Form 7-A

[See Rule 63(5)]

Form for Assessing Pension/Family Pension and Gratuity in respect of a Government servant against whom departmental or judicial
proceedings were pending at the time of retirement and to whom provisional pension was sanctioned in accordance with Rule 8

PART-I (To be filed by Head of Office)

1. Name of the retiring Government servant

Mother
Name of Mother Father Father

*Aadhaar No. (if PAN no. Date of Birth

available) DD-MM-YYYY

2. Post held at the time of retirement: -

(a) Name of the office (b) Post held
(c) Level of pay in the pay matrix (d) Basic pay
(e) Whether the appointment mentioned above was under Government or
outside the Government on foreign service terms
(f) Level of pay /basic pay in the pay matrix of the post in the parent department
Whether declared substantive in any post under the Central Government
3. Date of beginning of 4. Date of ending of service
service (DD/MM/YYYY) (DD/MM/YYYY)
5. Cause of ending of service (please tick one)
(a) Superannuation (Rule 33) (b) Voluntary retirement on being declared surplus (Rule 34)
(c) Voluntary retirement [under Rules 43 and FR 56 (k)]
(d) Premature retirement at the initiative of the Government [ Rule 42 or FR 56 (j) ]
(e) Permanent absorption in State Government/public sector undertaking/Autonomous Body (Rule
35, 36, 37 or 38)
(f) Invalidation on medical ground (Rule 39)
(g) Compulsory retirement (Rule 40) (h) Dismissal/ Removal from service (Rules 24 and 41)

6. Details of Service
(a)Period of service From To Total duration of service
(b)Details of omission, imperfection or deficiencies in the Service Book which have been ignored [under Rule 57]
(c) Period not counted as qualifying service :-
(i) Boy service (2nd proviso to Rule 11)
(ii) Extraordinary leave not counted 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 Nation Bodies for which no pension
contributions are payable/paid (Rule 29)
(vi) Any other period not treated as qualifying service (give details)
(d) Additions to qualifying service :-
(i) Civil service (Rule19) (ii) Military service (Rule 20)
(iii) Benefit of service in a State Government/ Temporary status service
Autonomous Body (Rule 13/Rule14) (Rule 15)
(e)Net qualifying service(a – b – c + d)
(f) Qualifying service expressed in terms of completed six monthly periods (Period of three months & above is to be treated as
completed six monthly period (Rule 44 and Rule 45)

7. Emoluments :-
(a) Emoluments in terms of Rule
31
(b) Emoluments drawn during ten From To
months preceding retirement- (DD/MM/YYYY) (DD/MM/YYYY)
Note: 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 may be mentioned in items (a) and (b) above (Rule 32)
(c) Average emoluments (Rule 32)
(d) Emoluments or average emoluments (whichever is higher) to be reckoned for pension (Rule 44)
(e)Emoluments reckoned for retirement gratuity (Rule 45)
(f) Pay reckoned for family pension (Rule 50)
8. Proposed Pension Details:-
(a) Amount of pension/service gratuity at full rates (Rule 44)
(b) Amount of retirement gratuity at full rates (Rule 45)
(c) Whether any part of pension or gratuity to be withheld/withdrawn on conclusion of
departmental/judicial proceedings under Rule 8
(d) Percentage of pension to be withheld / withdrawn
(e) Whether pension is to be withheld/withdrawn permanently or for a specified period
(f) Date from which pension is to be withdrawn / withheld
(g) Date up to which pension is to be withdrawn/withheld (if withheld/withdrawn for a
specified period)
(h) Amount of pension payable after deduction of the amount withheld / withdrawn
(i) Date from which regular pension is to commence
(j) Percentage of gratuity to be withheld under Rule 8
(k) Amount of gratuity after deduction of amount withheld
(l) Amount of provisional pension which was sanctioned under Rule 8
(m) Date from which provisional pension paid

9. Details of Government dues recoverable out of gratuity

(a) Licence fee for Government accommodation [see sub-rules (2), (3) & (4) of Rule 68]
(b) Dues referred to in Rule 69
(c) Amount indicated by Directorate of Estates to be withheld under sub-Rule (5) of Rule 68
10. Amount and Period of family pension : Amount
(a) Enhanced rate [Rule 50(2)(a)(iii)]
(b) Ordinary rate [Rule 50(2)(a)(i)]
Note: In the event of death of pensioner, the family pension at enhanced rate shall be payable for a period of seven years, or for
a period up to the date on which the retired deceased Government servant would have attained the age of 67 years had he
survived, whichever is less.
11. Name of the family member(s) to whom family pension is to be authorized in Pension Payment Order
(a)Name of the Spouse
(b) Percentage of family pension to be paid to
spouse, if the family pension is to be shared
with other members of the family (e.g. children
from a wife who is not alive or children from a
divorced wife)
(c) Names and relationship of other family 1
members, referred to in (b) above. 2
3
(d) Name of family member to be co-
authorised (i.e. disabled child/dependant
parent/disabled sibling)
12. Commutation of pension :-
(a) The percentage of pension commuted
(b) Amount of monthly pension commuted
(c) Commuted value of pension
(d) Amount of residuary pension after deducting commuted portion
Post-retirement address of the retiree
e-mail ID, if any Mobile number

