A.P.

FOREST SERVICES ASSOCIATION

PENSION PROPOSALS PREPARATION PACKAGE
PERSONAL DETAILS IDENTIFICATION MARKS
Name Sri Kamarsu V.S. Rajkumar 1 A mole on the right shoulder
Father Satyanarayana Murthy 2 A mole on the right cheek
Designation Senior Assistant
Emp. ID 0302496 GPF A/c No. 33105/for
PAN Card no. AWXXXXX36B Aadhar no. 309412131212

DATES NON-QUALIFYING SERVICE

Birth 17 08 1967 S.No. Leave Type Y M
Appointment 20 05 2000 F.N. a E.O.L 00 00
Retirement (If voluntary) b Suspension Period 00 00
Commutation Date c Dies-Non 00 00
Age of Superannuation 60 d Boy Service 00 00
Application Date 30 12 2020 e Any other 00 00

ADDRESS FOR COMMUNICATION

Office Address Present Address Permanent Address
Conservator of Forests Dr.no. 22-5-20, Ganesh Appartment Dr.no. 22-5-20, Ganesh Appartment
Social Forestry & Working Plan Circle Flat no. G2, Swarnamandir Street Flat no. G2, Swarnamandir Street
Vijayawada Veerabhadrapuram Veerabhadrapuram
Krishna District Rajahmundry - 533105 Rajahmundry - 533105

SALARY PARTICULARS BANK DETAILS

Pay 110,850 Bank Ac. No. 02315xxxxx31456
D.A. % 15.980 Name of the Bank SBI, Treasury Br., Kakinada
% Commutation 40.00 IFSC Code SBIN0001425 MICR code 533002130
Pension Disbursing Authority STO, Rajahmundry
NOMINATION DETAILS
Nominee Name Age Relation Share Identification Mark 1 Identification Mark 2
K.S.S.Madhuri 33 Wife 100 A mole on the right shoulder A mole on the right cheek

FAMILY MEMBERS

Name of the Member Relation Date of Birth Marital Status Employment

Status
K.S.S.Madhuri Wife 8/30/1975 Married No
K.S.O.Samana Daughter 8/7/1996 Unmarried No
K.S.S.Nimay Son 11/15/2001 Unmarried No

DDO DETAILS DDO OFFICE

Name Dr. C.K.Mishra, IFS Conservator of Forests,
Designation Prl.Cheif Conservator of Forests S.F.& W.P. Circle,
Letter No. & Date Lr.No.33/PEN/2012 12 07 2012 Vijayawada
 PENSION BENEFITS
Service Pension 54,586.00 Gratuity payable 1,200,000.00
Pension after commutation 32,751.00 Commutation of pension 2,146,992.00
Family Pension 33,255.00 Date of Restoration of Pension 8/17/2032
ERVICES ASSOCIATION
OSALS PREPARATION PACKAGE
###
A mole on the right shoulder ###
A mole on the right cheek ###
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33105/for ###
309412131212
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D ###
00 ###
00 ###
00 ###
00 ###
00 ###
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Permanent Address ###
Dr.no. 22-5-20, Ganesh Appartment ###
Flat no. G2, Swarnamandir Street ###
Veerabhadrapuram ###
Rajahmundry - 533105 ###
###
###
02315xxxxx31456 ###
SBI, Treasury Br., Kakinada ###
533002130 ###
STO, Rajahmundry ###
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Identification Mark 2 ###
A mole on the right cheek ###
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Conservator of Forests, ###
S.F.& W.P. Circle, ###
Vijayawada ###
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PENSION BENEFITS ###
1,200,000.00 ###
2,146,992.00 ###
8/17/2032 ###
###
###
 CHECK LIST FOR PENSION PROPOSALS
1 Name and Designation : KAMARSU V.S. RAJKUMAR, Senior Assistant

