FORM 5. Assessment and Authorisation of Gratuity when a Government Servant is missing: CCS (Payment of Gratuity under NPS) Rules, 2021
FORM 5
Assessment and Authorisation of Payment of Retirement Gratuity when a Government Servant is missing while in Service
[See sub-rule (4) of rule 33 ]
Part I
Section I
1. Details of employee:
| (a) Name | |||||||||
| (b) Mother’s /Father’s name | (c) Date of birth | D | D | M | M | Y | Y | Y | Y |
| (d) Date of missing | D | D | M | M | Y | Y | Y | Y | |
| (e) Religion |
2. Post held at the time of missing:
| (a) Name of the office | |
| (b) Post held substantively | (c) Officiating post |
| (d) Level of pay in the pay matrix | (e) Basic Pay |
| (f) In case the last post was held outside the Government on foreign service terms- | |
| (i) Level of pay of the post held in the parent department | (ii) Basic pay |
| 3. Date of beginning of service | 4. Date of ending of service |
5. Service in Autonomous Body/State Government, if any particulars of service:
| (a) Name of organisation | (b) Post held | (c) Period of service |
| From To | Total period | |
| (d) Whether the above service is to be counted for gratuity in the Government | O Yes O No | |
| (e) Whether the Autonomous Organisation has discharged its gratuity liability to the Central Government | O Yes O No | |
| (f) Amount of any gratuity received for the previous civil service, if any | (g) Nature of any pension received for the previous civil service, if any |
6. Service qualifying for retirement gratuity:
| (a) Details of omission, imperfection or deficiencies in the service book which have been ignored [under rule 36 (1) (b) (ii)] | |||
| (b) Periods of non-qualifying service: | From | To | No. of Days |
| Interruption in service condoned under rules 18 and 19 | |||
| Extraordinary leave not qualifying for gratuity | |||
| Period of suspension treated as non-qualifying | |||
| Periods of foreign service with United Nations bodies for which no contribution for gratuity received to the Government rule 20) | |||
| Any other service not treated as qualifying service | |||
| Total Period of non-qualifying service | |||
| (c) Additions to qualifying service: | From | To | No. of Days |
| Benefit of service in an Autonomous Body | |||
| (d) Net qualifying service | |||
| (e) Qualifying service expressed in terms of completed six monthly periods (Period of three months and above is to be treated as completed six monthly period (rule 22) | |||
| 7. Emoluments reckoned for retirement gratuity | 8. Amount of retirement gratuity |
| 9. Details of Government dues recoverable out of retirement gratuity: | |
| (a) Licence fee for occupation of Government accommodation [ See rule54] | |
| (b) Amount to be withheld as indicated by the Directorate of Estates [See rule 54 (i) . | |
| (c) Dues referred to in rule 54 (2) | |
| (d) Net amount payable as retirement gratuity |
10. Details of the nominee(s) to whom retirement gratuity is payable:
| S.No. | (a) Name | (b) Date of birth (DD/MM/YYYY) | (c) Share in death gratuity | (d) Relationship with deceased Govt. servant | (e) Address |
| 1. | |||||
| 2. | |||||
| 3. |
11. Details of guardian/nominee who will receive payment of death gratuity in the case of minor/mentally disabled children
| S.N. | (a) Name of minor/mentally disabled child | (b) Name of guardian | (c) Relationship with deceased Govt. servant | (d) Address of guardian |
| 1. | ||||
| 2. | ||||
| 3. |
12. Head of Account to which death gratuity is debitable.
| Place: | DD-MM-YYYY |
| Date: | (Signature of Head of Office) |
PART II
Account Enfacement
Section I
| Total period of qualifying service accepted for retirement gratuity |
| Net amount of retirement gratuity after adjusting Government dues |
| Head of account to which retirement gratuity is debitable |
Section II
Details of missing Government servant
| Name | Date of missing | D | D | M | M | Y | Y | Y | Y |
| Amount of gratuity authorised | Amount recoverable from gratuity |
| Amount of gratuity withheld pending receipt of ‘No Demand Certificate’ | |
| Place: Date: DD-MM-YYYY (Signature of Account Officer) |
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