Note: Commuted part of pension will be restored after 15 years from the date of payment of commuted value of pension.
 PART-II
(Account Authorisation (by Accounts Officer)

Date of receipt of pension papers by the Accounts Officer from Head of Office (DD/MM/YYYY)
Entitlements admitted -
A. Length of qualifying service
B. Pension - (i) Class of pension (ii) Amount of monthly pension
(iii) Percentage of pension to be withheld / withdrawn under Rule 8
(iv) Amount of pension payable after deduction of the amount withheld /
withdrawn
(v) Period for which pension is to be withdrawn / withheld
(vi) Date of commencement
(vii) Amount of provisional pension paid (Statement of provisional pension paid
every month to be attached)
C. Commutation of pension -
(i) Portion of pension commuted, if any
(ii) Commuted value of portion of pension commuted, if any
(iii) Residuary pension after commutation
(iv) Date from which reduced pension is payable (DD/MM/YYYY)
(v) Date of restoration of commuted portion of pension (subject to the pensioner continuing to
live) (DD/MM/YYYY)
D. Retirement/Death Gratuity -
(i) Total amount of gratuity
(ii) Percentage of gratuity to be withheld under Rule 8
(iii) Amount of gratuity after deduction of amount withheld
(iv) Amount to be adjusted towards arrears of licence fee for Government accommodation and
licence fee for retention of Govt. accommodation beyond retirement (Rule 68(1) and 68(4)
(v) Amount intimated by Directorate of Estates for being withheld on account of unassessed
licence fee (Rule 68(5))
(vi) Amount to be adjusted towards Government dues other than those pertaining to Government
accommodation (Rule 69)
(v) Net amount to be released immediately
E. Amount and period of Family pension – Amount Period
(i) At enhanced rate
(ii)At normal rate
F. Name of the family member(s) to whom family pension is to be authorized in Pension Payment Order
(a)Name of the Spouse
(b) Percentage of family pension to be paid to spouse, if the family pension is to be shared with
other members of the family (e.g. children from a wife who is not alive or children from a
divorced wife)
(c) Names and relationship of other family members, referred to in (b) above. 1
2
3
(d) Name of family member to be co-authorised (i.e. disabled child/dependant parent/disabled
sibling)
G. Head of account to which the amount of pension, retirement/death gratuity and family
pension are to be debited
H. Whether any order affecting pension/ gratuity issued under Rule 8 of CCS (Pension) Rules. Yes No
If so, details thereof

Signature of Accounts Officer

 PENSION CALCULATION SHEET

1. Name 2.
Designation
3. Date of birth 4. Level of pay in the pay
5. Basic pay
matrix
6 Date of entry in the Government 7.Date of retirement
service (DD/MM/YYYY) (DD/MM/YYYY)
8. Length of qualifying service reckoned for pension/gratuity(as indicated in
PPO)
9. Emoluments drawn during the last ten months
10. Emoluments or average emoluments, whichever is more beneficial for pension (as indicated in
PPO)
11. Pension admissible (if qualifying service is ten years or more) calculations to be shown as
follows :­
Emoluments or average emoluments/2
12. Amount of pension withheld/withdrawn
13. Amount of pension payable
14. Emoluments for gratuity (as indicated in
PPO)
15. Retirement gratuity admissible at full rates: calculation to be shown as follows :­
Emoluments/4 x Qualifying Service (In completed six monthly periods, not exceeding 66.)
16. Amount of Retirement Gratuity to be withheld/withdrawn
17. Amount of Retirement Gratuity payable
18. Pay for family pension (as indicated in PPO)
19. Family pension admissible (calculation to be shown as follows) :­
(a) Ordinary family pension :
Pay x 30% subject to prescribed minimum and maximum
(b) Enhanced family pension:
Pay /2 [Subject to prescribed minimum and maximum]
20. Details of Commutation of Pension, If any
(a) The percentage of pension commuted
(b) Amount of monthly pension commuted
(c) Commuted value of pension
(d) Amount of residuary pension after deducting commuted portion

Signature of the Head of Office

Countersigned by PAO

Copy to:- Shri/Smt./Kumari ………………………………………………………………..

(Retired/retiring Govt. servant)