VIJAYA BANK
Branch :
APPLICATION FOR THE GRANT OF FAMILY PENSION ON THE DEATH OF GOVERNMENT SERVANT / PENSIONER
 
Sl. No Particulars Information
1. Name of the applicant  
Widow / Widower  
Guardian, if the deceased person is survived by child / children  
2.
Name & age of the surviving widow / widower and children of the deceased government servant / pensioner
Sl. No Name Relation with the deceased Date of birth by Christian era
       
       
       
       
       
       

3. Name & No. Of the Pension Payment Order of the deceased  
4. Date of death of Government Servant / Pensioner  
5. Office / Department / Ministry in which the deceased Government Servant / Pensioner served last  
6. If the applicant is guardian, his date of birth and relationship with the Government Servant / Pensioner  
7. If the applicant is a widow / widower, the amount of service pension, which she / he may be in receipt on date of death of husband / wife.  
8. Full address of the applicant  


9. Place of payment of pension and Gratuity Vijaya Bank
Branch :
 
 
Details of enclosures
1. Two specimen signatures of the applicant duly attested (to be furnished in two separate sheets)
2. Two copies of passport size photographs of the applicant, duly attested
3. Two slips, each bearing left hand thumb and finger impressions of the applicant, duly attested.
4. Descriptive Roll of the applicant duly attested, indicating (a) height and (b) personal marks, if any, on the hand, face etc. (specify a few conspicuous marks, not less than two, if possible) in duplicate.
5. Certificate (s) of age (in original with two attested copies) showing the date of birth of the children. The certificates should be from Municipal Authorities or from the Local Panchayat or from the head of a recognised school in the child is studying in such a school. This information should be furnished in respect of such child or children the particulars of whose date of birth are not available with the Head of Office.
 
SIGNATURE OR LEFT THUMB IMPRESSION OF THE APPLICANT

Attested by:

Signature:

Name:

Address:

Witnesses:

Witness I Witness II
Signature   Signature  
Name   Name  
Address   Address  
 
Note :
1. Thumb impression should be attested in case the applicant is not literate enough to sign his/her name.
2. Witness should be done by two Gazetted Government Servants or two more persons of respectability in the town, village or Paraganas in which the applicant resides.
3. In case of the remarriage of the widow, while applying for the family pension, on behalf of the minor child, the widow should furnish (a) the date of her remarriage (b) Name of Treasury / Sub-treasury / Bank at which payment is desired and (c) her full address in the application for family pension.
 
It is not necessary to furnish a fresh application for the documents as they are already available with the pension papers on which family pension was originally admitted to her.