and finger impressions of the applicant duly attested* IV. Descriptive roll of the applicant in duplicate duly attested indicating height and personal identification marks. V. Certificates of age in duplicate attested copies showing the dates of birth of the children* The certificates should be from the Municipal authorities or from the local panchayat or from the head of a recognized school if the child is studying in such school* 10. Indicate whether family pension is admissible From any other source --- Military or state government And/or a Public sector undertaking/Autonomous body Local fund under the Central or a state government. 11. Signature or left hand thumb impression of the applicant 12. Attested by Name Signature 1. 2. 13. Witnesses Note - Attestation should be done by two Gazetted government servants or two or more persons of respectability in the town or village in which the applicant resides. 1. Name of the applicant i Widow / Widower ii Guardian if the deceased person is survived by child or children* 2. Name and age of surviving widow/widower and children of the deceased Government servant / pensioner Sr. Name and age of surviving widow/widower and children of the deceased Government servant / pensioner Sr. Name Relationship with deceased person Date of birth 3. Name and PPO no. of the deceased pensioner 4. Name Relationship with deceased person Date of birth 3. Name and PPO no. of the deceased pensioner 4. Date of death of the Government servant/pensioner 5. Office/Department/Ministry in which the deceased 6. Date of death of the Government servant/pensioner 5. Office/Department/Ministry in which the deceased 6. If the applicant is guardian his date of birth and of service pension which she/he may be in receipt on the date of death of the husband/wife 7. If the applicant is guardian his date of birth and of service pension which she/he may be in receipt on the date of death of the husband/wife 7. Full address of the applicant 8. Place of payment of pension and gratuity 9. Enclosures I. Two specimen signatures of the applicant duly attested to be furnished in two separate sheets.

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