
 State of Punjab - Act
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 The Punjab State Legislature Members (Pension and Medical Facilities Regulation) Rules, 1984
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 PUNJAB
   
 India
 
 The Punjab State Legislature Members (Pension and Medical Facilities Regulation) Rules, 1984
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 Rule THE-PUNJAB-STATE-LEGISLATURE-MEMBERS-PENSION-AND-MEDICAL-FACILITIES-REGULATION-RULES-1984 of 1984
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* Published on 25 January 1967
* Commenced on 25 January 1967
 The Punjab State Legislature Members (Pension and Medical Facilities Regulation) Rules, 1984
 
### 1. Short title and commencement.
(1) These rules may be called the Punjab State Legislature Members (Pension and Medical Facilities Regulation) Rules, 1984.
 
(2) They shall come into force at once.
 
### 2. Definitions.
 - In these rules, unless the context otherwise requires, -
 
(a) "Act" means the Punjab State Legislature Members (Pension and Medical Facilities Regulation) Act, 1977 (Punjab Act No. 5 of 1977);
 
(b) "Form" means a form appended to these rules;
 
(c) "Government" means the Government of the State of Punjab in the Department of General Administration (Research Cell, Parliamentary Affairs);
 
(d) "Pensioner" means a person to whom pension has been sanctioned under these rules;
 
(e) "Secretary" means the Secretary of the Punjab Vidhan Sabha;
 
(f) "Speaker means the Speaker of the Punjab Vidhan Sabha.
 
### 3. Application for pension.
(1) A person entitled to pension under the Act shall make an application in part A of Form I in duplicate, to the Secretary.
 
 [Provided that where a person entitled to pension under the Act had died before applying for pension or after applying but before receiving the amount of pension, the legal heir(s)  of the deceased shall make an application to the Secretary in Part AA of Form 1 enclosing herewith his (their) photograph(s) accompanied by a death certificate and a succession certificate]
 
 [ Added by Punjab government Notification No. G.S.R. 39/P.A.- 5/77/S. 5/Amd.(2) /86, dated 29th May, 1986.]
 
 .
 
(2) The application referred to in sub-rule (1), shall be accompanied by three passport size contemporary photographs of the applicant duly attested by a Gazetted Officer.
 
(3) On receipt of the application for pension, the Secretary or any Officer not below the rank of Deputy Secretary authorised by him, shall verify the facts stated therein, with reference to the records available with him and with a view to determining as to whether the applicant is entitled to any pension under the provisions of the Act and he may hold such enquiry and may call for such further information from the applicant, as he may deem fit :
 
 [Provided that where an application is made by the legal heir(s)  under the proviso to sub-rule (1), the Secretary or any officer not below the rank of Deputy Secretary authorised by him shall verify and satisfy himself as to the entitlement of pension of the deceased person under the Act and also to the claim of the heir(s) with reference to record available with him]
 
 [ Added by Punjab Government Notification No. G.S.R. 39/P.A.-5/77/S. 5/Amd. (2) /86, dated 29th May, 1986.]
 
### 4. Sanction of Pension.
 - The Secretary shall, if the facts stated in the application for pension made under rule 3 are found correct and the application is not otherwise defective, record a certificate as given in part B of Form I and submit the application to the Speaker, who shall pass an order in Part C or Part D of Form I, sanctioning the pension of the applicant or life time arrears as the case may be, of pension of the deceased person to the legal heir(s) .
 
### 5. Authorisation for payment of pension.
(1) After an order sanctioning the pension is passed under rule 4, a copy of the application submitted under rule 3 alongwith such order and two photographs of the applicant shall be sent to the Accountant General, Punjab.
 
(2) The Accountant General, Punjab, shall after satisfying himself that the papers submitted to him under sub-rule (1) are in every respect in order and the amount of pension has been correctly sanctioned, issue a Pension Payment Order as is issued in the case of a Class I Officer of the State Government.
 
### 6. Drawal of Pension.
(1) The pension under the Act shall be drawn by the Pensioner from the treasury in the manner in which a retired Class I Officer of the State Government draws his pension.
 
(2) The pensioner drawing pension under these rules shall also furnish a certificate to the concerned Treasury Officer in Form II, whenever he claims payment of his pension and no payment shall be made if he fails to do so.
 
