F O R M. O.A.P.-1

APPLICATION FORM FOR NATIONAL OLD AGE PENSION

District:-                                                                                               Block/Municipality

Village/ Panchayat/ Mohalla/ Ward/ House No.

1. Sri/Smti………………………………………………………………………………………………………………………………………………………………….
2. Name of father or husband………………………………………………………..

…………………………………………………………………………………….

3. Full Address:- Vill…………………………….P.O………………………………

P.S……………………………..District…………………………..

      4.   Categories:- SC/ST/Woman/Landless/Handicapped/General…………………….

            …………………………………………………………………………………….

5. Age on the date of application…………………………………………………….
6. Identification mark of the applicant……………………………………………….
7. I solemnly affirm that……………………………………………………………...

(i)                  I do not have any family income of Rs. 5,000.00/- per annum or more

(ii)                I have/have not applied previously for grant of old age pension under National Old Age Pension.

(iii)               I am a resident of …………………..(District/State) where I have been residing during the three years immediately preceding the date of this application.

(iv)              I declare that the information furnished in this application is true and correct to the best of my knowledge and belief.

      Place……………

      Date…………….                                                 

Signature or Thumb impression  

                                                                                    of the applicant.

(TO BE FILLED UP BY THE ENQUIRY TEAM)

                 Results of Preliminary Enquiry by the Village Panchayat level team.

1. Age………………………………………………………..
2. Income/Designation……………………………………….
3. Category/domicile…………………………………………
4. Whether applying for the first time. If not, the decision on the last application.
5. Recommendation:-

Date………..                                                         Signature of verifying persons

                                                                              at the village level panchayat

                                                                              Municipal Commissioner.

F U L L     A D D R E S S

Note:- This application should be sent with full particulars to the B.D.O./ Panchayat Samity concerned.

RECOMMENDATION OF THE B.D.O. /MUNICIPAL COMMISSIONER.

Dated…………                                                     Signature of B.D.O./ Municipal

                                                                              Commissioner.

F O R M – O.A.P.-II

Urban Local Body/ Gram Panchayatwise list of Application for National Old Age Pension.

1. Sl. No:-
2. Date of receipt from Gram Panchayat:-
3. Name of the applicant with father’s or husband’s name:-
4. Full address:- Town/ Village, Post Office,Taluk
5. Recommendation to the Pension Sanctioning Authority:-
6. Date of sending the application form:-
7. Orders of the Sanctioning Authority:-

F O R M – O.A.P.-III

Urban/Local Bodies/Panchayat Samitiwise Register of sanctioned pensions.

1. Sl. No:-
2. Name and address of the pensioner:-
3. Date of sanction of the pension:-
4. Pension Reference No. alloted to the pension.
5. Date of intimation of the sanction order.
6. Mode of payment:-
7. Remarks:-