Application Form
RETIREMENT BENEFIT AND DEATH COMPENSATION FUND
PAYMENT OF RETIREMENT BENEFIT
Part – 1
Paste Passport
1 Personal #
Size photograph
2 a) Name of Beneficiary
b) CNIC - -
c) Father / Husband Name
d) Last Position held
along with BPS
e) Name of Department
f) Station / place of posting
dd mm yyyy
3 Date of Birth - -
4 Date of Appointment - -
5 Date of Retirement OR removal
- -
form service on account of
a) Superannuation /
b) Dismissal from Service c) Removal
Qualifying Service
d) Termination
e) Resignation (Tick the relevant box)
Qualifying Service
6 Regular Contribution to
a) Group Insurance From To
b) RB & DC From To
c) Messing period in case of
Leave without pay etc. i From To
ii From To
iii From To
7 Address
a) Present / Postal
b) Permanent
c) Contact No.
Signature of Thumb Impression
Of Beneficiary
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Application Form
RETIREMENT BENEFIT AND DEATH COMPENSATION FUND
PAYMENT OF RETIREMENT BENEFIT
8 Bank Detail
a) Name of Bank b) Bank code
b) Title of Account
c) Type of Account (i.e. PLS, Saving, Current)
d) Account No
Signature of Branch Manager Stamp with Branch Code
PART - II
CERTIFICATE
1 Certified that the information contained above in respect of Mr/Miss/Mrs _________________________ is correct
and according to our record.
2 Certified that the above named employee was neither a contingency / work charged / adhoc / contract employee nor
a deputationist from any Provincial Government or Federal Government and he / she was regular contributor of
RB&DC & Group Insurance Funds.
3 Certified that the claim has been submitted for the first time and had never been sent previously from any office of
this department.
4 Certified that this department reserve the right to refund the amount of all grants sanctioned under RB&DC scheme,
in case of fake / fictitious documents / information in respect of the above named employee.
Dated: ___________________ Seal and signature
Head of the Office
Forwarded to the Board of Retirement Benefit & Death Compensation Fund, Finance Department Peshawar for grant
of retirement benefit.
Dated: ___________________ Seal and signature
Head of the Department
Required documents & instructions for submission of Application Form
a The application for must be countersigned by the Head of Department / Head of Attached Department.
b Attested Photocopy of Retirement Order / Notification.
c One Photograph of the beneficiary.
d Attested Photocopy of CNIC of beneficiary.
e Leave account duly signed by the DDO, in case of Gazetted be issued by the AG/DC/DCA/DAO/AAO(s).
f Computerized Pay Slip showing RB&DC deduction. Pay stoppage certificate duly signed by the office of the AG/DC/DCA/DAO.
g Attested Photo copy of first and 2nd page of S/Book, in case of Gazetted a Service Certificate be issued by AG/DC/DCA/DAO.
h A copy of the Medical Board proceedings duly attested by the Head of Department.
i The attached documents should be marked as Annexure A, B, C etc.
j Forward application from with covering letter to:
Project Manager (RB&DC), 1st Floor Directorate of Treasuries & Accounts, Khyber Pakhtunkhwa Peshawar
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Application Form
RETIREMENT BENEFIT AND DEATH COMPENSATION FUND
Payment of Death Compensation
Part – 1
1 Personal Information Paste Passport
Size photograph
a) Personal #
b) Name of Deceased
Employee
c) CNIC - -
d) Father / Husband Name
e) Last Position held
along with BPS
f) Name of Department
g) Station / place of posting
dd mm yyyy
h) Date of Birth - -
i) Date of Appointment - -
j) Date of Death - -
2 Whether regular Contribution to
a) Group Insurance From To
b) RB & DC From To
c) Messing period in case of
Leave without pay etc. i From To
b) RB & DC ii From To
iii From To
PART - II
3 Nomination of beneficiary
a) CNIC No. of Spouse (in case - -
of married employee)
b) Name of beneficiary (s) (nomination or otherwise)
S Date of Relationship %age of
Name Father’s Name CNIC No.
No Birth with the share
1
2
3
4
5
6
7
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Application Form
RETIREMENT BENEFIT AND DEATH COMPENSATION FUND
Payment of Death Compensation
4 Address of Beneficiary
Present / Postal
Permanent
Contact No.
Signature of Thumb Impression
Of Beneficiary
5 Bank Detail
a) Name of Bank b) Bank code
b) Title of Account
c) Type of Account (i.e. PLS, Saving, Current)
d) Account No
Signature of Branch Manager Stamp with Branch Code
PART - III
CERTIFICATES BY HEAD OF DEPARTMENT
1 The information contained above in respect of Mr/Miss/Mrs _________________________ is correct and according
to our record.
2 The above named employee was neither a contingent paid / work charged / adhoc / contract employee nor a
deputationist from any Provincial Government or Federal Government and he / she was regular contributor of RB&DC
& Group Insurance Funds. Further he/she was neither dismissed nor removed from service (in case of a deputationist
from one Federal Government Department to another the case will be prepared by his/her parent Department.
3 Certified that the employee died during the continuance of service After retirement.
4 The particular of nominee(s) and sum assumed etc. of the deceased employee mentioned in Part – I & II above are
correct and there is no other nominee(s) as per record of this office. In case particulars of nominee(s) given in Par –I
& II found incorrect at later stage by any forum our department will be responsible for refund of sanctioned amount(s)
to RB&DC Fund.
5 Certified that the claim has been submitted for the first time and had never been sent previously from any office of
this department.
6 The above named employee was not uniform employee of Armed forces at the time of death.
Dated: ___________________ Seal and signature
Head of the Office
Forwarded to the Board of Retirement Benefit & Death Compensation Fund, Finance Department Peshawar for grant
of retirement benefit.
Dated: ___________________ Seal and signature
Head of the Department
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Application Form
RETIREMENT BENEFIT AND DEATH COMPENSATION FUND
Payment of Death Compensation
Required documents & instructions for submission of Application Form
Last pay certificate / computerized pay slip duly countersigned by head of department showing personal No. allotted by the
a
Accountant General, Khyber Pakhtunkhwa / District Account Officer.
b First and second page of service book / PPO / Statement of service in case of gazette employee.
c CNIC in respect of the aforesaid deceased employee and the prospective beneficiaries and in case of any minor beneficiary.
B.Form (Both sides of CNIC must be copied on A-4 sixe paper).
d Death certificate issued by Union Council / Union Committee / Municipal Committee duly attested.
e Death Notification / order under which the name of the said employee was struck off strength.
f Nomination form for pertaining to Retirement Benefit & Death Compensation Fund filled in the employee during service.
g List of dependent family members i.e. wife / wives, natural son(s), father, mother, minor brothers and unmarried / divorced /
widowed sisters / daughters. The list should indicate name, CNIC No. relationship, age, marital status, profession, monthly
income, present mailing address and contact number(s).
h Wholly dependency certificate (Other than spouse) issued by the Head of the Department / Officer authorized by the department
(Authority letter must be attached).
i Envelope containing four copies of photographs duly attested in respect of each beneficiary / dependents duly attested by class-1
Gazetted Officer.
J In case of female prospective beneficiaries one widow / non-marriage / re-marriage certificate.
k Forward application from with covering letter to:
Project Manager (RB&DC), 1st Floor Directorate of Treasuries & Accounts, Khyber Pakhtunkhwa
Peshawar
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