2 Place of working : O/o Conservator of Forests, Social Forestry &

Working Plan Circle, Vijayawada,Krishna
District

3 Date of Birth : 17-08-1967

4 Date of Entry into Service : 20-05-2000

5 Date of Retirement : 31-08-2027

6 Total Service : 27 years 03 months 11 days

7 Break period (if any) : 00 years 00 months 00 days

8 Net qualifying service : 27 years 03 months 11 days

9 Weightage if any : 05 years 00 months 00 days

10 Total qualifying service for calculation of : 32 years 03 months 11 days

pension

11 Last Pay drawn and scale of Pay : Rs 1,10,850.00

12 Calculation of :

A. Gratuity : Rs.12,00,000.00

B. Pension : Rs.54,586.00

C. Family Pension :

Enhanced : Rs.55,425.00

Normal : Rs.33,255.00

13 Whether any charges are pending against the : Nil

retired employee

14 Whether any dues are to be recovered from : Nil

the incumbent

15 If so the details of amount to be recovered : Nil

from the incumbent

16 Whether the pension proposalsare furnished in : Yes

4 sets

17 Whether all the Service verification entries are : Yes

made in the service book of the incumbent

18 Whether final L.P.C. is produced : Provisional L.P.C. enclosed

19 Any other information :

 Government of Andhra Pradesh
Forest Department
Lr.No.33/PEN/2012 O/o the Conservator of Forests,
Date : 12-07-2012 S.F.& W.P. Circle, Vijayawada

From To
Dr. C.K.Mishra, IFS The Accountant General ( A&E )
Prl.Cheif Conservator of Forests/ Audit Office , LFA, Hyderabad
Conservator of Forests, Andhra Pradesh
S.F.& W.P. Circle, Vijayawada

Sir,

Sub : Forest Department - Pensions - Proposals of Sri Kamarsu V.S. Rajkumar, Senior Assistant O/o
Conservator of Forests, Social Forestry & Working Plan Circle - Pension / Service Pension / Family
Pension and other Retiring Benefits - Submitted.

Ref : 1. G.O.Ms.No.262, Fin. & Plg. (FW-PSC ) Dept., dt.23-11-1998

2. G.O.Ms.No.263, Fin. & Plg. (FW-PSC ) Dept., dt.23-11-1998
3. Application of the individual.

I am herewith forwarding the Service / Family Pension Proposals of Sri Kamarsu V.S. Rajkumar S/o
Satyanarayana Murthy who is working as Senior Assistant in the office of Conservator of Forests, Social Forestry
& Working Plan Circle, Vijayawada is due to retire / retired /expired while in service on the afternoon of 31-08-
2027

The following documents are forwarded herewith for authorizing Pensionery Benefits.

1. Part - I : Information furnished by the Govt. Servant / Family Pension

Beneficiary
2. Part - II : Information filled in by the Pension Sanctioning Authority

3. Part - II B : Sanction Order of Pensioner Benefits.

4. Annexure - I : Descriptive Roll
5. Annexure - II : Nomination
6. Annexure - III :
7. Service Register of Govt. Servant. :
8. L.P.C :
9. Death Certificate (in case of Death) :
10. Legal heir Certificate (- do-) :
11
12

The receipt of the advance pension papers along with Service Register may please be acknowledged and
necessary arrangements may please be made for issue of Pension Payment Order, Gratuity Payment Order and
Commutation Authorization.

No. of enclosures ( ) Yours Faithfully

Copy to Sri.Kamarsu V.S. Rajkumar

Office File.
 FORM OF APPLILCATION FOR SERVICE PENSION/FAMILY
PENSION/RETIREMENTGRATUITY/SERVICEGRATUITY /COMMUTATION
(To be furnished in duplicate)

PART-I
Information to be furnished by the Government Servant / Applicant
(The Pension Sanctioning Authority shall forward the application duly processed to the AG (A&E) /
L.F Authority within a period of 30 days)

1 (a)Name of the Government Servant Sri Kamarsu V.S. Rajkumar

(b) Post held Senior Assistant

Name of the Applicant

2 (in case of death of government servant)

Dr.no. 22-5-20, Ganesh Appartment Flat no. G2,

3 Permanent Address Swarnamandir Street Veerabhadrapuram
Rajahmundry - 533105

4 Employee I.D. Number 0302496

5 GPF Account Number 33105/for

6 PAN Card No AWXXXXX36B

7 Aadhaar No 309412131212

IFS code and MICR code of the Bank where IFSC: SBIN0001425
8 payment is opted MICR: 533002130

