FORM 5 – Assessment and Authorisation of Gratuity when a Government Servant is missing: CCS (Payment of Gratuity under NPS) Rules, 2021

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FORM 5 – Assessment and Authorisation of Gratuity when a Government Servant is missing: CCS (Payment of Gratuity under NPS) Rules, 2021

FORM 5 - Assessment and Authorisation of Gratuity when a Government Servant is missing: CCS (Payment of Gratuity under NPS) Rules, 2021 FORM 5 Asses

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FORM 5 – Assessment and Authorisation of Gratuity when a Government Servant is missing: CCS (Payment of Gratuity under NPS) Rules, 2021

FORM 5
Assessment and Authorisation of Payment of Retirement Gratuity when a Government Servant is missing while in Service

[See sub-rule (4) of rule 33 ]

Part I
Section I

1. Details of employee:

(a) Name
(b) Mother’s /Father’s name (c) Date of birth D D M M Y Y Y y
(d) Date of missing D D M M Y Y Y Y (e) Religion

2. Post held at the time of missing:

(a) Name of the office
(b) Post held substantively (c) Officiating post
(d) Level of pay in the pay matrix (e) Basic Pay
(f) In case the last post was held outside the Government on foreign service terms-
(i) Level of pay of the post held in the parent department (ii) Basic pay
3. Date of beginning of service 4. Date of ending of service

5. Service in Autonomous Body/State Government, if any particulars of service:

(a) Name of organisation (b) Post held (c) Period of service
From To Total period
(d) Whether the above service is to be counted for gratuity in the Government O Yes     O No
(e) Whether the Autonomous Organisation has discharged its gratuity liability to the Central Government O Yes     O No
(f) Amount of any gratuity received for the previous civil service, if any (g) Nature of any pension received for the previous civil service, if any

6. Service qualifying for retirement gratuity:

(a) Details of omission, imperfection or deficiencies in the service book which have been ignored [under rule 36 (1) (b) (ii)]
(b) Periods of non-qualifying service: From To No. of Days
Interruption in service condoned under rules 18 and 19
Extraordinary leave not qualifying for gratuity
Period of suspension treated as non-qualifying
Periods of foreign service with United Nations bodies for which no contribution for gratuity received to the Government rule 20)
Any other service not treated as qualifying service
Total Period of non-qualifying service
(c) Additions to qualifying service: From To No. of Days
Benefit of service in an Autonomous Body
(d) Net qualifying service
(e) Qualifying service expressed in terms of completed six monthly periods (Period of three months and above is to be treated as completed six monthly period (rule 22)
7. Emoluments reckoned for retirement gratuity 8. Amount of retirement gratuity

9. Details of Government dues recoverable out of retirement gratuity:

(a) Licence fee for occupation of Government accommodation [ See rule54]
(b) Amount to be withheld as indicated by the Directorate of Estates [See rule 54 (i) .
(c) Dues referred to in rule 54 (2)
(d) Net amount payable as retirement gratuity

10. Details of the nominee(s) to whom retirement gratuity is payable:

S.No. (a) Name (b) Date of birth (DD/MM/YYYY) (c) Share in death gratuity (d) Relationship with deceased Govt. servant (e) Address
1.
2.
3.

11. Details of guardian/nominee who will receive payment of death gratuity in the case of minor/mentally disabled children

S.N. (a) Name of minor/mentally disabled child (b) Name of guardian (c) Relationship with deceased Govt. servant (d) Address of guardian
1.
2.
3.
12. Head of Account to which death gratuity is debitable.
Place: DD-MM-YYYY
Date:   (Signature of Head of Office)

PART II
Account Enfacement
Section I

Total period of qualifying service accepted for retirement gratuity
Net amount of retirement gratuity after adjusting Government dues
Head of account to which retirement gratuity is debitable

Section II 

Details of missing Government servant
Name Date of missing D D M M Y Y Y Y
Amount of gratuity authorised Amount recoverable from gratuity
Amount of gratuity withheld pending receipt of ‘No Demand Certificate’
Place:
Date: DD-MM-YYYY

(Signature of Account Officer)

form-6-form-for-assessing-gratuity-checklist-and-calculation-sheet

FORM 5 – Assessment and Authorisation of Gratuity PDF

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Next: FORM 6 – Form for Assessing Gratuity, Checklist and Calculation Sheet

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

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