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

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

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

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APNDIX - VII<br />

(FORM-A)<br />

Pension Disburing Authorities/Head of Office<br />

(Name of Bank/Treasury/Accounts Officer, etc.)<br />

Place : .................................................................<br />

I ................................................... hereby nominate the person<br />

(Name of the Pensioner in Capital letters)<br />

Name below to receive L.T.A. of Pension<br />

Name and address of the nominee Relationship with Date of<br />

Pensioner birth<br />

(1)<br />

If nominee is minor<br />

(2) (3)<br />

Name and address of person Name and address Relationship<br />

who may receive the said pension of other nominee in with pensioner<br />

during the nominee’s minority case the nominee<br />

under Col.(1) above<br />

pre-deceases the<br />

pensioner<br />

(4) (5) (6)<br />

278<br />

Date of birth if the other Name and address of Contingency on<br />

nominee is minor person who may happening of which<br />

receive the pension nomination shall<br />

during the other<br />

nominee’s minority<br />

become invalid<br />

(7) (8) (9)<br />

Place : .......................................... Signature (or thumb impression if<br />

illiterate) and name of Pensioner<br />

Date : ........................................... Address :<br />

Witness : Signature, Name & Address<br />

Signature of Pension Disbursing Authority/Head of Office.<br />

(Acknowledgment to be sent by the Pension Disburing Authority/Head of Office)

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