for life time arrears of pension in respect
of Indian military pensioners/indian state forces pensioners
(NAME OF P.D.O.)
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.__________
@ Rs. __________from _____________ to _________ Rs.__________
Adhoc increase @ Rs. ______________from _____________
to _________ Rs.__________
C.A.A. @ Rs. ________________ ____from _____________
to _________ Rs.___________
: Rs. _____________________________
could not claim life time arrears of Pension/C.A./J.I.
earlier for reasons given below:
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.
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
was also not kept in any Government Institution during the period for which
C.A.A. has not been claimed.
Signature of thumb impression of the claimant
portion not applicable should be scored out.
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.
scored out if the pensioner has not been granted C.A.A.
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. 2_______________________
or thumb impression__________
Signature or thumb impression__________
No. _______________________ T .S./H.O.
of the _______________________
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
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.
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.
claimant has been identified by the witnesses mentioned above who have been duly
warned of the responsibility they are under taking.
following documents are enclosed:
Roll of the pensioner
heir ship II certificate
Designation of the P.D.O. ___________________
The portion not applicable should be scored
This should be scored out when
the claimant is the nominated heir.
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.
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.
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.