The Principal Secretary on being satisfied that the revision of the Family Pension Payment Order issued under rule 3 is necessary, may, sue moto or otherwise, issue revised Family Pension Payment Order from time to time as to confirm to the provisions of the Act and rules and upon the issue of a revised Family Pension Payment Order, the previous Family Pension Payment Order in force shall cease to be effective :
Provided that the amount of the family pension shall not be reduced or ceased without issuing a show cause notice and providing an opportunity to the person concerned for making his representation within a time to be fixed by the Secretary.
(123) Form-I Application for Family Pension (See rule 3) From :
…………………………………………………………………….……….
W/o/Husband/Son/Daughter of…………………………………………....
Ex-Member, Rajasthan Legislative Assembly…………….
To, The Principal Secretary, Rajasthan Legislative Assembly.
JAIPUR Subject : Grant of family pension under Rajasthan Legislative Assembly (Officers and Members Emoluments and Pension) Act, 1956.
Sir, Under section 4-C of the aforesaid Act, I am entitled to family pension as my husband/wife Shri/Shrimati……………………………… remained Member of Rajasthan Legislative Assembly From…………...… to…………………………………………………………………………...
……………………………………………………………………………..
…………………… It is requested that necessary action may be taken to grant family pension to me. I want to take my said family pension from public sector Bank Branch…………………..Treasury/Sub-Treasury………..
I attach herewith the copies of the following documents verified by Magistrate I Class/Gazette Officer of Central Government or State Government/existing member of Parliament/Rajasthan Legislative Assembly :-
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(1) Three specimen signature.
(2) Three latest photographs of passport size My present address………………………………………………………...
……………………………………………………………………………..
My permanent address……………………………………………………..
……………………………………………………………………………..
I hereby declare that :-
(1) I am not working on the elected post of President or Vice- President or on the post of the Governor of any State or post of the Administrator of any Union Territory.
(2) I am not a member of Council of States or House of the People or Legislative Assembly of any State or Union Territory or of Legislative Council of any State or Delhi Metropolitan Council framed under section 3of Delhi Administration Act, 1956.
(3) I am not paid employee of Central Government or of any State or under the ownership of any local authority or of any Corporation controlled by it or I am/we are not otherwise entitled for any remuneration from the said Government or Corporation or local authority.
(4) I am working on the post of ……………………. Or member of ………………………………… or appointed on the post of ………………….. or in a…………… and I ………… get Rs……………………… P.M. as a total remuneration.
(5) Identification mark of pension receiver ……………………..
(6) I have not been remarried.
(7) I have received pension/ other income from other sources Rs.
…..….., which is received from ……...….. as pension/income.
Yours faithfully, ………..……… (Signature)
(125) Name in clear words………………………………..
Place ………….
Date…………… Rajasthan Legislative Assembly Secretariat It is certified that Shri/Shrimati…………….……………..…..
remained member of Rajasthan Legislative Assembly for the following periods : - From…………………………..To…………………………………….…..
From…………………………..To…………………………………….…..
From…………………………..To…………………………………….…..
From…………………………..To…………………………………….…..
It is certified that Shri/Shrimati …………………… (In legible words) remained member of the House of the People for the following periods:- From…………………………..To…………………………………….…..
From…………………………..To…………………………………….…..
From…………………………..To…………………………………….…..
From…………………………..To…………………………………….…..
Secretary, Rajasthan Legislative Assembly It is certified that Shri/Shrimati………………………. (In legible words) remained member of the Council of the States for the following periods:- From…………………………..To…………………………………….…..
From…………………………..To…………………………………….…..
From…………………………..To…………………………………….…..
From…………………………..To…………………………………….…..
Principal Secretary, Rajasthan Legislative Assembly.
(126) Rajasthan Legislative Assembly Secretariat Jaipur, Dated ……….. 20 …… Till further orders and in the end of every month, pay the amount of Rs………………. to Shri/Shrimati…………………..…… ……………………………………………………………………………..
the family pension amount under Rajasthan Legislative Assembly (Officers and Members Emoluments and Pension) Act, 1956 and details of which is as follows: - Amount of family pension payable under Section 4-C of the Act, Rs………………………….
Debit remuneration/Family Pension amount Receiving under Section 4-C of the Act, Rs ………………………….
Net amount payable of Family Rs ………………………...