### 7. Due date for payment to pension.
 - The pension sanctioned under these rules becomes due for payment only on the expiry of the month to which it relates.
 
### 8. Cancellation or modification of pension.
(1) If after the communication of the order sanctioning the pension any fact, which has a bearing on the sanction or the amount of pension already sanctioned, comes to the notice of the Speaker, he shall after due verification, issue an order cancelling or modifying the order made under rule 4 and communicate the same to the Accountant General, Punjab:
 
 Provided that no order cancelling or modifying he pension shall be issued except after giving the pensioner an opportunity of being heard.
 
(2) The Accountant General, punjab shall, on receipt of an order under sub- rule (1), recall the pension payment order and cancel or modify the same accordingly.
 
(3) Consequent upon the cancellation or modification of pension under sub- rule (1), the excess amount, if any, received by the pensioner shall in case of cancellation, be recoverable in lump-sum and, in case of reduction, be liable to be adjusted against future payment of pension.
 
### 9. Any amount recoverable under section 3-A of the Act from any person may be recovered from his pension admissible under the Act by the Speaker.
 
### 9A. [ Family Pension. [Section 3-B read with section 5]
 
 [Added by Punjab Government Notification No. G.S.R. 85/PA5/77/55/Amd/94 dated 19.12.1994]
 
 - (1)  The spouse of the deceased member who is entitled to pension under the Act shall submit an application for claiming family pension to the secretary in Part 'A' of Form VIII.
(2) On receipt of an application for family pension under sub-rule (1), the Secretary or any other officer not below the rank of a Deputy Secretary authorised by him, shall verify the facts stated therein, with reference to the records available with him, with a view to determining as to whether the applicant is entitled to the family pension or not under the provisions of the Act and for this purpose he may hold such enquiry and may call for such further information from the applicant as he may deem fit.
 
(3) The Secretary or the Deputy Secretary, as the case may be shall, if the facts stated in the application for family pension submitted under sub-rule (1) are found correct and the application is not otherwise defective, submit the application to the Speaker who shall pass an order in Part B of Form VIII, sanctioning the family pension to the applicant.
 
(4) (a) 
 After an order sanctioning the family pension is passed by the Speaker under sub-rule (3) , a copy of the application alongwith the sanction order and two photographs of the applicant shall be sent to the Accountant General, Punjab by the Secretary for issuing family pension Payment Order.
 
(b) the Accountant General, Punjab shall after satisfying himself that the papers submitted to him are in very respect in order and the amount of family pension has been correctly sanctioned, issue a family pension Payment Order.
 
(5) (a) 
 The family pension shall be drawn by the spouse of the deceased member from the concerned Treasury.
 
(b) The spouse of the deceased member drawing family pension under these rules shall also furnish a certificate to the concerned Treasury Officer in Part C of Form VIII whenever he or she claims payment of his or her family pension and no payment shall be made if the spouse fails to do so.
 
(6) the family pension sanctioned under these rules shall become due for payment only on the expiry of the month to which, it relates.]
 
 [10. Medical reimbursement. - (1)  A member shall be entitled, for himself and for the members of his family, to the same medical facilities as are available to Class I Officers of the Punjab Government.]
 
 [Substitued by Punjab Government Notification No. G.S.R. 64/P.A,- 5/77/S. 5 Amd. (3)  86, dated 7th October, 1986.]
 
 (2) A member for claiming medical reimbursement for himself and for the members of his family shall submit the bill to the Secretary in Form III along with the essentiality certificate in Form IV:
 
 Provided that where a member entitled to medical reimbursement under the Act dies before claiming the amount of medical reimbursement, the legal heirs of the deceased member shall make an application to the Secretary in Form V accompanied by a death certificate and also a succession certificate for claiming payment of such an amount of medical reimbursement:
 
 Provided further that where a member entitled to medical reimbursement under the Act dies after claiming but before actually receiving the amount of medical reimbursement, the legal heirs of the deceased member shall submit the death certificate of the deceased member as also a succession certificate to the Secretary.
 
 (3) If the Secretary is satisfied that the documents and the bill submitted to him under sub-rule (2) are complete in all respects he shall sanction the amount of reimbursement and any officer not below the rank of Deputy Secretary authorised by him in this behalf shall counter-sign Form III.
 