Dr.no. 22-5-20, Ganesh Appartment Flat no. G2,

9 Address after retirement Swarnamandir Street Veerabhadrapuram
Rajahmundry - 533105

10 Commutation of Pension

(a) Whether willing to commute *40% of

monthly pension, subject to A.P. Civil Pensions Yes, 40% of Family Pension
(Commutation) Rules, 1944

(b) If the answer is ‘NO’ specify the fraction

less than *40%

(a) Name of the Pension Disbursing Authority STO, Rajahmundry

11
i.e., Treasury officer/Pension Payment Officer

(b) Name of the Paying Bank from where

Name of the Bank &
pension payment is desired by the pensioner S.B. Account no.
Branch
/family pensioner gratuitant
SBI, Treasury Br.,
02315xxxxx31456
Kakinada

*Note :-Consequent on the issue of orders in G.O.Ms.No.158 Fin &Plg (FW.Pen.I) Dept., dt. 16.9.99 enhancing the
maximum pension that can be commuted upto 40% w.e.f. 1.4.99, this 1/3rd was to be changed as 40% at both the places.
12. List of family members
(e ) Marital / Employment status of the
(a) (b) (c) (d) Children of the applicant / deceased
Relationship Government servant.
whether employed or
S. Name of the family member Date of birth with Married or not .Give details of
No. government unmarried employment
1 K.S.S.Madhuri 30-08-1975 Wife
servant Married No
2 K.S.O.Samana 07-08-1996 Daughter Unmarried No
3 K.S.S.Nimay 15-11-2001 Son Unmarried No
4
5
6

Instructions:
1 The Government servant is instructed to fill up the format carefully as the data furnished is vital for
sanction of family pension. He/She may note that alterations of the data furnished at a later date is not
permissible.
2 The "family for the purpose mean "wife" or "husband" as the case may ne "sons" and "unmarried
daughters" as laid down in Rule 50(12) (for Family Pension) and Rule 46(5) (for gratuity) of AP Revised
Pension Rules,1980.
3 In case of death while service of Government servant, at the answer 'Married' in case of daughter will be
understood that the daughter is already married as on the date of death of the Government servant.

DECLARATION
1 I undertake to refund the amount of Pension. Gratuity and commutation, if it is found subsequently to be
in excess of the amount to which I was entitled under the Rules.
2 I solemnly affirm that the particulars given by me in part – 1 at item 7 are correct and true to the best of
my knowledge. If found false in future, I am liable for suitable action as may be taken by the Government.
3 The particulars given above are correct and true to the best of my knowledge. If found false in future I
may be liable for any action that may be taken by the Government.

Place: Vijayawada
Date: 30-12-2020 ( KAMARSU V.S. RAJKUMAR )

Signature of the Government Servant / Applicant

To be filled in by the Head of the Office
1. Applicant for pension / gratuity etc. in Part-I is received on __________ (Date to be recorded).

2. Certified that the person/persons mentioned by the Government servant/Applicant in item 7 of Part I are
legally entitled to receive the pension/share in gratuity.

3. Guardianship certificate : (to be filled in wherever necessary)

This is to certify that the following minors of the deceased Government Servant Late
Sri/Smt.___________________________________ is/are under the guardianship of Sri/Smt.
_________________

Sl.N Date of
Name Relationship
o Birth
1
2
3
4

Place: Vijayawada
Date: 30-12-2020
 Signature of the Head of Office
Office Seal :
 Part II (A) Information to be filled up the Pension Sanctioning Authority

1 Name of the Government Servant and Post held Sri Kamarsu V.S. Rajkumar, Senior Assistant

2 Father's Name/Husband's Name Satyanarayana Murthy

Name of the Applicant

3 ( in case of death of government servant)

4 Date of Birth of Government servant 17-08-1967

5 Date of entering in to service 20-05-2000 F.N.

6 Date of retirement/death 31-08-2027

Designation and officer from which the Government Senior Assistant, O/o Conservator of Forests, Social
7 servant retires / retired / died Forestry & Working Plan Circle, Vijayawada, Krishna
District

