ATTENTION – N.F.RLY., SURVIVING SRPF (C) RETIREES

.

APPLICATION FORM FOR ENHANCED EX-GRATIA PAYMENT TO RLY.EMPLOYEES WHO RETIRED BETWEEN 01.04.1957 TO 31.12.1985.

To.

(Name of concerned office from where retired) –

(Ex-gratia sanctioning authority).

Sub:- Application for Grant of enhanced Ex-Gratia Pay to the surviving SRPF( C )

retirees in terms of Rly. Bd’s L/No. F(E)III/98/PN 1/Ex-Gratia dt. 15.11.2006

.

Sir,

In reference to the above, I am furnishing my detailed particulars as mentioned below:-

1. Name of the applicant (in Block letters): -------------------------------------------------

2. Full Postal address(In Block letters). : -------------------------------------------------

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Telephone No. – if any : -------------------------------------------------

E. Mail address – if any : -------------------------------------------------

3. Name & designation of the Ex-gratia : ------------------------------------------------

Payment holder. ------------------------------------------------

4. Last pay and scale. : ------------------------------------------------

5. Date of retirement. : ------------------------------------------------

6. Date of birth of ex-gratia payment

holder. : ------------------------------------------------

7. Date of commencement of Ex-gratia

payment. : ------------------------------------------------

8. Ex-gratia Payment Order No (Photo

copy enclosed). : ------------------------------------------------

9. Office/Department last served at the

time of retirement. : ------------------------------------------------

10. Details of the Pension Disbursing

Authority. : ------------------------------------------------

I) Name & Postal address of the

Pension Paying Bank. : ------------------------------------------------

II) SB A/c Number of the Pensioner/

Family Pensioner. : ------------------------------------------------

III) Phone No/Fax No/E-mail : ------------------------------------------------

Address of Bank ( to facilitate quick

Communication). ------------------------------------------------

Dated:- Yours faithfully,

Address for communication

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Signature of the Ex-gratia Payment

Holder