Pension Payment should be from date…………………………...and should be up to date …………………..…… (Signature……………….)
Principal Secretary, Rajasthan Legislative Assembly.
(127) Form-II (See rule- 4) Family Pension Payment Order (In triplicate)
1. Amount disbursing officer’s portion.
2. Pensioners Portion
3. Office.
Debitable to the State Government.
Account Head : - Major Head Major Head Voted Photo of Ex-members Family Pensioner/Person authorized under rule 3 Verified by competent officers
1. Family Pensioner’s Name ........................................
(i) Name of the person authorised.
2. Address of the residence ………… …………………………………..
Village & Sub-Division …………
3. Identification mark of the Family pensioner
4. Class of pension- Pension under Rajasthan Legislative Assembly (Officers and Members Emoluments and Pension) Act, 1956
5. Monthly Family pension amount Rs ………………… (In figures) Rupess ………………………………..…...(In words) Signature of family pensioner the person Authorized under rule 3 Photo
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6. Payment should be made from 1st August, 2009 or with effect from the date of death of such Ex-member (whichever is later) and thereafter the amount Rs. …….. may be paid.
7. Payment office and place ………………….
Principal Secretary, Rajasthan Legislative Assembly, Jaipur Amount of family pension in Rupees…………………...…….… (In words) to be recorded under every separate payment by the order of disbursing officers.
20 20 20 20 Date of payment Signature of amount disbursing officer Date of payment Signature of amount disbursing officer March April May June July August September October November December January February Month for which family pension is due
(129) Form–III (See rule 5) Declaration (To be submitted with the family pension bill two times in the first and subsequent year i.e. in the month of November by the person authorised under rule 15) I hereby declare that :-
1. I…………………………………………..…..have not been elected/ appointed on the State or post of the President/Vice President or on the post of Governor of a on the post of an Administrator of an Union, Territory; or
2. I…………………………………………….. am not member of Council of States or House of the People or of any State Legislative Assembly or Council; or
3. I …………………………………..am not paid employee of Central Government or any State Government or any Corporation owned or controlled by Central or State Government or any Local Authority; or
4. I ………………………..am not entitled otherwise to get remuneration from said Government or Corporation or Local Authority; or
5. I ………………………,……………...…………am working on the post of …………….or am member of …………. or am appointed as a ………………… (write here the name of the office of Central Government/State Government/Local Authority/office of the corporation owned, controlled by Central Government of State Government) ………………… and I am receiving total remuneration Rs………………..P.M.
6. I have not been remarried.
…………………….
Signature Address………………… ……………………….
(130) Form-IV (See rule 5) (A) Rajasthan Legislative Assembly Family Pension Bill Rs. P.M. ………………………………..Family Pension Payment Order No ….……………………………………….dated ………………..
Memo:- Use this form the submitting next bill.
Months ………………….
Vouchers of the list of Payment for the year………… ………………..........................
District………………………………………………….……..Accounts Item No ……………… I received my due family pens ion for the month……..20………..Amount Rs………..
Income Tax dedication Rs………………………………………..
Net Amount Rs….………………………………….…………….
(Rs. In words) ……………………………………………………………..
Place …………… Date …………….
Address of the family pensioner Received Payment Identify (Revenue Stamps) Pensioner Signature Designation & Address …………………………………...……………..
(131) (A-1) Certificate to be given when one does not appear in person (except where such certificate is not essential under any rule or order) It is certified that I have seen the family pensioner that he/she is alive and that he/she has signed this bill.
Name………..………….
Date………………………..……...….Designation…………..…….……..
Endorsement to be signed by the family pensioner Please, pay to…………………………………..……….. family pensioner For the use of Treasury Bank/Treasury………………………………………….…………………..
Pay Rs……………………………………………………………..……… Debited in the accounts…………………………………………………….
Date………… Accountant T.O. or Sub-T.O.
Receipt of the receiver Received the payment I identify Signature of the Bearer or agent Signature………………………………… Designation and Address……….……….
……….…………....…………………… For Bank/Treasury Payment made for Rs …………………….(in words…………...………..)
Bank/Treasury
(132) For the use of in the office of Rajasthan Legislative Assembly Granted Rs……………………………………………..………… objection for Rs ………………….……..
Auditor Superintendent Secretary By Order of the Governor, S. D. Tak Principal Secretary to the Government