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i) "Medical authority" means medical authority referred to in Rule ;
by MAHI
Place :
Signature Date : Postal Address * The applicant should indicate the percentage of the amount of the monthly pension subject to maximum of 40% thereof which he desires and not the amount in Rupees. 1 Score out which is not applicable.
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PART II
ACKNOWLEDGEMENT
Received from Shri........................(name)......................(former designation) application in Part I of Form 1 for the commutation of a percentage of pension without medical examination.
Place : Date :
Signature Head of Office
NOTE. - This acknowledgement is to be signed, stamped and dated and is to be detached from the Form and handed over to the applicant. If the form has been received by the post, it has to be acknowledged on the same day and the acknowledgement sent under registered cover.
PART III
Forwarded to the Accounts Officer..............................................(here indicate the address and designation) with the remarks that -
(i) the particulars furnished by the applicant in Part I have been verified and are correct ; (ii) the applicant is eligible to get a percentage of his pension commuted without medical examination ; (iii) the commuted value of pension determined with reference to the Table applicable at present comes to
Rs............................... (iv) the amount of residuary pension after commutation will be Rs..................
2. 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, 1981.
3. The receipt of Part I of the Form has been acknowledged in Part II which has been forwarded separately to the applicant on................................
4. The commuted value of pension is debitable to Head of Account ----.
Place : Date :
Signature Head of Office
FORM 1-A
FORM OF APPLICATION FOR COMMUTATION OF A PERCENTAGE OF SUPERANNUATION PENSION WITHOUT MEDICAL EXAMINATION WHEN APPLICANT DESIRES THAT THE PAYMENT OF THE COMMUTED VALUE OF PENSION SHOULD BE AUTHORIZED THROUGH THE PENSION PAYMENT ORDER
[see Rules 5(2), 12,13(30,14(i) and 15(3)
(To be submitted in duplicate at least three months before the date of retirement)
PART I
The...........................................................................................................................
................................................................................................................................. (Here indicate the designation and full address of the Head of Office)
Subject: - Commutation of pension without medical examination.
Sir,
I desire to commute a percentage of my pension in accordance with the provisions of the Central Civil Services (Commutation of Pension) Rules, 1981. The necessary particulars are furnished below -
1. Name (in Block letters) 2. Father's name (and also husband's name in the case of a female Government servant) 3. Designation 4. Name of Office/Department/Ministry in which employed 5. Date of Birth (by Christian era) 6. Date of retirement on superannuation or on the expiry of extension in service granted under FR 56 (d) 17. Percentage of superannuation pension proposed to be commuted (The applicant should indicate the percentage of the amount of monthly pension subject to be maximum of forty percent thereof which he/she desires to commute and not the amount in Rupees) 28. Disbursing authority from which pension is to be drawn after retirement (score out which is not applicable) (a) Treasury/Sub-Treasury (Name and complete
address of the Treasury/Sub-Treasury to be indicated) (b) (i) Branch of the nominated nationalized bank with complete postal address ... ... ... (ii)Bank Account No. to which monthly pension is to be credited each month ... ... ... (c) Account Office of the
Ministry/Department/Office
Place : Date : Signature Present Postal address.
............................................... Postal address after retirement
Footnote : 1. The applicant should indicate the percentage of the amount of monthly pension (subject to a maximum of forty percent thereof) which he/she desires to commute and not the amount in rupees.
2. Score out which is not applicable.
PART II
(ACKNOWLEDGEMENT)
Received from Shri/Smt./Kumari................................................(name)...................................(designation) application in Part I of Form I-A for commutation of a percentage of pension without medical examination.
Place : Date :
Signature Head of Office
NOTE. - If the application has been received by the Head of Office before the date of retirement on superannuation, this acknowledgement should be detached from the Form and handed over to the applicant. If the form has been received by post, it has to be acknowledged on the same day and the acknowledgement sent under registered cover to the applicant. In case it is received after the specified date, it should be accepted only if it has been put into the post on or before that date subject to the production of evidence to that effect by the applicant.
