Get Example of Information of retirement pension beneficiary

Information of retirement pension beneficiary

(Filled up by record office)

(Picture)

1.      Personal information:

A.     Personal/ army number: BJO- 26793

B.     Designation: Subedar

C.     Name: Mizanur Rahman

D.     Core/ regiment: E Bengal

2.      Personal information of pension dependent/ family:

A.     Name of pension dependent/ family: .............................

..........................................................................................

B.     Relation with the death person: ........................................

C.     Description of child pension receiving:

(1)    Name: ................................................. Date of birth: ...............................

............................................................

(2)    Name: ................................................. Date of birth: ...............................

...........................................................................................

Picture of dependent pension beneficiary/ family:

Picture

Picture of pension beneficiaries:

Name: ........................................

...................................................

(Picture)

Name: ..........................................

....................................................

(Picture)

Page No- 3

3.      Address:

(1)    If the retirement person is alive his address:

Village: Shikarpur

Post Office: Same above

Upazilla: Kosba

Poilice Station: Same above

District: B. Baria

(2)    Dependent beneficiary/ family

Address:

Village:

Post Office:

Upazilla:

Police Station:

District:

4.      Bank Account:

A.     Name of the Bank: Janata Bank

B.     Branch (Including address) B- Baria (Prodhan)

B- Baria

C.     Savings- 8966

Duplicate signatures of dependent beneficiary/ family beneficiary/ retirement beneficiary (Three):

Sd/ Illegible

Identification marks of dependent beneficiary/ family beneficiary/ retirement beneficiary:

Signature: Sd/ Illegible

Identification mark: There is cutting mark in the smallest finger of left hand.

Identification marks of child pension receivers:

Name: ..................................... Identification mark: .................................................

................................................                 ................................................................................

Name: ............................................. Identification mark: .........................................

................................................ ................................................................................

Five fingertips of dependent beneficiary/ family beneficiary/ retirement beneficiary:

A.     No 1 finger: X                    B. No 2 finger: X                                             C. No 3 finger: X

D.     No 4 finger: X                    E. No 5 finger: X

Page No- 4

9. Five fingertips of child pension receivers:

A. Name: .....................................................................

(1) ........................................ (2) ......................... (3) ............................. (4) ..................................

(No 1 finger)                                     (No 2 finger)                      (No 3 finger)                      (No  finger)

(5) ........................................

(No 5 finger)

B. Name: .....................................................................

(1) ........................................ (2) ......................... (3) ............................. (4) ..................................

(No 1 finger)                                     (No 2 finger)                      (No 3 finger)                      (No  finger)

(5) ........................................

(No 5 finger)

To be seen:

1.      If there is no instruction in case of child pension mother can receive in favor of the child.

2.      Information of section ‘1’ will be applied in case of family/ dependent beneficiaries, but there will be needed picture.

3.      Cut off the unnecessary part completely making it clear and giving signature it is certified that the information mentioned is correct.

Date: 30/07/2000 AD

Sd/ Illegible

(Seal of office)

Full name with signature of record officer

Name: Md. Aftab Uddin

Major

Personal Number: BA- 2742

Core/ regiment: E Bengal

Information related to retirement pension

(Filled up by FC/ FPO)

Name, designation and number of retirement beneficiaries: BJO- 26793/ Subedar

Mizanur Rahman

Date of retirement: ....................................

PPO refenrence no: PG/ pen/BJO-26793/reshon/ 4beer date not mentioned, Riva no- 21/5/220

TS No- 12680/EBR

Classification of retirement pension:

A.     Service Pension: (Service Pension)

B.     Disability Pension: (Disability Pension)

C.     Family Pension: (Family Pension)

D.     Dependent Pension: (Dependent Pension)

E.      Child Pension: (Child Pension)

F.      Special Pension to Reservist: (Special Pension to Reservist)

G.     Ex Gratia Pension: (Ex Gratia Pension)

(Provide signature and cut off the unnecessary part)

Pension is payable by the bank on dated: 01/01/1990

If any information is available as pre reference of section- ‘3’. ...............................................

Page No- 5

8. Proportionate of retirement pension:

Retirement pension/ other pension	Monthly rate	Bank will pay on the dated	Comments
A.     Retirement pension	511/69
B.     Medical pension	100/=
C.     Festival pension	75/=	01/01/1990
D.     Other pension	46/40
E.      Reshon pension: her wife	247/- 247/-	01/07/2007 AD to lifetime on dated 01/07/2007 AD
F.      From dated 01/07/2010	321/- 321/-

The retirement pension is paid to May 2000 AD.

Total (amount) 733/09

Total (words)

Seven hundred

Taka/ 09 paisa

9. Child pension:

A. Name:..............................................................

(1) ............................... to ................................... dated: monthly: ..............................................

(2) ................................ to .................................. dated: monthly: ..............................................

(3) ................................ to .................................. dated: monthly: ..............................................

(Office seal of AC FPO)

(Seal)

Name:..............................................................

(1) ............................... to ................................... dated: monthly: ..............................................

(2) ................................ to .................................. dated: monthly: ..............................................

(3) ................................ to .................................. dated: monthly: ..............................................

10. Proportionate as mentioned above and as per date to necessity related retirement pension beneficiary pay to him.

Date: 30/07/2000 AD

Signature: Sd/ Illegible

Full name:...........................

Designation:..........................

Office:............................

(Seal)

30/07 AD