FORM 6

[See rules 57(1), 58, 59 and 60, 62, 80]

Particulars to be obtained by the Head of Office from the retiring/retired Government Servant

Photograph(s)

1. Detail of Government servant:

Name Designation/ Rank
Date of birth Date of retirement
Ministry/Department/Office PAN No.
Aadhaar No.*(voluntary) Nationality
2. Address after retirement for future correspondence:
Flat/House No./Bldg. Name Street/Locality
Village & Post Office/Block City & District
State Pin Code
Telephone No. (If any) Mobile No.
E-mail ID
3. Details of Bank through which Pension is to be drawn:
Type of A/c Single Joint with Spouse A/c No.
Bank’s Name Branch
IFS Code
Note 1: Please attach a copy of the first page of passbook/cancelled cheque/document showing the name of Account Holder. (The
name should be the same in the bank account, this form and the office records.)
Note 2: Please ensure that the Government servant is the Primary Account holder in the Joint Account
Note 3: In case Head of Office is satisfied that it is not possible for the retiring Government servant to open a joint account for
reasons beyond his/her control, this requirement may be relaxed.

4. Details of member of the family of Government servant who has been authorised under Rule 57(3) to submit this Form on behalf
of the retiring/retired Government servant:
Name Relationship with the
Government servant
Aadhaar No.*(voluntary) Nationality
Flat/House No./Bldg. Name Street/Locality
Village & Post Office/Block City & District
State Pin Code
Telephone No. (If any) Mobile No.
E-mail ID Reasons why Government
servant is not able to submit
this form

5. I desire to commute % of my pension under Central Civil Services (Pension) Rules, 2021 in accordance with the
provisions of the Central Civil Services (Commutation of Pension) Rules, 1981.

Note : A member of family who has been authorised under Rule 57(3) to submit this Form on behalf of the retiring/retired
Government servant shall not be eligible to apply for commutation of a percentage of pension.

6. Indicate whether family pension is also admissible from any other source- (Tick whichever is applicable)
Military
 State Govt.
Public sector undertaking/ autonomous body/ local fund under the Central or State Govt.

7. Whether any departmental or judicial proceedings pending against the Government servant? If so, the details thereof. ........

8. Whether any member of the family (other than spouse) is proposed to be co-authorised for family pension?
(If yes, please attach Form 8.) ......Yes/No

9. Whether the Government servant wants to receive Pension Payment Order (PPO) in Office through Head of Office? ..... Yes/No

Declarations:
*(1) I am satisfied with the length of qualifying service to be reckoned for pension and gratuity, as intimated by the Head of Office
under Rule 57(1)(c)
OR
I am not satisfied with the length of qualifying service to be reckoned for pension and gratuity, as intimated by the Head of Office
under Rule 57(1)(c) and I have submitted a representation in this respect separately.
OR

I have not been intimated about the length of qualifying service to be reckoned for pension and gratuity.

*Tick the statement which is applicable.

*(2) I am satisfied with the emoluments and average emoluments to be reckoned for pension and gratuity, as intimated by the
Head of Office under Rule 57(1)(c).
OR
I am not satisfied with the emoluments and average emoluments to be reckoned for pension and gratuity, as intimated by the Head
of Office under Rule 57(1)(c) and I have submitted a representation in this respect separately.
OR

I have not been intimated about the emoluments and average emoluments to be reckoned for pension and gratuity.

*Tick the statement which is applicable.

(3) I am aware that future good conduct of the pensioner/family pensioner shall be an implied condition for every grant of
pension/family pension and its continuance.

Enclosures: As per list attached

Place:

Date: ( Signature of Government servant/Family member (with name) authorised to

submit this Form)

Note 1: Commutation of pension is optional. Item 5 may be struck off if the retiring Government servant does not desire to
commute a percentage of pension.
Note 2: A separate application for commutation of superannuation pension in Form 1-A of Central Civil Services (Commutation
of Pension) Rules, 1981 is required to be submitted in case the retiring/retired Government servant desires to apply for commutation of
pension after submission of this form.
Note 3: Commutation of pension after one year or for commutation of pension in case of compulsory retirement
pension/invalid pension/compassionate allowance will be applied in Form-2 of Central Civil Services (Commutation of Pension) Rules,
1981.

*Providing Aadhaar No. is voluntary. However, if it is provided, consent to link it to bank account and also for authentication of identity
from UIDAI for pension related purpose only, is presumed.

List of Documents to be attached with Form 6

1. Two specimen signatures (to be furnished in a separate sheet). If the claimant cannot sign his/her name then he/she is
required to put the impression of his/her left/right thumb on the document in lieu of specimen signature.
2. Form 8, if a family member is proposed to be co-authorised for family pension. In accordance with Rule 63(1), the following
members of family are eligible for co-authorisation for family pension along with spouse, if there is no other member of family
eligible for family pension before them:

• Disabled child/ children (Disability certificate to be attached for co-authorisation.)

• Dependent parents.

• Disabled siblings. (Disability certificate to be attached for co-authorisation.)

3. Three copies of Joint photograph with spouse or, if it is not possible to submit joint photograph with spouse, separate
photographs of self and spouse, along with three copies of photograph of the member or members of the family whose
names are to be included in the Pension Payment Order as a co-authorised family pensioner. (Photographs to be attested by
Head of Office).
4. Form 4 – Details of Family.
5. Undertaking in Format 9 for refunding any excess payment made by the pension disbursing bank.
6. Nomination for Gratuity, Central Government Employees' Group Insurance Scheme and General Provident Fund in Common
Nomination Form –Form 3.
7. Nomination for arrears of pension and commuted value of pension (if applied for commutation of pension) in common
nomination form - Form A.
8. Undertaking in Format 1 ( applicable for those who served in Security-related or Intelligence Organizations referred to in rule
7 of the Central Civil Services (Pension) Rules, 2021).
9. Form for submitting details under Anubhav (optional).
10. Form of option for availing Medical facilities of Central Government Health Scheme or Fixed Medical Allowance after
retirement
11. Photocopy of the first page of Pass Book of the Bank Account in which the pension is to be credited or any other bank
document showing the name and account details of Account Holder
12. Copy of PAN Card