PART III
Forwarded to the Accounts Officer.
(here indicate the address and designation)........................................................ with the remarks that -
(i) the particulars furnished by the applicant in Part I have
been verified and are correct ; (ii) the applicant is eligible to get a percentage of his pension commuted without medical examination ; (iii) the commuted value of pension determined with reference to the Table applicable at present comes to
Rs.........................; and (iv) the amount of residuary pension after commutation will be Rs.......................
2. The pension papers of the applicant completed in all respects were forwarded under this Ministry/Department/Office Letter No......................., dated............................ It is requested that the payment of commuted value of pension may be authorized through the Pension Payment Order which may be issued one month before the retirement of the applicant.
3. The receipt of Part I of this Form has been acknowledged in Part II which has been forwarded separately to the applicant on.............................
4. The commuted value of pension is debitable to Head of Account..........................
Place : Date :
Signature Head of Office
FORM 2 FORM OF APPLICATION FOR COMMUTATION OF PENSION AFTER MEDICAL EXAMINATION BY AN APPLICANT REFERRED TO IN RULE 18 OF THE CENTRAL CIVIL SERVICES (COMMUTATION OF PENSION) RULES, 1981 [see Rules 5(2),9(3),13(2), 14(2),19,20(1),(2) and (3), 21(1) and 25(2)] (To be submitted in duplicate) PART-I
SPACE FOR PHOTOGRAPH The...........................................................................................................................
................................................................................................................................. (Here indicate the designation and full address of the Head of Office)
Subject :- Commutation of pension after medical examination.
Sir,
I desire to commute a percentage of my pension in accordance with the provisions of the Central Civil Services (Commutation of Pension) Rules, 1981. An attested copy of my photograph is pasted on the application and an unattested copy is enclosed. The necessary particulars are furnished below -
1. Name (in Block letters) 2. Father's name (and also husband's name in the case of a female Government servant) 3. Designation 4. Name of Office/Department/Ministry in which employed 5. Date of Birth (by Christian era) 6. Date of retirement 7. Class of pension on which retired [ See Chapter V of the Central Civil Services (Pension) Rules, 1972 ... ... ... 8. Amount of pension authorized (indicate the amount of provisional pension if full pension not authorized) ... ... ... 9. 1 Percentage of pension proposed to be commuted (the applicant should indicate the percentage of the amount of monthly pension subject to a maximum of forty percent thereof which he desires to commute and not the amount in rupees) ... ... ... 10. Designation of the Accounts Officer who authorized the pension and the number and date of the Pension
Payment Order ... ... ... 11. 2Disbursing authority for payment of pension (score out which is not applicable)(a) Treasury/Sub-Treasury (name and complete
address of the Treasury/Sub-Treasury to be indicated) (b) (i) Branch of the Nationalized Bank with complete postal address ... ... ...
(ii)Bank Account No. to which monthly pension is being credited each month ... ... ... (c) Accounts Office of the Ministry/Department/Office ... ... ... 12. Approximate date from which commutation is desired to have effect ... ... ... 13. The amount of pension already commuted, if any ... ... ... 14. Preference for station where medical examination is desired to take place ... ... ...
Signature Postal Address........
Place : Date :
Footnote : 1. The applicant should indicate the percentage of the amount of monthly pension (subject to a maximum of forty percent thereof) which he desires to commute and not the amount in rupees. 2. Score out which is not applicable.
NOTE. - The payment of commuted value of pension shall be made through the disbursing authority from which pension is being drawn. It is not open to an applicant to draw the commuted value of pension from a disbursing authority other than the authority from which pension is being drawn.
PART- II ACKNOWLEDGEMENT
Received from Shri.\ Kum.\Smt.........................................(name)...........................................(designation) application in Part I of Form 2 for commutation of a percentage of pension after medical examination.
