Back

Form for Medical Allowance

To be filled by the pensioner and submitted to (a) HOO with application for grant of pension  (b) to Pension Disbursing Agencies if submitted after retirement  

ANNEXURE - I

(i)         I .  hereby   opt   the   medical facilities under CGHS or other similar Health Scheme namely .

OR 

(ii)        I . hereby opt to claim fixed medical allowance of Rs.100/-pm as I am residing in area where no CGHS medical facilities are available. 

Existing Address:-                                   

.. 

Signature

Name .

Designation ...

Office to which employed

Date:

Station:

(i)         To be scored out if not applicable.

(ii)        This is one time option.

ANNEXURE - II

 Form of undertaking to be furnished by pensioner to his PDA. 

            I hereby declare and undertake that I am entitled to medical facilities under CGHS or other similar Scheme namely . But I am residing in an area where no such out door facilities are available. 

My residential address is                                                                                     Vill/Moh

                        PO

                        Distt ..

                        Pin .

Name .

PPO No .

TS/PS No.

SB/Current A/c No.

PDA 

Station:

Dated:

ANNEXURE - III

Intimation to Chief CDA(P) Allahabad regarding payment of Medical Allowance to pensioner.(to be prepared in duplicate)

Name of the pensioner/family pensioner

PPO No.

TS/PS/HO Number

Saving/Current A/c No.

Whether opted for Medical Allowance                                            Yes/No

Whether pensioner has submitted an undertaking                               Yes/No

Whether necessary entries regarding payment of                               Yes/No

Medical allowance has been made in PPO and

pension certificate of the pensioner.

 

Signature of Pensioner

Disbursing Authority

Bank Branch

Distt.