FORM 7

[See Rules 58, 60, 61(1) and (3) and 65 (1)]

Form for assessing Pension / Family pension and Gratuity.

PART 1

1. Name of the retiring Government employee

2. Father's/ Husband's name:

3. Height:

4. Marks of Identification:

5. Date of Birth:

6. Service to which belongs:

7. Particulars of post held at the time of

retirement:
(a) Name of the office:

(b) Post held:

(c) Whether the appointment mentioned

above was under Government or outside
the Government on foreign service terms?

8. Whether declared substantive in any post

under the Central Government?
9. Date of beginning of service:

10. Date of ending of service:

11. Cause of ending of service-----

(a) Voluntary retirement on being declared Surplus (Rule 29)
(b) Permanent absorption in Public Sector Undertaking / Autonomous body (Rule 37-A)
(c) Due to abolition of post (Rule 59)
(d) Superannuation (Rule 35)
(e) Invalidment on medical ground (Rule 38)
(f) Voluntary / premature retirement at the Initiative of the Government servant [under Rules 48, 48-A
or FR 56 (k)]
(g) Premature retirement at the initiative of the Government [Rule 48 or FR 56 (j)]
(h) Compulsory retirement (Rule 40)
(i) Removal / dismissal from service (Rule 24 and 41)
(j) Death
12. In the case of compulsory retirement, the orders of the competent
authority, whether pension may be allowed at full rates or at
reduced rates and, in case of reduced rates the percentage at
which it is to be allowed
13. In case of removal / dismissal from service whether orders of
competent authority have been obtained for grant of
compassionate allowance and if so, at what rate

14. Particulars relating to military service, if any---

(a) Period of military service
(b) Terminal benefits drawn / being drawn for Military service
(c) Whether opted for counting of military service
towards civil pension?
(d) If answer to (c ) above is in the affirmative whether the terminal
benefits have been refunded.
(e) In case of ex-servicemen who are eligible for Family pension
under the Armed Forces Rules, whether opted to retain family
pension under the Armed Forces Rules or to draw family
pension
15. Particulars relating to service in Autonomous body, if any
(a) Particulrs of Service :
Name of Organisation Post held Period
From To

(b) Whether the above service is to be counted for pension

(c) Whether the Autonomous organization has discharged its
pensionary liability to the Central Government?
16. Whether any departmental or judicial proceedings are pending against the retiring employee

17. Qualifying service-------

(a) Detail of omission, imperfection or deficiencies in the Service
Book which have ignored [under
(b) Period not counting as qualifying service
(i) Boy Service (2n proviso to Rule 13)
(ii) Extraordinary Leave not counting as qualifying service
(Rule 21)
(iii) Periods of suspension not treated as qualifying service
(Rule 23)
(iv) Interruptions in service [Rule 27 (1) (b) and Rule 28 (c)]
(v) Periods of foreign service with United Nations bodies for
which United Nations pension has been availed
(vi) Any other period not treated as qualifying service
(give details)
(c) Additions to qualifying service----
 (i) Military service (Rule 19)
(ii) War service (Rule 20)
(iii) Weightage on voluntary retirement on being declared
surplus (Rule 29)
(iv) Weightage under Rule 30
(v) Benefit of service in an Autonomous Body (Rule 37)
(vi) Weightage under Rule 48-B
(d) Net Qualifying service
(e) Qualifying service expressed in terms of completed six
monthly periods (Period of three months and over is treated
as completed six monthly period)

18. Emoluments---
(a) Emoluments drawn during 10 months preceding retirement-
From To Rate of Pay Amount

(b) If the officer was on foreign service immediately preceding

retirement, the notional emoluments which he would have
drawn under Government but for being on foreign service

(c) Average emoluments reckoned for pension

(d) Emoluments reckoned for retirement gratuity/death gratuity
(e) Emoluments reckoned for family pension
19. Date on which the retiring employee submitted his application for pension in Form 5.
20. Complete and up to date details of the family as given in Form 3
SI.No Name of the member of the family Date of Birth Relation with the Government
servant
21. Whether nomination made for death gratuity/retirement gratuity?
22. The date on which action initiated to ------
(a) Obtain the 'No demand' certificate from the Directorate of
Estates as provided in Rule 57.

(b) Assess the service and emoluments qualifying for pension as

provided in Rule 59
(c) Assess the Government dues other than the dues relating to
the allotment of Government accommodation as provided in
Rule 73(1)

23. Details of Government dues recoverable out of Gratuity---

(a) Licence fee for Government accommodation
(b) Dues referred to in Rule 73
24. (a) Proposed pension / service gratuity
(b) Proposed dearness relief on pension
(as on date of retirement)
(c) Date from which pension is to commence
25. Rate of Family pension
(a) Enhanced rate
(b) Period for which family pension will be payable at enhance
rate
(c) Ordinary rate
(d) Date from which ordinary rate of family pension will be payable
26. Amount of retirement gratuity / death gratuity
27. Commutation of Pension
(a) Whether simultaneously applied for commutation of pension
with the pension application (applicable only in the case of
those who retire on Superannuation pension.)
(b) The portion of pension commuted
(c) Commuted value of pension
(d) Amount of residuary pension after deducting commuted portion
(e) Date from which reduced pension is payable.
28. Name and address of Bank/ Pension accounting
office from where pension is to be drawn
29. Head of account to which pension and gratuity
are debitable
30. Post retirement address of the retiree

Signature of the
Head of Office
 PART-II

1. Date of receipt of pension papers by the Accounts Officer from Head

of Office
2. Entitlements admitted
A. Length of Qualifying service
B. Pension
(i) Class of pension
(ii) Amount of monthly pension
(iii) Date of commencement
C. Commutation of pension

(i) Commuted value of portion of pension commuted, if any

(ii) Residuary pension after commutation
(iii) Date from which reduced pension is payable
(iv) Date of restoration of commuted portion of pension
subject to the pensioner continuing to live
D. Retirement / Death gratuity

(i) Total amount payable

(ii) Amount to be adjusted towards Government dues
(iii) Amount to be withheld for adjustment of unassessed
dues
(iv) Net amount to be released
E. Family pension

(i) At enhanced rates

(ii) Period for which family pension at enhanced rate is
payable
(iii) At normal rates
3. Head of account to which the amount of pension,retirement/death
gratuity and family pension are to be debited

Accounts Office