Place : Date :
Signature Head of Office
PART- III
Forwarded to the Accounts Officer................................................................(here indicate the address and designation) with the remarks that the particulars furnished by the applicant in Part I have been verified and are correct and the applicant is eligible to get a percentage of his pension commuted after medical examination. 2. It is requested that Part IV of the Form may be completed and returned to this office as early as possible. Place : Signature Date : Head of Office
PART- IV (To be completed by the Accounts Officer)
1. Name of the applicant 2. Date of birth (by Christian era) 3. Date of retirement 4. Amount of pension including provisional pension, if final pension not authorized ... ... ...
5. Class of pension [ See Chapter V of the CCS (Pension) Rules, 1972 ] 6. Amount of pension desired to be commuted ... ... ...
7. (i) Sum payable if commutation becomes absolute before the applicant's next birthday, which falls on............................
(ii) Sum payable if commutation becomes absolute after the applicant's next birthday, which falls on......................... 8. The Head of Account to which commuted value is debitable 9. Number of enclosures, if any [ See Note below ]
Place :
Date :
On the basis of Normal age Added years 1 years 2 years
Rs. Rs. Rs.
Signature and Designation of the Accounts Officer
Countersigned
(Head of Office) Full address NOTE. - The Accounts Officer should enclose with the Form a copy of the report or statement of the applicant's case if the applicant has been granted invalid pension or has previously commuted a part of his pension or declined to accept commutation on the basis of an addition of years to actual age, or has been refused commutation on medical grounds.
FORM 3 FORM OF LETTER OF THE CHIEF ADMINISTRATIVE MEDICAL AUTHORITY [see Rules 20(3) and (4) and 28(5) ]
(Please see Annexure) No................................................... Government of India Ministry of........................................ Department of.................................. Dated the.........................................
To
Subject:- Medical Examination - Commutation of Pension.
Sir,
Shri./Smt/Kumari......................................who retired from service on........................................ as........ .....................................(designation) has applied for commuting a percentage of his pension for a lumpsum payment. The following documents are forwarded herewith :-
(a) Application in Form 2 in original together with (i) an unattested copy of the applicant's photograph, (ii)Part IV of Form 2 in original duly completed by the Accounts Officer. (b) A copy of Form 4 with a spare copy of Part III of that Form. (c) Report of the statement of the applicant's case if he has been granted invalid pension or has previously commuted a percentage of his pension or declined to accept commutation on the basis of addition of years to his actual age or has been refused commutation on medical grounds.
2. In terms of Rule 22 of the Central Civil Services (Commutation of Pension) Rules, 1981, Shri./Smt/Kumari ..................................................... should be examined by a Medical Board/Medical Officer not lower than the rank of Civil Surgeon or a District Medical Officer. It is requested that arrangement may be made to get Shri../Kumari/Smt.................................................examined as expeditiously as possible before his/her next birthday which falls on..................................
3. It is requested that arrangements for medical examination by the medical authority indicated in para. 2 above may be made at the nearest available station mentioned by Shri./kumari/Smt.................................in his/her application in Form 2. The attention of the medical authority may be drawn to the provisions of Rule 25 of the Central Civil Services (Commutation of Pension) Rules, 1981.
4. It is requested that Shri./smt/kumari.......................................may be informed direct under intimation to this Ministry/Department/ Office as to where and when he should appear before
the appropriate authority for medical examination. A copy of this letter is being endorsed to him/her so that he/she may comply with your instructions on hearing from you.
5. The receipt of this letter may please be acknowledged.
Yours faithfully, (Head of Office)
Copy forwarded to Shri./Smt/Kumari...............................................................................(here give complete postal address) with the remarks that subject to the medical authority recommending commutation, he/she will, on the basis of the report of the Accounts Officer, be eligible for the lumpsum payment in lieu of the amount of pension to be commuted as follows :
(i) Sum payable if commutation becomes absolute before the applicant's next birthday which falls on............................. (ii)Sum payable if commutation becomes absolute after applicant's next birthday which falls on......................................................
On the basis of Normal age Added years 1 years 2 years
Rs. Rs. Rs.