 (4) Where an application is made by the legal heirs under the prosio to sub- rule (2), the Secretary shall verify and satisfy himself as to the entitlement of claim of the deceased member under the Act and also to the claim of the heirs with reference to the record available with him and then sanction the amount of reimbursement and any officer not below the rank of Deputy Secretary authorised by him in this behalf shall convey the sanction in Form VI.
 
 Explanation - For the purposes of this rule, the expression "members of the family" in relation to a member shall mean, -
 
 (a) husband or wife, as the case may be;
 
 (b) sons and daughters;
 
 (c) father and mother; and
 
 (d) brothers and sisters :
 
 Provided that they are residing with the member and are wholly dependent upon him and are un-employed and have no source of income of their own.
 
### 10A. Ex-gratia Grant.
 - [(1)  If a member of the Punjab Legislative Assembly, dies while serving as an elected Member, an ex-gratia Grant of rupees five lakh, shall be given to the members of his family.]
 
 [Substituted by Notification No. G.S.R. 68/P.A.5/1977/S.5/Amd.(7) /2018, 29.8.2018.]
 
(2) The member of the family of the deceased member shall submit an application for claiming ex-gratia Grant to the Secretary in Part 'A' of Form VII :
 
 [Provided that where the member dies as a result of terrorist act, the members of his/her family shall submit alongwith the application a certificate issued by the Deputy Commissioner of the concerned district to the effect that the death of the member had occurred as a result of terrorist act.]
 
 [Added by Panjab Grovernment notification dated 19.12.1994]
 
(3) On receipt of application for ex-gratia grant, the Secretary or any officer not below the rank of Deputy Secretary authorised by him, shall verify the facts stated therein, with reference to records available with him with a view to determining as to whether the applicants) is/are entitled to any ex- gratia grant under the provisions of the Act and for this purpose he may hold such enquiry and may call for such further information from the applicants(s) as he may deem fit.
 
(4) Sanction of ex-gratia Grant. - The Secretary shall, if the facts stated in the application for ex-gratia grant submitted under sub-rule (2) are found correct and the application is not otherwise defective, forward the application to the Speaker who shall pass an order in Part B of Form VIII, sanctioning the ex-gratia grant to the applicant(s).
 
(5) Authorisation for payment of ex-gratia Grant. - After the amount of ex- gratia grant is sanctioned by the Speaker, a copy of the application alongwith the sanction order shall be sent to the concerned Deputy Commissioner for drawing and disbursing the amount to the applicant(s) and the expenditure so incurred shall be debi/table to the major head "288-Social Security and Welfare- E. Other social Security and Welfare Programme, C-Other Programme 8 ex-gratia payments to families of Minister, Government Servant etc. dying in harness other charges (Non-Plan)".
 
 Explanation. - For the purposes of this rule, the expression "members of his family" in relation to a deceased member shall mean the husband or the wife, as the case may be, of such deceased member who was residing with him and was wholly dependent upon him, his sons and daughters, who are unemployed and having no source of income of their own and were wholly dependent on the deceased member, as certified by the Deputy Commissioner.
 
### 11. Interpretation.
 - If any question arises as to the interpretation of these rules, the government shall decide the same.
 
### 12. Repeal and saving.
 - The Punjab State Legislature Members (Pension and Medical Facilities Regulation) Rules, 1977 are hereby repealed:
 
 Provided that any order issued or any action taken under the rules so repealed shall be deemed to have been issued or taken under the corresponding provisions of these rules.
 
 Form I
 
 Part A – [See Sub-rule (1)  of rule 3]
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 Application for grant of pension under the Punjab State Legislature Members (Pension and Medical Facilities Regulation) Act, 1977.
 