8 TAN of the DDO

9 Signature of the DDO

10 The rule applicable

a)
The relevant Rule under the A.P Revised Pension Rule 33 Superannuation Pension (Rule 42)
Rules. 1980 applicable (tick the rule number(s) Rule 34 retiring Pension (Rule 43/44)
Applicable and strike out the rest) Rule 35 Pension on absorption under a corporation

Rule 38 Compensation Pension Rule 37 Invalid Pension

Rule 40 Compassionate Allowance Rule 39 Compulsory Retirement Pension
Rule 43 Retirement on completion of 20 years of
Rule 44 Retirement on completion of 33 years of qualifying service
qualifying service Rule 46 Retirement Gratuity
Rule 50 Family Pension

b) Whether ANTICIPATORY PENSION is being

sanctioned in terms of Rule - 51.
c) Whether PROVISIONAL PENSION is being
Sanctioned in terms of Rule 9(4) read with Rule 52

d) Any other rule applicable

Years Months Days

11 Total service (6-5) 27 3 11
12 Period of non-qualifying service
a) E.O.L 0 0 0
b) Suspension period 0 0 0
c) Dies-non 0 0 0
d) Boy service 0 0 0
e) Any other service not qualifying for pension 0 0 0
Total non-qualifying service (a to e) 0 0 0
13 Net qualifying service (9-10) 27 3 11
14 Weightage, if any 5 0 0
15 Total qualifying service for calculation of pension 32 3 11
(11+12)
 Last pay drawn ( Rule 31,46(4),50 (12)( C ) of APRPRs,
16 1980) Para 4 of G.O Ms. No 87, Rs 1,10,850.00
Fin & Plg (FW-Pen.I ) Dept., dt.25.05.1998

17 Calculation of service pension/service Gratuity (Rule Rs.1,10,850.00 X 65/66 X 1/2 = Rs.54,586.00

45 of APRPRs, 1980)

Basic Pay Rs.1,10,850.00, DA@15.98%=

18 Calculation of Retirement gratuity Rs.17,714.00(1,10,850.00 + 17,714.00) X 65 X 1/4 =
( Rule 46 APRPRs, 1980) Rs.12,00,000.00
19 Calculation of Family Pension
Rs 55,425.00 (Rs.1,10,850.00 X 50/100 =
a) Enhanced family Pension Rs.55,425.00)

b) Normal Family Pension Rs 33,255.00( Rs.1,10,850.00 X 30/100 =

Rs.33,255.00)

20 Period of Payment of Pension

a) Service Pension From 01-09-2027 to till death

b) Enhanced Family Pension From 01-09-2027 to 16-08-2032

c) Normal Family Pension From 17-08-2032 to till death

21 Government dues to be recovered in respect Principal Interest Total

a) House Building Advance
b) Motor Car/Cycle Advance
c) Marriage Advance
d) Advance Leave Salary
e) Advance salary on Transfer
f) Dues on Account of Government Qrtrs
g) Telephone/Trunk call Charges
h) Festival Advance
i) Education Advance
j) Computer Advance
k) Other Government Dues
Total
Note: Information with conditions will not be accepted by Pension Authority. Amounts for recovery should be
specify and should be in whole rupees. Absence of information will be understood as no dues for
recovery

20 LPC is enclosed/LPC will be sent after retirement

CERTIFICATE
(As per Cir.Memo.No.42/PSC/2012, Dt: 17.02.2012 of Finance(PSC)Department)

Certified that in the capacity of pension sanctioning authorities, that they have verified the services with
reference to pay rolls, pay fixations, including the automatic advancement schemes, appointments/pay fixations
from time to time till the date of retirement.

Pension Sanctioning Authority

 PART - II (B)
SANCTION OF PENSION
a) Certificate of competency to accord sanction (applicable in case of sanction of Pension to non gazetted officers
including Class - IV employees)

i) I am declared by the Head of the Department to be the Head of an office to accord sanction in this case
under the powers delegated modified orders issued by G.O.Ms.No.132, F&P (FW.PSC) Department dated
18-9-2000 and read with G.O.Ms.No.262 F&P (FW.PSC) Dept, dt 23-11-98.