The Table of the present value, on the basis of which the calculation by the Accounts Officer has been made, is subject to alteration at any time without notice and consequently the basis is liable to revision, before payment is made. The sum payable will be the sum appropriate to the applicant's age on his birthday next after the date on which the commutation becomes absolute or if the medical authority directs that years will be added to that age, to the consequent assumed age.
Shri/Smt/Kumari.......................................should report for medical examination to the medical authority direct on hearing from.............. She/He should take with him/her the enclosed Form 4 with the particulars required in Part I completed except the signature or thumb or finger impressions.
Signature Date : (Head of Office)
Copy forwarded to the Accounts Officer...........................................................(here indicate designation and address) with reference to his Letter No..............................., dated...................................
Signature (Head of Office)
FORM - 4
MEDICAL EXAMINATION BY THE.............................................................................................. (Here enter the medical authority) [ see Rules 6(1), 20(3), 25(1), (2) and (3), 26(3), 27(1) and (3), 28(2), 30(1) and 31(2)]
PART-I
PART I
The applicant must complete this statement prior to his examination by the........................................................... (Here enter the medical authority) and must sign the declaration appended thereto in the presence of that authority.
1. Name of the applicant (in Block letters) ... ... ... 2. Date of birth (by Christian era) ... ... ... 3. Place of birth ... ... ... 4. Particulars regarding parents, brothers and sisters -
Father's age, if living and state of health Father's age at death and cause of death Number of brothers living, their ages and state of health Number of brothers dead, their ages at death and cause of death Mother's age, if living and state of health Mother's age at death and cause of death Number of sisters living, their ages and state of health Number of sisters dead, their ages at death and cause of death
5. Have you ever been examined (a) for Life Insurance, or/and (b) by any Government Medical Officer or State Medical Board If so, state details and with what results ............. 6. Have you been granted or considered for grant of invalid pension? If so, state the ground thereof 7. Have you ever been granted leave on medical certificate during the last five years? If so, state periods of leave and nature of illness ... ... ... 8. Have you ever (a) had smallpox, intermittent or any other fever, enlargement or suppuration of glands, spitting of blood, asthma, inflammation of lungs, pleurisy, heart disease, fainting attacks, rheumatism, 31
appendicitis, epilepsy, insanity or other nervous disease, discharge from or other disease of the ear, syphilis or gonorrhea ; or (b) had any other disease or injury which required confinement to bed, or medical or surgical treatment ; or
... ... ... (c) undergone any surgical operation ; or ... ... ... (d) suffered from any illness, wound or injury sustained while on active service ... ... ... (e) presence of albumin or sugar in urine ... ... ... 9. Present state of health (a) Have you a hernia? ... ... ... (b) Have you varicocele, varicose veins or piles? ... ... ... (c) Is your vision in each eye good (with or without glasses)? ... ... ... (d) If your hearing in each ear good? ... ... ... (e) Have you any congenital or acquired malformation, defect or deformity? ... ... ... (f) Have you lost or gained weight markedly during the last three years? ... ... ... (g) Have you been under treatment of any doctor within the last three months and nature of illness for which such treatment was taken?
Declaration by Applicant (To be signed in the presence of the medical authority)
I declare all the above answers to be, to the best of my belief, true and correct.
I am fully aware that by willfully making a false statement or concealing a relevant fact I shall incur the risk of losing the commutation I have applied for and of having my pension withheld or withdrawn under Rule 8 of the Central Civil Services (Pension) Rules, 1972.
Applicant's signature or thumb-impression in case of illiterate applicant
Signed in the presence of................................. (Signature and designation of medical authority)
PART- II (To be filled in by the examining medical authority)
1. Apparent age 2. Height 3. Weight 4. Describe any scars or identifying marks of the applicant
5. Pulse rate (a) Sitting (b) Standing
What is the character of pulse? 6. Blood pressure (a) Systolic (b) Diastolic 7. Is there any evidence of disease of the main organs (a) Heart (b) Lungs (c) Liver (d) Spleen (e) Kidney 8. Investigations (i) Urine (State specific gravity) (ii) Blood (iii)X-Ray Chest (iv)ECG 9. Has the applicant a hernia? (If so, state the kind and if reducible) 10. Any additional finding
PART- III (To be filled in by the examining medical authority)
I/We have carefully examined Shri/Shrimati/Kumari.........................................................and am/are of opinion that -
He/She is in good bodily health and has the prospect of an average duration of life.