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 1. Name of applicant (in block letters)
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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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 2. Father's name (and also husband's name in the case of a
 
 married woman)
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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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 3. Permanent residential address showing village or town and
 
 district.
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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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 4. Particulars of period for which the applicant remained
 
 member of the Punjab Legislative Assembly/Punjab Legislative
 
 Council/Pepsu Legislative Assembly:-
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 Name of
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 Constituency
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 House of
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 represented
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 Legislature
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 Period of Membership
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 From\_\_\_to\_\_\_Years\_\_\_months\_\_\_ days
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 From\_\_\_to\_\_\_Years\_\_\_months\_\_\_ days
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 From\_\_\_to\_\_\_Years\_\_\_months\_\_\_ days
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 From\_\_\_to\_\_\_Years\_\_\_months\_\_\_ days
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 5. Identification marks
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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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 6. Whether the copies of the photographs duly attested are
 
 enclosed.
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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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 7. Whether specimen signatures, duly attested, are enclosed.
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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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 8. Whether the applicant is also entitled to any pension from
 
 the Central Government or any State Government or any Corporation
 
 owned or controlled by the Central Government or any State
 
 Government or any local authority, under any law or otherwise if
 
 so, the details thereof.
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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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### 9. I hereby certify that since \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (Date from which entitled to pension under the Act) :- (i) I have not been elected to the office of the President or Vice- President of India or appointed to the office of the Governor of any State or the Administrator of any Union Territory;
 
 (ii) I am not a member of the Council of States or the House of the People or any Legislative Assembly of a State or Union Territory or any Legislative Council of a State or Metropolitan Council of Delhi constituted under section 3 of the Delhi Administration Act, 1966;
 
 (iii) I am not employed on a salary under the Central Government or any State Government, or any Corporation owned or controlled by the Central Government or any State Government or any local authority, not I have become otherwise entitled to any remuneration from such Government, Corporation or Local Authority.
 
 (Note - Score out the certificate which is not applicable).
 
### 10. I hereby further certify that from \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(date)  I am holding the office of \_\_\_\_\_\_\_/ am a member of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ am employed as \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ under \_\_\_\_\_\_\_\_\_\_\_\_\_\_ and the salary/remuneration payable to me for holding such office being such member/being such employee is Rs. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ per mensem.
 A certificate to this effect from the competent authority is attached.
 
 (Note - Score out the certificates if not applicable).
 
### 11. I certify that I have never incurred a disqualification under the Representation of the People Act, 1951, or any other law for the time being in force. ###
 12. I hereby declare that the particulars stated above are true and correct to the best of my knowledge.
 (Signature of applicant)
 
 Place:
 
 Date:
 
 Part AA – [See sub-rule (1)  of rule 3]
 
 [Added by Punjab Government Notification No. G.S.R. 39/P.A.-5/77 S.5/Amd. (2) /86, dated 29th May, 1986.]
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 Application for grant of life time arrears of pension under the Punjab State Legislature Members (Pension and Medical Facilities Regulation) Act, 1977.
 
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 1. Name of deceased Ex-Member (in block letters)
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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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 2. Father's name (and also husband's name in the case of
 
 married woman).
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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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 3. Permanent residential address of the deceased (Ex-Member)
 
 showing village or town and district;
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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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 4. Particulars of period for which the deceased ex-Member
 
 remained Member of the Punjab Legislative Assembly/Punjab
 
 Legislative Council/Pepsu Legislative Assembly:-
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 Name of
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 Constituency
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 House of
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 represented
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 Legislature
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 Period of Membership
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 From\_\_\_to\_\_\_Years\_\_\_months\_\_\_ days
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 From\_\_\_to\_\_\_Years\_\_\_months\_\_\_ days
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 From\_\_\_to\_\_\_Years\_\_\_months\_\_\_ days
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 From\_\_\_to\_\_\_Years\_\_\_months\_\_\_ days
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 5. Whether the copies the photographs, of the applicant(s) [Legal heir(s)] duly attested are enclosed.
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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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 6. Whether the deceased ex-member was also entitled to any
 
 pension from the Central Government or any State Government of any
 
 Corporation owned or controlled by the Central Government or any
 
 State Government or any local authority under any law or otherwise
 
 if so, the details thereof
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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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 7. Name(s)  of legal heir(s) with age and relationship to the
 
 deceased ex- member.
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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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 8. Whether copy of death certificate attached
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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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 9. Whether succession certificate attached
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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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 10. Period for which life time arrears of the deceased
 
 ex-member are pending/being claimed.
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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
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### 11. I/We hereby declare that the particulars stated above are true and correct to the best of my/our knowledge. Signature of Legal heir(s) "
 
