The decision of the Secretary on all matters covered by these rules shall be final.
FORM 1 APPLICATION FOR PENSION (See Rule 3) From Shri/Smt/Kumari Ex-member To The Secretary, Kerala Legislative Assembly, Legislative Secretariat, Thiruvananthapuram.
Sir, Sub:- Sanction of Pension under the Kerala payment of Pension to Members of Legislature Act, 1976.
I am entitled to receive pension under the Kerala Payment of Pension to Members of the Legislature Act, 1976, having been a member of the Legislative Assembly and / or Legislative Council mentiond below and during the period mentioned therein, Name of the Legislative Assembly Period and /or Legislative Council in which From To served as a Member
2. I request that steps may kindly be taken to sanction pension to me. I desire to draw my pension from the Government District Treasury/Sub Treasury at ...........................................in person/and the amount may be sent to me by Postal Money Order to my present/permanent address furnished in paragraph 4 below.
3. I enclose herewith the following documents duly attested by I Class Magistrate /Class I Officer of the Central/State Government / a Sitting Member of the Kerala Legislature of Member of Parliament.
(i) Three specien signatures (if the applicant can sign his name) or three copies of the impression of the thumb and fingers of the left hand (if the applicant cannot sign his name)
(ii) Three copies of latest photographs in passport size.
4. (1) My Present address is .....................................................................................
...........................................................................................................................
............................................................................................................................
(ii) My Permanent address is ..................................................................................
...........................................................................................................................
...........................................................................................................................
............................................................................................................................
5. Date of Birth (in Christian Era)............................................................................
6. I hereby declare that :
(i) I am not holding the elected Office of the President/Vice President of India or is 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 the Legislative Assembly of any State or Union Territory or the Legislative-Council of a State or the Metropolitan Council of Delhi constituted under section 3 of the Delhi Administration Act, 1966 ; or
(iii) I am not employed on a salary under the Government of India or any State Government or any Corporation owned or controlled by the Government of India or any State Government or any Local authority or becomes otherwise entitled to any' remuneration from such Government, Corporation or Local Authority.
(iv) I am not in receipt of any Political /Military /Civil Pension .
(v) I am holding the Office of .................................................................................
.................................................................................................................... .........
.......................................................................................................... or employed as ........................................................................................................................or in ................................................................................................................and the total remuneration received by me is Rs.
............................................................................................................................p.m (A certificate from the competent authority to be attached)
(vi) I am in receipt of Rs ...........................................................................................
as Political/Military/Civil Pension being drawn from............................................
............................................................................................................................. .
(A Certificate from competent authority to be attached).
Yours faithfully Name in Block Letters: Signature.
Station :
Date :
FORM IA APPLICATION FOR PENSION (See Rule 3) From Shri/Smt .............................................................................................................
Spouse of late Shri/Smt .....................................................................................
Member.
To The Secretary, Kerala Legislative Assembly, Legislative Secretariat, Thiruvananthapuram.
Sir, Sub:- Sanction of Pension under the Kerala Payment of Pension to Members of Legislature, Act, 1976.
I am entitled to receive pension under the Kerala Payment of Pension to Members of Legislature Act, 1976, having been the spouse of Late Shri/Smt.......................................
Member of the Legislative Assembly/or Legislative Council mentioned below and during the period mentioned therein.
Name of the Legislative Assembly Period and/or Legislative Council in which From To served as a Member
2. I request that steps may kindly be taken to sanction pension to me. I desire to draw my pension from the Government District Treasury/Sub Treasury at ................................................. in person/and the amount may be sent to me by Postal Money Order to my present/permanent address furnished in paragraph 4 below.
(i) Three specimen signatures.
(ii) Three copies of latest photograph in passport size.
(iii) A Certificate obtained from the Tahsildar, having jurisdiction over the area showing my relationship with the Member.
(iv) An affidavit duly countersigned by the Tahsildar having jurisdiction over the area, that I have not remarried and in case of remarriage the matter will be intimated to the Secretary, Kerala Legislative Assembly promptly, for cancelling the pension payment.
(v) Three copies of death certificate of the late member.
4. (i) My present address is ........................................................................................
...............................................................................................................................
...............................................................................................................................
.............................................................................................................................
(ii) My permanent address is .....................................................................................
.................................................................................................................................
............................................................................................................................. .....
..................................................................................................................................
5. Date of Birth (in Christian Era) Yours faithfully, Signature.
Name in Block letters ................................................
Station ..............................................
Date .................................................
FORM II (See Rule 4) ORDER The undersigned having satisfied that Shri/Smt./Kumari ..........................................
has served as a ......................................................Member Council/Assembly during the following periods :
From To is the spouse of late Shri .........................................................................................
who has served as a Member ...................................................................................
Council / Assembly during the follwing periods :
From To hereby orders the grant of pension of Rs. .............................................................
per mensem to Shri/Smt./Kumari .........................................................................
which may be accepted by Accountant General as admissible under the Rules ..
...............................................................................................................................
# The grant of this pension shall take effect from :
# The date of birth of the Ex-Member is:
# The Ex-Member is also eligible to have additional pension per mensem on completion of the age of 70/80/90 years as follows admissible as per the Kerala Payment of Pension to Member of Legislature (Amendment) Act, 2012 (Act 5 of 2012) which may be accepted by the Accountant General Age Amount of Additional Pensioner On completion of 70 years on .............................................................. Rs. 2,500/- On completion of 80 years on .............................................................. Rs. 3,000/- On completion of 90 years on .............................................................. Rs. 3,500/- Place : Secretary, Date : Kerala Legislative Assembly