Or
He/She is not in good bodily health and is not a fit subject for commutation.
Or
Although he/she is suffering from...............................he/she is considered a fit subject for commutation but his/her age for the purpose of commutation, i.e., the age next birthday should be taken to be..................................(in words) years more than his/her actual age.
Station :
Date : Signature and designation of examining medical authority
FORM 5 [ see Rule 7 ]
To Head of Office (Place)............................................
I,....................................................(Name of the pensioner in Capital Letters) hereby nominate the person named below, under Rule 7 of the Central Civil Services (Commutation of Pension) Rules, 1981.
If nominee is minor
Name and address of the nominee
Reletionship with the pensioner Date of birth Name and address of person who may receive the said commuted value during the nominee's minority Name and address of other nominee in case the nominee under column (1) predeceases the pensioner
Reletionship with pensioner Date of birth if the other nominee is minor
Name and address of person who may receive the commuted value of pension during the other nominee's minority Contingency on happening of which nomination shall become invalid
1 2 3 4 5 6 7 8 9
Place : Date : Witness : Signature : Name and Address : Signature (or thumbimpression if illiterate) and name of Pensioner : Address: Signature of Head of Office :
STAMP
Acknowledgement to be sent by the Head of Office
Certified that the nomination has been received from....................................................................(name of Pensioner) whose address is......................................................
Place : Date : Signature of Head of Office Full Address :
PRO FORMA [ see Decision(2), Rule 10 ]
Subject :-Restoration of commuted portion of pensions after 15 years Implementation of the judgment of the Supreme Court.
Sir,
Kindly restore my commuted portion of pension in terms of Ministry of Personnel, Public Grievances and Pensions, Department of Pension and Pensioners' Welfare, O.M. No. 34/2/86P. & P.W., dated the 5th March, 1987.
Requisite particulars are given below 1. Name in Block letters 2. Date of retirement 3. PC/PPO No. 4. Amount of original pension 5. Amount of pension commuted (if any) 6. Name of the Accounts Officer, viz., the authority who issued PC/PPO 7. Name of the Treasury/Post Office/PPM/other pension disbursing agency
Signature of Pensioner
Date : Postal address :
Particulars verified.
Signature
Rubber Stamp of Pension Disbursing Authority
TABLE COMMUTATION VALUES FOR A PENSION OF Re. 1 PER ANNUM Effective from 1st January,2006 [ see Rules 3(1)(m) 8,26(7), 28(5) and 29(1) and 29(2) ]
Age next birthday Commutation value expressed as number of year's purchase Age next birthday
Commutation value expressed as number of year's purchase Age next birthday
Commutation value expressed as number of year's purchase 20 9.188 41 9.075 62 8.093 21 9.187 42 9.059 63 7.982 22 9.186 43 9.040 64 7.862 23 9.185 44 9.019 65 7.731 24 9.184 45 8.996 66 7.591 25 9.183 46 8.971 67 7.431 26 9.182 47 8.943 68 7.262 27 9.180 48 8.913 69 7.083 28 9.178 49 8.881 70 6.897 29 9.176 50 8.846 71 6.703 30 9.173 51 8.808 72 6.502 31 9.169 52 8.768 73 6.296 32 9.164 53 8.724 74 6.085 33 9.159 54 8.678 75 5.872 34 9.152 55 8.627 76 5.657 35 9.145 56 8.572 77 5.443 36 9.136 57 8.512 78 5.229 37 9.126 58 8.446 79 5.018 38 9.116 59 8.371 80 4.812 39 9.103 60 8.287 81 4.611 40 9.090 61 8.194
[Basis: LIC (94-96) Ultimate Tables and 8.00% interest]
Explanatory Note :
Due to implementation of the recommendations of the sixth Central Pay Commission, it has become necessary to give retrospective effect to the proposed amendments from the date from which the recommendations of the |Sixth Central Pay Commission were given effect to. It is certified that the interest of no person is adversely affected by giving retrospective effect to the proposed amendments. The revised Table of Commutation Value for pension, appended to these rules shall be used for all commutation of pension which becomes absolute from the 2nd September, 2008 and in the case of pensioners whose commutation of pension became absolute on or after 1st January, 2006 but before 2nd September, 2008, the pre revised Table of Commutation Value for Pension shall be used for payment of commutation of pension based on pre revised pay or pension and in respect of such pensioners, the revised Table of Commutation Value for Pension, appended to these rules shall be used for the commutation of additional amount of pension that has become commutable on account of retrospective revision of pay and pension.