 Place
 
 Dated
 
 Part B – (See rule 4)
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 Certified that Shri/Shrimati \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ remained a member of the Punjab Vidhan Sabha from \_\_\_\_\_\_\_\_ to \_\_\_\_\_\_\_, from \_\_\_\_\_\_\_\_\_\_ to \_\_\_\_\_\_\_\_\_\_\_ and from \_\_\_\_\_\_\_\_\_\_\_ to \_\_\_\_\_\_\_\_\_\_ and from \_\_\_\_\_\_\_\_\_\_\_\_\_\_to \_\_\_\_\_\_\_ of the Punjab Legislative Council from\_\_\_\_\_\_\_\_\_\_\_\_\_ to \_\_\_\_\_\_\_\_ and from \_\_\_\_\_\_\_\_\_ to \_\_\_\_\_\_\_\_\_\_and from \_\_\_\_\_\_\_\_\_\_\_ to \_\_\_\_\_ and of the Pepsu Legislative Assembly from \_\_\_\_\_\_\_\_\_\_ to \_\_\_\_\_\_\_\_ from \_\_\_\_\_\_\_\_\_to \_\_\_\_\_\_\_\_\_and from \_\_\_\_\_\_\_to\_\_\_\_\_\_
 
 Secretary,
 
 Punjab Vidhan Sabha.
 
 Place:
 
 Date:
 
 Part C – ( See rules 4 and 9 )
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 Order
 
 Sanction is hereby accorded to the payment of Rs.\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (Rupees \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_only) per mensem under the Punjab State Legislature Members (Pension and Medical Facilities Regulation ) Act, 1977, to Shri/Shrimati \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ son/daughter/wife of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ , residing at\_\_\_\_\_\_\_\_\_\_\_\_ with effect from \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ till death subject to the provisions of the Punjab State Legislature Members (Pension and Medical Facilities Regulation) Rules, 1984, as amended from time to time.
 
### 2. A sum of Rs. \_\_\_\_\_\_\_\_ (Rupees \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_only) is due from the above named person on account of advance granted to him for the purpose of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ An amount of Rs. \_\_\_\_\_\_\_\_\_(Rupees \_\_\_\_\_\_\_\_\_\_\_\_\_) on account of interest thereon is also recoverable from the said person. The whole of this amount may without prejudice to any other right or remedies available to the Government be recovered from the pension hereby sanctioned. ###
 3. This order is liable to cancellation or modification under rule 8 of the aforesaid rules.
 Speaker,
 
 Punjab Vidhan Sabha.
 
 Part D – ( See rule 4)
 
 [Added by Punjab Government Notification No. G.S.R. 2/P.A. 5/71/S.5/Amd.(1) /86, dated 27th January, 1986.]
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 Order
 
 Sanction is hereby accorded to the payment of Rs. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (Rupees \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_only) under the Punjab State Legislature Members (Pension and Medical Facilities Regulation ) Act, 1977 to Shri/Shirmati \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ , son/daughter/wife of the late Shri/Sardar \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Ex-M.L.A./Ex-M.L.C, resident of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ as life time arrears of pension of the deceased from \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ to \_\_\_\_\_\_\_\_\_\_\_\_\_\_ subject to the provisions of the Punjab State Legislature Members (Pension and Medical Facilities Regulation) Rules, 1984, as amended from time to time.
 
 Speaker,
 
 Punjab Vidhan Sabha.
 
 Form II
 
 [See sub-rule (2)  of rule 6]
 
 Certificate
 
 I hereby certify that there is no change in the facts stated or certified by me in the application on the basis of which I have been sanctioned the pension under the Punjab State Legislature Members (Pension and Medical Facilities Regulation) Act, 1977.
 
 Signature of Pensioner
 
 (with date)
 
 Note : In case there is any change in the facts stated or certified by the pensioner in his application for pension, he shall forthwith report the matter to the Secretary, Punjab vidhan Sabha.
 
 Form III
 
 (See rule 10)
 
 For claiming medical reimbursement by members under the Punjab State Legislature Members (Pension and Medical Facilities Regulation) Act, 1977.
 
