ANDHRA PRADESH REVISED PENSION RULES, 1980 (As ... - APHB

APNDIX - IV
To
Sir,
Annexure - II
Application form for commutation of pension where medical
examination is necessary
The
..........................................
(Head of Office)
“Form-A”
PART-I
Subject :- Commutation of Pension.
242
Space for Photograph
I furnish below the relevant particulars and request that I may be permitted
to commute a part of my pension as indicated below. An attested copy
of my photograph is affixed on this application.
1. Name in Block Letters :
2. Date of Birth :
3. Pension rules by which governed (*)
4. a) Whether a portion of pension
has already been commuted, if
so, how much ?
b) Whether any application for
commutation of pension has
ever been rejected.
c) Whether commutation of pension
has ever been accepted/
* Pension Rules contained in Civil Service Regulations, old Pension Rules in
H.C.S Rules, Revised Pension Rules, 1951 or Liberalised Pension Rules, 1961.