OR
ii) I am the next Gazetted Authority in the hierarchy to the Head of the office in this case who is a non-
gazetted officer and hence, I am competent to accord sanction under the powers delegated modified
orders issued by G.O.Ms.No.132, F&P (FW.PSC) Department dated 18-9-2000 and read with
G.O.Ms.No.262 F&P (FW.PSC) Dept, dt 23-11-98 & G.O.Ms.No.208 Finance(PSC) Dept, dt 04.06.2010

(Strike off whichever is not applicable)

b) Sanction Order :

Pensionary benefits including commutation found admissible under the rules may be authorized. It is verified
from the records in my custody and certify that no disciplinary or judicial proceedings are pending /
contemplated against retiring / retired government servant to whom I am the authority for sanction of
Pension.

i)Service Pension Rs.54,586.00

ii)Retiring Gratuity Rs.12,00,000.00
iii)
Commutation Rs.21,46,992.00
iv)Family Pension
a) Enhanced Family Pension Rs.55,425.00 upto 16-08-2032
b) Normal Family Pension Rs.33,255.00 from 17-08-2032
(v) Under Revised Pay Scales :

Signature and Designation of

Office Seal Pension Sanctioning Authority
Date:

Note 1 This is to be prepared in duplicate by the Pension Sanctioning Authority. One for the record of Pension
Sanctioning Authority and the other one to be sent to Accountant General/Local fund Audit Officer.

Note 2 The Pension Sanctioning Authority should satisfy about the correctness of the particulars of family
furnished by the Government Servant/Applicant in Part-I

Note 3 If the Pensionary benefits are not to be released Part-II-B(b) shall be struck off.

Note 4 If there is any likelihood of delay. Anticipatory Pension/Anticipatory Gratuity as per Rule 51 of A.P.
Revised Pension Rules 1980 shall be drawn and paid by the Head of Office to the beneficiary without any
delay.
Note 5 Heads of Departments are those listed in Appendix-I mentioned in Article 6 of A.P. Financial Code Volume
-I / Subsidiary Rule 32(ii) of FR 9.
 ANNEXURE - I
DESCRIPTIVE ROLLS
A. SPACE FOR PHOTOGRAPHS

Single Photo Joint Photo

Service Pensioner/Family
Joint Photo of Service Pensioner with Family Pension
Pensioner/Gratuitant/Guardian of
beneficiary/Guardian with Minor or Handicapped Child.
Minor or Handicapped Child.

(Attestation has to be done across the Photos by a Gazetted Officer of AP Government in Service)

B. SPECIMEN SIGNATURE OF :

(I) Service Pensioner :

Speicimen Signature of Sri.Kamarsu V.S. Rajkumar
Son of Sri Satyanarayana Murthy

(II) Family Pensioner/Gratuitant/Guardian of Minor or Handicapped Child:

Speicimen Signature of Smt K.S.S.Madhuri
Wife of Sri Kamarsu V.S. Rajkumar

C. PERSONAL IDENTIFICATION MARKS OF :

(i) Service Pensioner : Sri Kamarsu V.S. Rajkumar, Senior Assistant
1. A mole on the right shoulder
2. A mole on the right cheek
(ii) Family Pensioner/Gratuitant/Guardian of Minor or Handicapped Child :
Smt K.S.S.Madhuri
1. A mole on the right shoulder
2. A mole on the right cheek
 D Left hand thumb and finger impressions of Service Pensioner / Family Pensioner / Gratuitant /
Guardian of Minor or Handicapped Child:

(To be given by the illiterate or those unable to sign and for others it is optional)

Details Thumb Finger Fore Finger Middle Finger Ring Finger Little finger

Service Pensioner

Family Pensioner

Gratuitant

Guardian of
Minor /
Handicapped
Child.

