Checklist of documents to be submitted to CPPC

For conversion of Family Pension (spouse) after death of Regular Pensioner

To,
The Chief Manager
Central Pension Processing Centre (CPPC)
Bank of Baroda, Baroda Global Shared Services,
RLBO, 21st Floor, Gift One Tower,
Gift City, Gandhinagar, Gujarat -382355

Sub: Conversion of Family Pension after demise of Regular Pensioner

We are enclosing the list of documents scanned with 200dpi and uploaded through BDMS portal in single pdf as
per the below given checklist advised by CPPC. These documents are readable and are clearly visible.
(Branch to mark “Yes” or “N/A” as applicable)
Documents to be submitted by Pensioner
Form No. 14
1) (Not applicable if the Family Pensioner is Joint Account holder with Regular Pensioner)

Request letter from family pensioner to start the family pension with Account No.
2) (Duly verified by Branch Officer with stamp, Branch Officer’s signature & EC No) (Format Enclosed)

Death certificate of the original / Regular/ Service pensioner from competent authority
3) (Duly verified by Branch Officer with stamp, Branch Officer’s signature & EC No)

Letter of undertaking. All the options given in Undertaking should be mandatorily filled without fail
4) (Format enclosed for reference)
(Duly verified by Branch Officer with stamp, Branch Officer’s signature & EC No)

Documents to be submitted by Branch and not to be collected from Pensioner

A copy of PPO/Revision Authority issued to Bank (Disburser Portion of PPO) along
with other documents/letters received from Railway (if any)
Full name of the family Pensioner must mandatorily be mentioned in the PPO/PPOs. PPO issued to Bank
5) related to Railway Pensioner is signed by FA & CAO along-with embossed seal. (Do not send the
Pensioner portion of PPO, as the same is not countersigned by Railway Authority and
cannot be acted upon)
(Duly verified with original PPO by Branch Officer with stamp, Branch Officer’s signature & EC No)

Branch should not open separate Bank account in case Regular Pensioner’s account was already
opened as “Joint Account” with Spouse as per Circular issued by DOPPW vide No. 12/4/2020-
6) P&PW(C)-6300 dated 15th May 2020.
(i.e., Required clear scanned copy of passbook or account statement)

A copy of KYC of Family Pensioner (we recommend only Aadhar Card copy since the option for Digital
7) Life certificate will only be available when Aadhar is updated in PPS for Family Pensioner).
(Duly verified with original PPO by Branch Officer with stamp, Branch Officer’s signature & EC No)

Non-Conviction Certificate from nearest Police Station

8) (only in case if family pensioner is not approached within 01 year of death of regular pensioner)
(Duly verified by Branch Officer with stamp, Branch Officer’s signature & EC No)

Important Points to Note:

 Thumb impression must contain RTI/LTI mandatorily (Duly verified by Branch Officer with stamp, Branch
Officer’s signature & EC No)
 Documents should be send to CPPC through BDMS application. Kindly DO NOT send the documents through
different modes, as it duplicates the process for CPPC.

Date:
Branch Officer / Branch Head Name: Branch Officer/Branch Head
Branch Officer / Branch Head EC No.:
Signature & Stamp
 APPLICATION TO BE SUBMITTED BY FAMILY PENSIONER

Dated: …………………...

Name of family Pensioner……………………………………….

…………………………………………………………………….

Address……………………………………………………………

.……….……………………………………………………………

To,
Branch Manager
Bank of Baroda

Branch-……………………………..

……………………………………….

……………………………………….

Dear Sir/Madam,

SUBJECT: Grant Of Family Pension On demise of Regular Pensioner Mr/Mrs…………………………………………

I regret to inform you that my husband/ Wife Mr/Mrs…………………………………….. maintaining Account Number

……………………………………………………, PPO Number ………………………………………………….has expired dated ...……………………

He/she was drawing his pension through your Branch………………………………………..

Kindly, stop the payment of his/her pension and Start payment of family pension in Account no. ……………………………………..,

maintained in the name of ……………………………………………………………………

Copy of death certificate is attached for your ready reference.

Yours faithfully,

Name of Family Pensioner……………………………………………………

Signature of Family Pensioner……………………………………………….

 FORM 14
[See rules 77 (3) and 81 (2)]
Form
Form of application
of application for family
for family pension
pension on death
on death of a Government
of a Government servantservant/pensioner/family
or pensioner or on death pensioner
or ineligibility
of a family pensioner
1 (i) Name of the Government servant in respect of
. whom family pension is being claimed
(ii) Office/Department/Ministry served last
(iii) Date of retirement of Government servant
(iv) Date of death of Government servant/pensioner/
family
date of pensioner
death or ineligibility of family pensioner
(v) PPO No. of Government servant/pensioner/
family pensioner
2 Name and other details of claimant—
Name Date of Relationship with Postal Address
birth the deceased
Government servant

3. In case the claimant is minor or suffering from disorder or disability of mind, including mental
retardation, details of guardian/nominee, wherever applicable—
Name Date of Relationship with Relationship Postal Address
birth the minor/ with
mentally disabled the deceased
claimant Government
servant

4. Details of surviving widow/widower, children, dependent parents and disabled siblings of the
deceased Government servant / pensioner are enclosed in Form 3.

5. Account No., name and BSR code of Branch of Bank to which family pension is to be credited:

6. Other source of family pension - Military or State Government and/or a Public Sector Undertaking/
Autonomous body/Local Fund under the Central or a State Government, if any—

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

Encl: As per the check-list.

Signature or left hand thumb impression of the claimant/guardian
Mobile/Telephone No……………………
Permanent Account Number for Income Tax (PAN)……………………..
Aadhar No., if available - ………………………………
Signatures of two Witnesses with names and full addresses:

(i)

(ii)
Note: Form 14 is not to be filled if the spouse had a joint account with the deceased pensioner. In such
cases, family pension shall be allowed by the Pension Disbursing Authority on the basis of an
application on plain paper. The permanently disabled children/siblings and dependent parents to
whom family pension has been authorised in the PPO of the pensioner will submit this Form to the
Pension Disbursing Authority.