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 District of
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 Head of Service chargeable..................
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 Major Head ..........................................
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 Sub-Major Head ..................................
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 Minor Head .........................................
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 Sub-Head.............................................
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 Medical charges Bill of 199 , Cost of medicines as per vouchers
 
 enclosed.
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 Object of Expenditure......................... . for the month
 
 of
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 Amount Rs. P.
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 Certified that:-
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 (i)  I have actually spent the amount for the cost of medicines
 
 prescribed by the authorised medical attendant (whose essentiality
 
 certificate is attached) claimed in this Bill for my
 
 treatment/treatment of my \_\_\_\_\_\_\_\_\_\_\_\_\_\_ who is member of my
 
 family within the meaning of rule 10 of the Punjab State
 
 Legislature Members (Pension and Medical Facilities Regulations)
 
 Rules , 1984, who is residing with me and is wholly and solely
 
 dependent upon me and he/she is not in Government service and has
 
 no source of income of his/her own. I was not supplied these
 
 medicines from the Government hospital/dispensary:
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 (ii)  I have actually purchased the medicines duly prescribed by
 
 the authorised medical attendant for the purpose during the period
 
 of treatment;
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 (iii)  I have not already claimed the reimbursement of cost of
 
 medicines as now claimed in this Bill;
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 (iv)  I am drawing pension from the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Treasury
 
 against P.P.O. No. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_; and
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 (v)  I am not re-employed and do not draw any reimbursement of
 
 medical charges from any other source.
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 Counter-signed
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 Signature of Member Deputy Secretary.
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 Date
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 Passed for Rupees
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 Received payment of Rs \_\_\_ as medical charges for the month of
 
 \_\_\_\_\_\_\_ 198 .
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 Total
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 Signature of Member
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 Stamp.
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 Form IV
 
 (See Rule 10)
 
 Essentiality certificate for use of members under the Punjab State Legislature Members (Pension and Medical Facilities Regulation) Act, 1977.
 
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 Outdoor Ticket No.
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 dated
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 Rate of Pension
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 Rs.
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 I certify that Mr./Mrs./Miss\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Wife/son/ daughter of Shri \_\_\_\_\_\_\_\_\_\_\_\_, member under the Punjab State Legislature Members (Pension and Medical Facilities Regulation) Act, 1977, has been under my treatment at the\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_/Hospital/Dispensary/my consulting room and the undermentioned medicines prescribed by me in this connection were absolutely essential for the treatment and recovery and prevention of serious deterioration in the condition of the patient. The medicines were not stocked in the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (name of Hospital/Dispensary) for supply to the entitled patient and do not include proprietary preparations for which cheaper substitute of equal therapeutic value are available or preparations which are primarily food, toilets or disinfectants.
 
### 1. Certified that treatment as in-patient was not necessary. ###
 2. Certified that the medicines charged have no cheaper effective substitute.
### 3. Certified that the medicines are borne/not borne on the list of Medical Store Depot. ###
 4. Certified that the medicines are not in the nature of tonic, etc, the cost of which is not reimbursable under government order issued on the subject from time to time.
### 5. Certified that the price claimed is reasonable. ###
 6. Certified that the medicines prescribed are not in the list of non- imbursable medicines/articles/last revised - vide Punjab government letter No. 17-14-S/15831-CH-IHVI-56/7706, dated the 25th January, 1967.
### 7. She/He was suffering from ###
 8. Period of treatment from \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ to \_\_\_\_\_\_\_\_\_\_\_\_\_\_
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 Quantity of Medicines
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 Name of the Medicines
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 Name of the Chemist
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 No. and date, Price Rs.
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 Signature and Designation of Authorised Medical Attendant.
 
 [Form V]
 
 [Substituted by Punjab Government Notification dated 7.10.1986.]
 
 (See rule 10)
 
 For claiming reimbursement due to the deceased member under the Punjab State Legislature Members (Pension and Medical Facilities Regulation) Rules, 1984, by the heir(s)  of such member.
 
