FORM 4 – Application for retirement Gratuity i.ro. missing Government servant: CCS (Payment of Gratuity under NPS) Rules, 2021

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FORM 4 – Application for retirement Gratuity i.ro. missing Government servant: CCS (Payment of Gratuity under NPS) Rules, 2021

FORM 4 - Application for retirement Gratuity i.ro. missing Government servant: CCS (Payment of Gratuity under NPS) Rules, 2021 FORM 4 Application fo

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FORM 4 – Application for retirement Gratuity i.ro. missing Government servant: CCS (Payment of Gratuity under NPS) Rules, 2021

FORM 4
Application for the Grant of retirement Gratuity in the case of missing Government servant
[See sub-rule (2) of rule 33 ]

(To be filled in separately by each claimant and in case the claimant is minor, the form should be filled in by the guardian on his/her behalf. Where there are more than one minor and one guardian for all of them, the guardian should claim gratuity in one Form on their behalf)

1. Details of missing Government servant:

Name and designation Date of report DD/MM/YYYY
Office/Department/Ministry in which the deceased served last

2. Details of claimant(s):

Sl. No. Name Date of birth (DD/MM/YYYY) Relationship with the missing Govt. servant Postal address
1.
2.
3.

3. In case the claimant(s) is/are minor or suffering from disorder or disability of mind, including mental retardation, details of guardian:

Name Date of birth (DD/MM/YYYY) Relationship with the minor/mentally disabled Relationship with the missing Govt.

Servant

Postal address

4. Details of bank:

Bank’s Name A/c No. IFS Code

Place:

Date:

(Signature of the claimant/guardian)
Mobile no.: … …. …. ….. ….. ….

 

Enclosure:
a. Copy of report of missing in Police Station.
b. Guardianship Certificate/ Indemnity Bond and Date of Birth Certificate in case the claimant is a minor.
c. Guardianship Certificate/ nomination and Medical Certificate in case the claimant is mentally disabled.

form-4-application-for-retirement-gratuity-i-ro-missing-government-servant

FORM 4 – Application for retirement Gratuity Hindi & English PDF

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Next: FORM 5 – Assessment and Authorisation of Gratuity i.r.o. Missing Employees

Central Civil Services (Payment of Gratuity under National Pension System) Rules, 2021 – Notification G.S.R. 658 (E)

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