Place : Vijayawada Attested by

Date : 30-12-2020

Name : Dr. C.K.Mishra, IFS

Designation : Prl.Cheif Conservator of Forests
Office Seal:

(Attestation has to be done by a Gazetted Officer of AP State Government in Service)

Note : 3 Copies will be forwarded to Accountant General/Local Fund Audit Officer by Pension Sanctioning
Authority and one will be retained by the Pension Sanctioning Authority.
SIGNATURE OF THE PRL.CHEIF CONSERVATOR
OF FORESTS
 ANNEXURE II
NOMINATION
( The Government servant may use separate forms, if he wishes to make different nominations for
each type of payment mentioned below)

I here by nominate the person / persons mentioned below and confer on him / her / them the right
to receive Life Time Arrears of Pension, Retirement Gratuity that may be sanctioned by Government, in
the event of my death while in service and right to receive on my death Life Time Arrears of Pension.
Retirement Gratuity, Commuted value of Pension. Death Relief having become admissible to me on
retirement which may remain unpaid at my death.

the nominee(s) in Col.1.

payable to each in Col.1

payable to each in Col.6

need not be mentioned
happening of which the

relationship and age of

of nomination to him /
become invalid (Death

the right conferred on

shall pass in the event

Name and address of

her / them becoming

Contingencies on the

nominee(s) to whom
Government Servant

Age / Date of Birth

Relationship with

Amount or share
Amount of share

nomination shall

Name, address,

the alternative
Nominee(s).

ineffective
1 2 3 4 5 6 7

K.S.S.Madhuri, Dr.no. 22-

30-08-1975

5-20, Ganesh Appartment 1. K.S.O.Samana-Daughter 2.

Equal
100%
Wife

Flat no. G2, Swarnamandir K.S.S.Nimay-Son

-

Street Veerabhadrapuram
Rajahmundry - 533105

This nomination supersedes the nomination by me earlier on------------

NB: The Government servant shall draw lines across the blank space below the last entry to prevent
insertions of any name after he/she has signed

Dated this…………………………… day of …………………………… at

Witness:-
1. Signature: ( KAMARSU V.S. RAJKUMAR )
Name and Address Signature of the Government Servant
Designation : Senior Assistant
Office of Conservator of Forests, Social
Forestry & Working Plan Circle, Vijayawada

2. Signature: Countersigned
Name and Address

Signature of
Head of Office/Department:
Date :
Office Seal : Name & Designation :

Note (1) : The Government servant who has a family may nominate one member or more than one member of the family as defined in Rule 46(5) of AP
Revised Pension Rules, 1980
Note (2) : The Government servant who has a family may nominate one member or more than one member of the family as defined in Rule 46(5) of AP
Revised Pension Rules, 1980
Note (3) : The Government servant may not that the nomination with signature of two witnesses shall only have the legal validity of a WILL.
Note (4) : This nomination form is to be submitted by the employees in triplicate, one for use of the pension sanctioning authority and two copies to be
forwarded to the forwarded to the Account General Local Fund Audit Offices.

Note (5) : For the purpose of Rules 46, 47, 48 and 49 of Revised Pension Rules 1980, family in to a Government servant means:-
(i) Wife or wives in the case of a male Government Servant (ii) Husband in the case of a female Government Servant (iii) Sons including step sons,
posthumous son and adopted sons (Whose personal law permits such adoption) (iv) Unmarried daughters including step daughters posthumous
daughters and adopted daughters (Whose personal law permits such adoption) (v) Widowed daughters including daughters and adopted
daughters (vi) Father including adoptive parents in the case of individuals whose personal law permits adoption (vii) Mother (viii) Brothers below
the age of 18 years including step brothers (ix) Unmarried sisters and widowed sisters including step sisters (x) Married daughters and (xi) Children
of a predeceased son.
 BY REGISTERED POST
ANNEXURE III

From
Dr. C.K.Mishra, IFS
Prl.Cheif Conservator of Forests
Conservator of Forests,
S.F.& W.P. Circle, Vijayawada

To
The Accountant General ( A&E )
Audit Office , LFA, Hyderabad
Andhra Pradesh

( Disciplinary Authority / Appointing

Authority / Head of the Department )

Sub : - Pension – Sanction of Pension and Other Retirement Benefits in respect of Sri.Kamarsu V.S.
Rajkumar, Senior Assistant, O/o the Conservator of Forests, Social Forestry & Working Plan
Circle, Vijayawada, Krishna District - Regarding

***

I am to inform you that the Pensioner/Family pension application from Sri Kamarsu V.S.
Rajkumar, Senior Assistant O/o the Conservator of Forests, Social Forestry & Working Plan Circle,
Vijayawada retires on 31-08-2027 as Senior Assistant was forwarded to AGAP/LFA on 30-12-2020. As
per the records held by me no disciplinary / judicial proceedings are pending/contemplated against the
above retiring/retired government employee.