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 District of
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 Head of service chargeable....................
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 Major Head............................................
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 Sub-Major Head....................................
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 Sub-Head...............................................
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 Object of Expenditure...........................
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 Quantity of Medicines
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 Name of the Medicines
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 Name of Chemist
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 No. and date
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 Price Rs.
  |
 Medical Charges bill of.................. for the month of .............., 198 .
 
|  |  |
| --- | --- |
| 
 Cost of Medicines Amount as per vouchers Rs. P. enclosed
  | 
 (i)  Certified that Shri/Shrimati Ex-Member for
 
 the cost of medicines prescribed by the authorised medical
 
 attendant (whose essentiality certificate is attached) claimed in
 
 this bill for his/her treatment of his who is a member of his
 
 family within the member of rule 10 of the Punjab State
 
 Legislature Members (Pension and Medical Facilities Regulation)
 
 Rules, 1984, who was residing with him/her and was wholly
 
 dependent upon him/her and he/she is not in Government service and
 
 has no source of income of his/her own. He/she was not supplied
 
 there medicines from the Government hospital/dispensary.
  |
| 
 | 
 (ii)  He had actually purchased the medicines duly
 
 prescribed by the authorised medical attendant for the purpose
 
 during the period of treatment;
  |
| 
 | 
 (iii)  He had not already claimed the
 
 reimbursement of cost of medicines as now claimed in this bill :
  |
| 
 | 
 (iv)  He was drawing pension from the Treasury
 
 against P.P.O. No.
  |
| 
 Countersigned
  | 
 Signature of legal heir(s) .
  |
| 
 Date :
  | 
 |
| 
 Passed for Rupees
  | 
 |
| 
 | 
 Deputy Secretary.
  |
| 
 | 
 as medical charges for the
  |
| 
 Received payment of Rs.
  | 
 |
| 
 month of , 198. Total;
  | 
 Signature of legal heir(s)  Stamp.
  |
 [Form VI]
 
 [Added by Punjab Government Notification dated 07.10.1986]
 
 [See sub-rule (4)  of rule 10]
 
 Sanction is hereby accorded to the payment of Rs.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Rupees \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_only under the Punjab State Legislature Members (Pension and Medical Facilities Regulation) Act, 1977, to Shri/Shrimati \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ son/daughter/wife of the late Shri/Shrimati\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_Ex-M.L.A., Ex- M.L.C., resident of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_as life time arrears of medical reimbursement of the deceased from \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_to \_\_\_\_\_\_\_\_\_\_\_\_\_subject to the provisions of the Punjab State Legislature Members (Pension and Medical Facilities Regulation), Rules, 1984, as amended from time to time.
 
 Deputy Secretary, Punjab Vidhan Sabha.
 
 [Form VII]
 
 [Added by Punjab Government Notification dated 7.10.1986.]
 
 Part A – [See rule 10-A(2) ]
-----------------------------
 Form of application of ex-gratia grant
 
 Application from the members(s)  of family of late Shri/Sardar/Shrimati \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ who was serving as Member of Legislative Assembly.
 
|  |  |  |
| --- | --- | --- |
| 
 1
  | 
 Name and Full Address of the applicant.
  | 
 |
| 
 2
  | 
 Relationship to the deceased member of the Punjab Legislative
 
 Assembly.
  | 
 |
| 
 3
  | 
 Circumstances and date of death of the member of the Punjab
 
 Legislative Assembly.
  | 
 |
| 
 4
  | 
 Name and ages of surviving relations of the deceased.
  | 
 |
| 
 | 
 Name
  | 
 Age
  |
| 
 | 
 ----------------------
  | 
 ----------------------------
  |
| 
 | 
 ----------------------
  | 
 ----------------------------
  |
| 
 | 
 (A)  Widow/Husband
  | 
 |
| 
 | 
 (B)  Wholly dependentChildren : 123
  | 
 |
| 
 5
  | 
 The Treasury from which ex-gratia grant is to be drawn.
  | 
 |
| 
 6
  | 
 Any other relevant information
  | 
 |
| 
 | 
 Place:
  | 
 |
| 
 | 
 Dated :
  | 
 |
 Signatures of the applicant(s) Part B – [See rule 10-A(4)]
-----------------------------
 Order
 
 Sanction is hereby accorded to the payment of ex-gratia grant of Rs. \_\_\_\_\_\_\_ (Rupees \_\_\_\_\_\_\_\_\_ only) under the Punjab State Legislature Members (Pension and Medical Facilities Regulation) Act, 1977, to Shri/Shrimati \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ son/ daughter/wife of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, residing at \_\_\_\_\_\_\_\_\_\_\_\_subject to the provisions of the Punjab State Legislature Members (Pension and Medical Facilities Regulation) Rules, 1984, as amended from time to time.
 
 Speaker, Punjab Vidhan Sabha.
 

