Claims for life time arrears of pension in respect of Indian military pensioners/indian state forces pensioners

 IAFA (CDA)-652-FORM-B

 

PART-I

 

TO

_____________________________

(NAME OF P.D.O.)

_____________________________

 

Shri/Smt._____________________________________________________________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 was allotted T.S. / H.O. No. _______________________________ by you.  He/She died on ______________________ and before his/her death, he / she was paid his/her pension/C.A./J.I.* for the period upto ______________________________ as I am his/her nominated/legal heir, I request that / life time arrears or pension/C.A./J.I.* for period from _______________ to ____________  as per details given below may kindly be paid to me.

Pension @ Rs. ____________________from _____________ to _________ Rs.__________

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

Adhoc increase @ Rs. ______________from _____________ to _________ Rs.__________

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

Total :     Rs. _____________________________

Deduct :  Rs. _____________________________

Total:      Rs. _____________________________

I could not claim life time arrears of Pension/C.A./J.I. earlier for reasons given below:

During the aforesaid period, the Pensioner/C.A./J.I. holder* was neither convicted of any criminal or political offence nor was in receipt of any other pension.  He/She was also not re-employed under the Government in any capacity (civil or Military), during this period except  from_______________________ to ________________ I.A.FA.-397 in respect for which is enclosed.

I also declare that during the period of the claim the remarried/did not marry the real brother (born of same parents) of her last husband and was living communal life with and/or contributing towards the support of other eligible member of the family

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

 

Date

Village

Tehsil

P.O.

Yours faithfully,

Signature of thumb impression of the claimant

 

-           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 is the nominated heir as per descriptive roll of the pensioner/C.A./J.I. holder* /no heir was nominated by the pensioner/C.A./J.I. holder * and that the claimant is the legal heir as per heir ship certificate attached.

The claimant has been identified by the witnesses mentioned above who have been duly warned of the responsibility they are under taking.

The following documents are enclosed:

 

Descriptive Roll of the pensioner

Death certificate

Legal heir ship II certificate

Last pay certificate

 

Signature

 

Designation of the P.D.O. ___________________

 

Dated:

-           The portion not applicable should be scored out.    

            This should be scored out when the claimant is the nominated heir.

            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. will state so and give brief reasons for his views.

            If the deceased 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.

            The last pay certificate need be sent only in those cases of services, mustering out and disability pensions in which no payment at all has been drawn by the pensioner and when pension was sanctioned before the 1st October 1951.  In all other cases this part should be scored out.