Forms

APPLICATION FOR PREMATURE RETIREMENT / RESIGNATION (NOTE : Strike out portions not applicable, state `Yes’, `No’, `Nil’ or `NA’ where required and do not use dot or dashes) SECTION-I PARTICULARS OF THE OFFICER 1.

Personal No.

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CDA (O) Account No.

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Rank (a) Substantive (b) Acting

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Name as per Army List

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Date of

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Arms / Services

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Decoration

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Qualification

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Present unit / formation with date of : assumption of duty and whether under orders of posting

10.

Previous units / formations and duration : of posting

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Service in ranks, if any (Give details of : service as JCO/OR separately)

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Former civil service reckonable for pension (mention separately class I/II/III appt held with periods)

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Courses attended in India indicating : dates & service liability where applicable

14.

Courses attended abroad with dates and service liability

(a) Birth : (b) Commission : (c) Seniority : (d) Relegation in seniority if any

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Details of service on deputation in India

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Details of service on deputation abroad : and service liability, if any

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Details of study leave, availed with dates and service liability if any

18.

Present medical category (if in temp/ : perm low medical category, authentic copy of the latest medical board proceedings duly approved by higher medical authorities should be attached)

19.

Details of statutory / non statutory complaints pending

20.

Details of disciplinary judicial or quasi : judicial proceedings if any pending (Application for premature retirement / resignation in such cases can be considered only after such proceedings are finalized.

21.

Details of previous applications (s) for premature retirement / resignation

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22.

Whether belongs to Adm Cadre or Spl Cadre, If specialist, Name of speciality

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Home state of the officer

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Posting profile of the officer since commissioning indicating locations

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Whether the officer is an AFMC graduate: or done PG from the Dept channel and period thereof.

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SECTION –III (To be filled by officers seeking premature retirement only) (Delete certificate not applicable) 1. MR No. _____________ Rank _________ Name ____________________ (a) I have read Integrated HQ of MoD (Army/Navy/Air) letter No. _____________________________ dated ______________ and understand the implications and obligations / entitlement of proceeding on premature retirement. (b) I have submitted this application after consideration of all the factors involved and will not here-in-after withdraw my request. (c) I have not attended any course involving obligatory period of service during the last five years. Or I have attended __________ Course from ___________ to ___________ and the obligatory period will expire on ______________. (d) In the event of my request being accepted, I will refund the proportionate cost of training for the un-served period to the Govt. I will credit the said amount into the treasury payable to the concerned CDA (Army/Navy/AF) in one lump sum, before I am relieved of my duties / the said amount may be adjusted against my entitlement or gratuity as confirmed by concerned CDA (Army/Navy/AF) vide their letter No. _______________________________________ dt _________. (e)

I have not availed study leave during the last three years, Or

I have availed study leave for _________ years/months from _____________ to ___________ and the obligatory period will expire on _______________. In the event of my request being accepted, I will refund the total cost of study leave expenditure including pay and allowance etc for the period of study leave to the Govt in one lump sum before I am relieved of my duties, I also understand that in such an event, the total period of study leave will not count towards pensionable service. (f) My conduct is not presently under investigation by any authority, no inquiry is either pending or envisaged against me. I am not personally involved in a disciplinary case / administrative action or any other penal action including penal recoveries due from me. (g) I am aware of the provisions of para 22 of pension regulations for the Army 1961 (Part-I). I am prepared to accept Death-cum-Retirement gratuity / service gratuity as applicable at the rates to be decided by the President of India.

-4(h) I have/ have not drawn any advance for purchase of motor conveyance/house or for house building. (j) If the amount outstanding to the Govt. on account of advance for house building / outright purchase of house / purchase of motor conveyance / proportionate cost of training of course is in excess of the gratuity admissible to me, I hereby undertake to refund to the Govt from my own resources the amount in excess of entitlement of gratuity before I am relieved of my duties. Or No amount is outstanding from me to the Govt. on account of advance for house building / purchase of motor conveyance etc. Or I owe to the Govt. the following amount which I undertake to credit into the treasury before I am relieved of my duties / may be adjusted against my entitlement of gratuity as confirmed by the concerned CDA (Army/Navy/AF) vide their letter No. _______________________________ dt ___________ (copy enclosed) Sr. Particulars Advance No. i) Advance for house building / out-right purchase of house ii) Advance for purchase of motor conveyance iii) Any other advance iv) Proportionate cost of training

Interest

Total

Total (k) I have not preferred any statutory / non statutory / legal proceedings prior to the date of application. Should I prefer any such complaint / proceedings before my request for premature retirement / resignation is finalized. I will inform Army /Navy / Air HQ immediately. In such an eventuality I understand that my request for premature retirement / resignation is liable to be closed or pended till my complaint / proceedings are finalized.

