Application for Pensioner's Multipurpose I.D.card

TREASURIES & ACCOUNTS DEPARTMENT

ANDHRA PRADEH:: HYDERABAD

Application For Pensioner's(Service/Family)Multipurpose I.D Card
PART-I(Applicant Details)
1	Employee Code if available before retirement
2	Pensioner I.D. No*
3	Name of the Treasury/PPO from   where pension is being drawn*
4	Pensioners Name & Surname        Fathers  name/Husband name
5	Date of Birth (dd/mm/yyyy)*
6	Date of death of service Pensioner In case of Family Pensioner *
7	Date of Retirement of Service Pensioner*
8	Date of Commencement of pension(Sp/Fp)*
9	Retirement type (See Overleaf) *
10	Type of Family pension (See Overleaf)*
11	Name of the Department from Where  Service Pensioner Retired*
12	Designation at the time of retirement of Service Pensioner*
13	Designation grade (See Overleaf)*
14	Gender(M/F)*
15	Marital status (See Overleaf)*
16	Blood Group(Overleaf)
17	Ailments if any (See Overleaf)
18	Pensioner Category (See Overleaf)
19	Pensioner Employment Category (See Overleaf)
20	P.R.C. Year*
21	Present Basic pension*
22	PAN. NO
23	Ration Card No
24	Adhar Card No
25	Present Residential Address with Pincode*
26	Residential Phone No
27	Cell NO
28	E-Mail Address

PART-II DEPENDENT DETAILS(In case of Service Pensioner only)
S.No               (1)	Dependent Name*           (2)	Gender* (M/F)             (3)	Date of birth* (dd/mm/yyyy) (4)	Marital Status  (See Overleaf)*  (5)	Relationship  with Pensioner (See Overleaf)* (6)	Employment status*     (7)	Blood Group (8)

Declaration By The Pensioner (Only In case of Service Pensioner )

                I______________________________ do here by Confirm that, the list of my family members mentioned above is complete and they are fully dependent on me. I also declare that, the information above is true. I also declare that, if my declaration is found to be false at a latter date, I may be held responsible for the lapse as per rules.

                Signature of the Service Pensioner/ Family Pensioner.

                                    Emp.Code_________(if available)

                                                                                Pensioner I.D.No____________________

(For Treasury Officer use only)

(If rejected,Specify Reasons)    

                                                                                Counter Signature of the Treasury Officer

                                                                                                Authority with Office Seal

*  In case of Pensioner's drawing more than one pension need to apply for service pension only.

** In case of employment,no need to apply under this scheme by the Family Pensioner.

Part-1(Overleaf)

Sl.no  Descriptions

09.    Service-Normal/Service-Provisional/Service-Voluntary/Service-Invalid/Service- Prorata.

10.    Family-Normal/Family-Share/Family-Minor/Family-Pcmr/Direct Family.

13.    Gazetted/Non-Gazetted/Class-IV.

15.    Married/Unmarried/Widowed/Divorced/Remarried.

16.    A+ve, A-ve, B+ve, B-ve, AB+ve, AB-ve, O+ve and O-ve.

17.    B.P/Sugar/Cardiac Problems/Neurological Problems/Kidney Problems/Others.

18.    Civil/AST/FA/Political/Others

19.   State Normal/UGC/AIS/Judicial officer/UGC-Doctors/AICTC/Other States /Others

Part-II(Overleaf)

Sl.no  Descriptions

5.     Married/Unmarried/Widowed/Divorced/Remarried

6.     Father,Mother,Spouse,Son Including Adopted & step sons, Daughter including step Daughter.

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