ANNEXURE [ see Rule 20(3) ] CHIEF ADMINISTRATIVE MEDICAL AUTHORITIES IN THE STATES AND UNION TERRITORIES
Sl. No. Name of the State Designation and Address
STATES 1. Andhra Pradesh Director of Health Services, Andhra Pradesh, Hyderabad.
2. Assam Director of Health Services, Assam, Shillong.
3. Bihar Director of Health Services, Bihar, Patna.
4. Gujarat
Director of Medical Services, Gujarat, Ahmedabad. 5. Haryana Director of Health Services, Haryana, Chandigarh. 6. Himachal Pradesh Director of Medical and Health Services, Himachal Pradesh, Simla. 7. Jammu and Kashmir Director of Health Services, Jammu and Kashmir, Srinagar/Jammu (Tawi).
8. Karnataka
Director of Health Services, Karnataka, Bangalore. 9. Kerala Director of Health Services, Kerala, Trivandrum. 10. Madhya Pradesh Director of Health Services, Madhya Pradesh, Bhopal. 11. Maharashtra (i) The Superintendent, JJ. Group of Hospitals, Mumbai or the Civil Surgeon, Pune, if the applicant is to be examined by a Medical Board. (ii) Civil Surgeon of the District concerned or the Presidency Surgeon, Mumbai, if the applicant is not to be examined by a Medical Board.
12. Manipur
13. Meghalaya
14. Nagaland
15. Orissa
16. Punjab
17. Rajasthan Director of Medical and Health Services, Manipur, Imphal. Director of Health Services, Meghalaya, Shillong. Director of Health Services, Nagaland, Kohima. Director of Health Services, Orissa, Bhubaneswar. Director of Health Services, Punjab, Chandigarh. Director of Medical and Health Services, Rajasthan, Jaipur. 37
18. Sikkim Director of Health Services, Sikkim, Gangtok.
19. Tamil Nadu
Director of Health Services and Family Planning, Tamil Nadu, Chennai. 20. Tripura Director of Health Services, Tripura, Agartala. 21. Uttar Pradesh Director of Medical and Health Services, Uttar Pradesh, Lucknow. 22. West Bengal Director of Health Services, West Bengal, Writers Building, Calcutta.
THE UNION TERRITORIES
1. Delhi (i) The Chairman of the Central Standing
Medical Board,
Dr. Ram Manohar Lohia Hospital, New
Delhi. (ii) The Chairman of the Central Standing
Medical Board,
Safdarjang Hospital, New Delhi.
2. The Andaman and Nicobar Islands
Senior Medical Officer, Andaman and Nicobar Islands, Port Blair. 3. Lakshadweep Director of Medical and Health Services, Lakshadweep, P.O. Kavaratti (via), Head Post Office, Calicut. 4. Dadra and Nagar Haveli Medical Officer of Health, Dadra and Nagar Haveli, Silvassa. 5. Goa, Daman and Diu Director of Health Services, Goa, Panjim. 6. Pondicherry Director of Health Services, Pondicherry. 7. Chandigarh Medical Officer of Health, Union Territory of Chandigarh, Chandigarh. 8. Mizoram Director of Health Services, Mizoram, Shillong. 9. Arunachal Pradesh Director of Health Services, Shillong.
