Mode of exit (Specify) : *(Retirement/ Resignation/ Pre-matured retirement/ VRS/ Leaving service on account of Total Permanent Disablement or Sudden Disappearance/ Completion of tenure of Board Level Appointees) Date of : Details of Nominee : Sl. No. Name of Nominee Address of Nominee Relation-ship Date of Birth of Proportion with Member Nominee $ by Pension will be shared $ (attach self-attested copy of date of birth of nominee) Option to choose pension Annuity for life Annuity for life with return of Capital (ROC) Annuity for 5 certain & Life thereafter Annuity for 10 years certain & Life thereafter Annuity for 15 certain & Life thereafter Annuity for 20 years certain & Life thereafter Annuity for life increasing at a simplest rate of 3% p.a. Annuity for life with a provision for 50% of the annuity payable to the spouse on death of the annuitant Annuity for life with a provision for 100% of the annuity payable to the spouse on death of the annuitant Annuity for life with a provision for 100% of the annuity payable to the spouse on death of the annuitant with return of purchase price on death of last annuitant Mode of payment of pension: __________ (Monthly/Quarterly/Half-yearly/Yearly) Mode of Annuity Payment: * By NEFT transfer. Encls: 1. DOB Certificate of Nominee 2. NEFT Mandate form (Signature of Member) To be completed by A/Cs / Pay Roll Remittance particulars after last schedule i.e. as on 31st March of the Preceding Year) Month Year Employer Share of Employee Share of Contribution Contribution April May June
Mode of exit (Specify) : *(Retirement/ Resignation/ Pre-matured retirement/ VRS/ Leaving service on account of Total Permanent Disablement or Sudden Disappearance/ Completion of tenure of Board Level Appointees) Date of : Details of Nominee : Sl. No. Name of Nominee Address of Nominee Relation-ship with Member Date of Birth of Nominee $ Proportion by Pension will be shared $ (attach self-attested copy of date of birth of nominee) Option to choose pension Annuity for life Annuity for life with return of Capital (ROC) Annuity for 5 certain & Life thereafter Annuity for 10 years certain & Life thereafter Annuity for 15 certain & Life thereafter Annuity for 20 years certain & Life thereafter Annuity for life increasing at a simplest rate of 3% p.a. Annuity for life with a provision for 50% of the annuity payable to the spouse on death of the annuitant Annuity for life with a provision for 100% of the annuity payable to the spouse on death of the annuitant Annuity for life with a provision for 100% of the annuity payable to the spouse on death of the annuitant with return of purchase price on death of last annuitant Mode of payment of pension: __________ (Monthly/Quarterly/Half-yearly/Yearly) Mode of Annuity Payment: * By NEFT transfer. Encls: 1. DOB Certificate of Nominee 2. NEFT Mandate form (Signature of Member) To be completed by A/Cs / Pay Roll Remittance particulars after last schedule i.e. as on 31st March of the Preceding Year) Month Year Employer Share of Contribution Employee Share of Contribution April May June