--------------------------------------Signature of the officer Station Date

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-5SECTION-IV (To be filled in by the officer seeking permission to resign their commission only ) (Delete portion not applicable) 1.

Personal No. ____________ Rank __________ Name _______________ (a) I have read Army HQ /Naval HQ/Air HQ letter No. ____________ _____________________________ dated ______________ and understand the implications of and obligations / entitlement on seeking permission to resign my commission. (b) I have submitted this application after consideration of all the factors involved and will not here-in-after withdraw my request. (c) I have not attended any course involving obligatory period of service during the last five years. Or I have attended __________ Course from ___________ to ___________ and the obligatory period will expire on ______________. (d) In the event of my request being accepted, I will refund the proportionate cost of training for the un-served period to the Govt. I will credit the said amount into the treasury payable to the concerned CDA (Army/Navy/AF) in one lump sum, before I am relieved of my duties. (e)

I have not availed study leave during the last three years, Or

(f) My conduct is not presently under investigation by any authority, no inquiry is either pending or envisaged against me. (g) I have/ have not drawn any advance for purchase of motor conveyance/house or for house building. Or No amount is outstanding from me to the Govt. on account of advance for house building / purchase of motor conveyance etc. Or

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I owe to the Govt. that any loan from AGI / the following amount which I undertake to credit into the treasury before I am relieved of my duties / may be adjusted against my entitlement of gratuity as confirmed by the concerned CDA (Army/Navy/AF) vide their letter No. _______________________________ dt ___________ (copy enclosed) Sr. Particulars Advance No. i) Advance for house building / out-right purchase of house from AGI etc. ii) Advance for purchase of motor conveyance iii) Any other advance iv) Proportionate cost of training

Interest

Total

--------------------------------------Signature of the officer Station

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Date

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-7SECTION-V CERTIFICATE FOR REGULAR RESERVE OF OFFICER CLASS (X) LIABILITY TO BE FILLED BY OFFICERS UPTO THE RANK OF LT COL WHO APPLY FOR PREMATURE RETIREMENT (A) I understand that I will be in Regular Reserve of officers Class (X) upto a period of five years from the date of SOS or upto the age of superannuation in my present rank whichever is earlier. (B) If I so desire during the period of Reserve Liability to visit a foreign country or acquire foreign citizenship, I will obtain prior permission of the Govt. as required vide para 32 of SAO 10/S/63 as amended. (C) I will report on duty to the earmarked HQ / Establishment on mobilization within 72 hours after receiving order on TV / Radio / by letter, whichever is earlier. (D)

My permanent residential address is as under :i) ii) iii) iv) v)

House No. Road/Street/Locality Post office with Pin Code District State

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(E) I will inform DGMS (Army)/Navy/Air of any change in my permanent residential address as given above immediately on occurrence alongwith appropriate amendment to Para (D) upto liability period. (F) The following five Military HQ / Establishments are located nearest to my home at approximate distance shown against each :HQ/Establishment Distance (in Km.) i) ii) iii) iv) v) (Give names of HQ/establishment such as Headquarters/Corps/Area/ Div/Sub Area/ Bde, Category `A’ Establishment Training Centres, Embarkation HQ / NSC Group HQ, NCC, Industrial Security unit, Ordance Depots, Army/Static Workshop) -----------------------------------Signature of the officer Station Date

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COUNTERSIGNED (By immediate superior officer / officiating incumbent with rank Name and designation)

-8SECTION –VI RECOMMENDATIONS OF THE COMMANDING COMMANDANT / OFFICIATING INCUMBENT COMMENTS

OFFICER / ALONGWITH

Station : Date : SECTION –VII RECOMMENDATIONS OF MEDICAL AUTHORITY AT FORMATION / STATION LEVEL / OFFICIATING INCUMBENT ALONGWITH COMMENTS

Station : Date : SECTION –VIII RECOMMENDATIONS OF MG (MED) / CMO / PMO / OFFICIATING INCUMBENT ALONGWITH COMMENTS

Station : Date : SECTION –IX RECOMMENDATIONS OF THE HEAD OF THE BRANCH/ DTE/ ORGANIZATION INCLUDING COMMENTS

Station : Date :

-9Appendix `B’

CERTIFICATE 1. It is certified that I have not been allotted a PPO No. by CDA (P) and have not drawn any amount on account of pensionary awards, including pension, DCRG, commuted value of pension etc to date. Or Certified that I have been allotted PPO No. ______________ and have drawn an amount of Rs. ___________ on account of pensionary awards, including pension, DCRG, commuted value of pension etc from CDA (P). 2. In the event of cancellation of premature retirement orders, I undertake to refund the above amount to CDA (P) immediately, through MRO.

Signature MR No. Rank Name Unit

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COUNTERSIGNED BY COMMANDING OFFICER

Signature MR No. Rank Name Unit

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