I request you to verify whether any such case is pending against the above employee which
entails withholding or with-drawing pension or part of pension permanently or for specified period as
laid down under rule 9 of RPRs 1980. If so the AG(A&E) / Dy. Accountant General (Pension), O/o the
AG(A&E) A.P., Hyderabad / Local Fund Officer may be intimated accordingly by name either by
Registered post or through a special messenger within one month from the date of issue of this letter
for withholding pensionary benefits as contemplated in Govt. Memo. No. 33764/55/PSC/93, Finance &
Planning (FW-PSC) Department, dt. 15-10-1993 and reiterated in Government
Memo.No.37254/361/A2/Pen-I/98, Finance & Planning (FW-Pen.I) Department, dated 4-7-1998.
Copies of such orders shall also be sent to the concerned Treasury Officers / PPO for withholding the
pensionary benefits. In this connection the instructions issued in para 2, Part – II B of G.O.Ms.No 263,
Finance & Planning (FW – PSC) Department, dt 23-11-1998 may be scrupulously followed.

Yours Sincerely

Station : Vijayawada
Date : . 12/30/2020 ( Pension Sanctioning Authority )
 LAST PAY CERTIFICATE
1 Last pay certificate of Sri Kamarsu V.S. Rajkumar, Senior Assistant O/o Conservator of
Forests, Social Forestry & Working Plan Circle, Vijayawada who retires from the service
on 31-08-2027.

2 He has been paid up to 31-08-2027 at the following rates.

Basic Pay Rs. 110,850.00

D.A. Rs. 17,714.00

3 He made over charge as Senior Assistant of the Office of Conservator of Forests, Social
Forestry & Working Plan Circle on the after noon of 31-08-2027
4 Recoveries are to be made from the pay Government Servant as detailed on the reverse

5 He has been paid leave salary as detailed above deduction have been made as noted on
the reverse.

PERIOD RATE AMOUNT

From………………… to ……………………… Rs………………… A month …………………………

From………………… to ……………………… Rs………………… A month …………………………
From………………… to ……………………… Rs………………… A month …………………………
6 He is entitled to draw the following.
7 He is also entitled to joining time for ……… ……… ……… ……… days
8 The details of the income-tax recovered from him upto the date from the beginning of
the current year are noted on the reverse

Signature of the
Certifying Officer

NO DUE CERTIFICATE

Certified that no amounts are due from Sri Kamarsu V.S. Rajkumar of Conservator
of Forests, Social Forestry & Working Plan Circle, Vijayawada, Krishna District who
retired service on the afternoon of 31-08-2027

Signature of the
Certifying Officer
 APPENDIX
DETAILS OF RECOVERIES
Nature of recovery ……………………………………….……………………………………………………………………
Amount Rs ….………………………………………………..…………………………………………………………………..
To be recovered in …………………………………………………………………………………..…… Installment

DEDUCTIONS MADE FROM LEAVE SALARY

From ………….…….……… to ………….…….……… on account of ………….…….……… Rs ………….…….………

From ………….…….……… to ………….…….……… on account of ………….…….……… Rs ………….…….………

From ………….…….……… to ………….…….……… on account of ………….…….……… Rs ………….…….………

From ………….…….……… to ………….…….……… on account of ………….…….……… Rs ………….…….………

Name of the Gratuity Fee Fund and other amount of Income

Pay Remarks
month etc. deductions Tax
April

May

June

July

August

September

October

November

December

January

February

March
 NO DUES CERTIFICATE

Certified that no dues are pending agaist Sri Kamarsu V.S. Rajkumar, Senior
Assistant of Conservator of Forests, Social Forestry & Working Plan Circle, Vijayawada,
Krishna District who retired from service on the afternoon of 31-08-2027 as per the
records available in this office as on upto date.

