Claim for arrears of pensions in respect of Indian militry pensioners/state forces pensioners

IAFA (CDA)-651- FORM-A

PART-I

TO

_____________________________

(NAME OF P.D.O.)

_____________________________

I _________________________________________________________________ was granted pension/CA/JI* in the C.M.A./C.D.A. ____________________ P.C./P.P.O. No. ____________________ dated ______________________ (D.S.No. ____________ ) as amended by the C.M.A. /C.D.A. _________________________ P.C./P.P.O. No. ____________________________ dated _____________________ and have been allotted T.S. / H.O. No. _______________________________ by you.  I have not drawn my Pension/C.A./J.I* ____________________________________________ for the period __________________________ to ______________________________ and such a sum of Rs. _______________________________ as per details given below may kindly be paid to me.

Pension @ Rs. ____________________from _____________ to _________ Rs.__________

Temporary  increase @ Rs. __________from _____________ to _________ Rs.__________

C.A.A. @ Rs. ________________ ____from _____________ to _________ Rs.___________

====================================

Total :     Rs. _____________________________

Deduct :  Rs. _____________________________

====================================

Total:      Rs. _____________________________

I could not draw my pension/C.A./J.I.  earlier for reasons given below:

During the aforesaid period, I was neither convicted of any criminal or political offence nor was in receipt of any other pension.  I was also not re-employed under the Government in any capacity (civil or Military), local bodies like municipalities and District Board during this period except    from_______________________ to ________________ I.A.F-397 in respect for which is enclosed.

I also declare that I have/have not re-married / married the real brother (born of same parents) of my late husband and am living communal life with and / or contributing towards the support of other eligible members of the family.

I was also not kept in any Government Institution during the period for which C.A.A. has been claimed.

Yours faithfully,

Signature of thumb impression of the pensioner

Village ___________________________

Tehsil ____________________________

Post office _________________________

District ___________________________

________________________________________________________________________

-The portion not applicable should be scored out.    

-The portion "except from _____________ enclosed" should be scored out if the pensioner has not been re-employed at all under the Government.

-To be scored out if the pensioner is not a female.  In the case of female pensioner, the portion in the certificates which is not applicable to her should be scored out.

-To be scored out if the pensioner has not been granted C.A.A.

PART-II

We certify that the claimant is known to us and he/she is the same person who was granted pension/C.A./J.I. * as per details given by him/her.  We certify that to the best of our knowledge and belief, the statements made by him/her above are correct.

Witness No. 1_______________________     Witness No. 2_______________________

Name______________________________     Name______________________________

Signature or thumb impression__________     Signature or thumb impression__________

T.S./H.O. No. _______________________     T  .S./H.O. No. _______________________

Station_____________________________     Station_____________________________

Date_______________________________     Date_______________________________

PART-III

No. ______________________________

Office of the _______________________

Date _____________________________

Forwarded to the C.D.A. (P), Allahabad, for favour of according sanction to the payment of arrears.  The claim was first preferred on ___________________ and the arrears are due from ___________________ to _________________ as per entries in his pension certificate and the records of this office.  I consider the explanation of the pension / C.A./ J.I. holder * credible and satisfactory  and certify that:

The pensioner/C.A./J.I. holder* was in my payment throughout the period for which the arrear have been claimed and was last paid up to and for ________________________ and the arrears now claimed have not been paid before.

The claimant has been indentified . I am satisfied that he / she is the same person, who was granted pension / C.A./J.I.* as per details given by him/her.

The following documents are enclosed:

Pension/C.A./J.I.* certificate of the pensioner

Descriptive Roll of the pensioner.

Signature

Designation of the P.D.O. ___________________

-           The portion not applicable should be scored out.    

-           Where the explanation of the claimant for delay in drawing his pension/allowances/J.I. is not considered credible and satisfactory the P.D.O. willl state so and give brief reasons for his views.

-           If the claimant was not in his payment throughout the period for which the arrears have been claimed, the date from which and the name of the P.D.O. from whose payment he/she was transferred should be stated.