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

APNDIX - IV
256
Name & Relationship Date of If nominee is Name &
address of with pensioner Birth minor, name address of
the nominee and address other
of Person (s) nominees in
who may case the
receive the nominee
said commuted under Col.
value during (1) predecnominee’s
eases the
minority pensioner.
1 2 3 4 5
Relationship Date of birth Name & address Contingency on
with pensioner if the nominee of the person (s) happening of
is minor who may receive which nomination
the commuted value shall become invalid
of pension during
the other nominees
minority
6 7 8 9
Place : ............................... Signature (or thumb impression of illiterate)
& name of the pensioner and address.
Date : .................................
Signature of the Head of Office :
Witness :
Stamp
Signature : ...........................
Name : ................................
Address : ...........................