Signature of the

NO ALLEGATIONS CERTIFICATE

Certified that no allegations are pending agaist Sri Kamarsu V.S. Rajkumar, Senior
Assistant of Conservator of Forests, Social Forestry & Working Plan Circle, Vijayawada,
Krishna District who retired service on the afternoon of 31-08-2027 as per the records
available in this office as on upto date.

Signature of the
 RESPONSIBILITY CERTIFICATE

I, Kamarsu V.S. Rajkumar, S/o Satyanarayana Murthy to be retired as Senior

Assistant of Conservator of Forests, Social Forestry & Working Plan Circle, Vijayawada,
Krishna District do here by declare that, if any amount to be excess paid due to
erroneous calculation, noticed at a later date, I shall be ready to refund the same
without any objection.

Signature of the Pensioner

Attested
Kamarsu V.S. Rajkumar

AUDIT OBJECTIONS CERTIFICATE

Certified that there are no audit objections pending in respect of Sri Kamarsu

V.S. Rajkumar, Senior Assistant of Conservator of Forests, Social Forestry & Working

Plan Circle, Vijayawada, Krishna District

Signature of the
 LEAVE CERTIFICATE

Certified that Sri Kamarsu V.S. Rajkumar, Senior Assistant of Conservator of

Forests, Social Forestry & Working Plan Circle, Vijayawada, Krishna District has not
availed any leave / has availed the following kind of leave during the period of his
service.
1

Signature of the

SUSPENSION CERTIFICATE

Certified that Sri Kamarsu V.S. Rajkumar, Senior Assistant of Conservator of

Forests, Social Forestry & Working Plan Circle, Vijayawada, Krishna District has not been

suspended any time during his service.

Signature of the
 CERTIFICATE UNDER ACT OF 1982

Certified that Sri Kamarsu V.S. Rajkumar, Senior Assistant of Conservator of

Forests, Social Forestry & Working Plan Circle, Vijayawada, Krishna District was not
sanctioned 130-250/150-300 grade under trained graduate teacher and no amount is
to be recoverable from under act 14 of 1982

Signature of the

RECOVERIES UNDER ACT 14 OF 1992

Certified that Sri Kamarsu V.S. Rajkumar, Senior Assistant was sanctioned
130-250/150-300 grade with effect from though he was untrained
graduate by virtue of Court order / Department order claim amount is recoverable
from him as per act 14 of 1992.

The amount has been recovered and recorded in the Service Book at Page No
a)
( )

b) The amount has been recovered

c) Not Applicable
Signature of the
 OPTION FOR GRATUITY UNDER A.P. REVISED
Pension Rules 1980 Under G.O.235, F & P, Dated 01-06-1993 & as per
Amended G.O.Ms.No.14, Finance & Planning, dated 30-01-1999
G.O.Ms.No.157, Fin. & Plg, dated 16-09-1999 and
G.O.(p) No.249, Finance ( Pension-1) Dept., dated 004-10-2005
G.O.Ms.No.51, Fin. & Plg, dated 01-04-2011

I, Kamarsu V.S. Rajkumar S/o Satyanarayana Murthy holding the post of Senior
Assistant in the office of the Conservator of Forests, Social Forestry & Working Plan Circle,
Vijayawada, Krishna District do hereby elect for calculation of gratuity under A.P. Revised
Pension Rules, 1980 as per the following formula.

i) 1/4 pf pay last drawn for every six monthly period of service subject to the limit

of 16 1/2 months pay last drawn or Rs.80000/- whichever is less

OR

ii) 3/4 pf pay last drawn for every six monthly period of service subject to the limit

of 12/375 months pay last drawn of Rs.175000/- whichever is less

The option hereby exercised is final

Date : 30-12-2020 Signature

Station : Vijayawada Name : KAMARSU V.S. RAJKUMAR

Designation : Senior Assistant

Office in which employed :

Conservator of Forests, Social Forestry & Working

Plan Circle, Vijayawada, Krishna District

COUNTER SIGNED

HEAD OF THE OFFICE / DEPARTMENT

Note: Strike out whichever is not applicable.