Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697803432003.pdf (India)
FORM NO.5 [See rule 59 (1) (c) and 61 (1)] Particulars to be obtained by the Head of Office from the retiring Govt.

servant eight months before the date of his retirement.

1.

Name 2.
Date of retirement 3.

Three specimen signatures duly attested (to be furnished in a separate sheet) duly attested by a Gazetted Govt.

servant (Annexure No.1) 4.
Three copies of passport size joint photograph with wife or husband (to be attested by the Head of Office) .. 5.

Three slips showing the particulars of height and personal identification marks duly attested by a Gazetted Govt.

servant (Annexure No.

II) 6.
II) 6.

Present address .

7.

Address after retirement (any subsequent change of address should be notified to the Head Office) .

8.
8.

Name of the Treasury or the Branch of Public Sector Bank or the pay and accounts office through which the pension is to be drawn.

 9.
Details of the Family in Form No.3 Signature Of the Pension Sanctioning authority Place..

Dated, the