Option forms for pention

DB/HO/PN/1079 /2010 September 3, 2010

To,The All the Departmental HeadsRegional ManagersDena Bank

Dear Sir

Re: Extending another Option-Prescribed Option Forms to be filled in by the employees/ex-employees of the Bank

We refer to Head Office Circular No. 179/24/2010-11 dated 30.08.2010 regarding the captioned matter.

In order that the various option forms applicable to each category of employee/ex-employee are easily distinguished the PF/GF & Pension Fund Department, Head Office, Mumbai has suitably given colour to different option forms as under:

a) Annexure-I : ( White Colour) Option Form to be filled in by the employees who are in the service of the bank prior to 29th September , 1995 and continue to be in the service of the bank on the date settlement i.e., 27th April, 2010 including employees who have retired/retiring after 27/04/2010.

b) Annexure-II : ( Yellow Colour) Option Form to be filled in by the employees who were in service of the bank prior to 29th September , 1995 and retired after the date and prior to the date of the settlement dated 27th April, 2010.

c) Annexure III : ( Blue Colour) Option Form to be filled in by the employees who were in service of the bank prior to 29th September, 1995 and retired under VRS 2000 after putting minimum period of 15 years of service.

d) Annexure-IV : ( Pink Colour) Option Form to be filled in by the family of those who were in service of the bank prior to 29th September, 1995 but retired on attaining superannuation/retired under VRS 2000 and subsequently expired, or expired while in service, before the date of Settlement / Joint Note dated 27.04.2010.

e) Annexure-V : ( Green Colour) Option Form to be filled in by the family of those who were in service of the bank prior to 29th September, 1995 but retired subsequently and expired, or expired while in service, after the date of Settlement / Joint Note dated 27.04.2010.

We are sending herewith 20 forms of each Option and request the concerned Departmental Head/ Regional Offices to obtain Photo Copies of the same in the same colour preferably and send to their respective branches/employees/ex-employees / family of employees/ ex-employees in sufficient numbers to enable all the employees/ex-employees/ family of employees/ ex-employees immediately.

Please acknowledge receipt and do the needful in the matter. Yours faithfully

Hon. Secretary & Chief ManagerPF/GF/ & Pension Fund Department

ANNEXURE- I ( WHITE COLOUR) ( EXISTING EMPLOYEES TO SUBMIT FOUR COPIES & RETIREE FIVE COPIES) )

[Option Form to be filled in by the employees who are in the service of the bank prior to 29th September , 1995 and continue to be in the service of the bank on the date settlement i.e., 27th April, 2010 including employees who have retired/retiring after 27/04/2010 ]

(Instruction given for filling in the forms have to be strictly followed)ToThe Asst. General Manager (HRM)Dena Bank,Head Office, MUMBAI- 400 051.

I hereby declare that I have read and understood the terms of Settlement/ Joint Note dated 27.04.2010 for extending another option to join Pension Scheme. I have understood the terms of the Settlement / Joint Note have been arrived at on the basis of the Unions/ Associations offering to contribute 30 % of the initial funding gap assessed for extending another option for joining the pension scheme. I am agreeable to the said contribution of 30 % towards the initial funding gap and hereby voluntarily opt to become a member of the Bank's Pension Scheme as per the provisions of the said Settlement / Joint Note and to cease to be a member of Contributory Provident Fund Scheme and irrevocably authorize the Bank/ Trustees of the Contributory Provident Fund to transfer the entire contribution of the bank along with entire interest accrued thereon to the credit of Pension Fund to be created for this purpose. I also authorize the bank to transfer to the pension fund an amount equal to 2.8 times of my revised pay for the month of November 2007 representing my share in the 30 % contribution mentioned above from the arrears payable to me on account of wage revision in terms of Bipartite Settlement / Joint Note dated 27.04.2010.

I desire to commute 1/3rd or ........................Part of the pension / I do not desire to commute any part of the pension ( Strike out whichever is not applicable ). [TO BE DECLARED ONLY BY THOSE EMPLOYEES RETIRED / RETIRING AFTER 27th April, 2010. ]

1 Name in Full : Shri/Smt./Kumari (Delete whichever is not applicable)

2 P.F No.

3 Designation

4. Branch/Department/Office

[**Write dates in the order day (DD), month (MM) and year (Y

5 Date of Birth

6 Date of Joining the Bank

7 Date of retirement

8 Present residential address Address 1

Address 2

City

Pin Code

9 Details of Bank’s Contribution and Interest.(including any such payment subsequent to retirement settlement. Please enclose photo copies of the documents in support of the above ) ( APPLICABLE IN CASE OF RETIREES AFTER 27/04/2010)

10 Details of 2.8 times of Basic Pay components of revised pay for November,2007 contributed towards Pension Fund Gap( APPLICABLE IN CASE OF /EMPLOYEES AS ON 27/04/2010/RETIREES AFTER 27/04/2010)

…2

::2::STATEMENT OF SALARY DRAWN BY THE RETIREE FOR THE LAST 10 MONTHS PERIOD PRIOR TO

THE DATE OF RETIREMENT (WHEREVER FULL SALARY DRAWN BY THE RETIREE)

YEAR & MONTH

BASIC PAY (PAID)

SPL. PAY F.P.P. P.Q.P. OTHER IF ANY( viz. Officiating Allowance, etc)

TOTAL

1

2

3

4

5

6

7

8

9

10

TOTAL

F.P.P. & P.Q.P. - FURNISH INCREMENT COMPONENENT ONLY (i.e. Without D.A.)TOTAL NO. OF DAYS ON LOSS OF PAY DURING THE ENTIRE SERVICE OF THE RETIRED EMPLOYEESUSPENDED & PUNISHMENT AWARDED DURING THE ENTIRE SERVICE OF THE RETD. EMPLOYEE Date:

Place : SIGNATURE OF THE APPLICANT Note : 1) Additions/alterations in the text of the above form will render the option invalid. 2) Blanks in the form have to be preferably typed, ensuring that all copies are legible.

Alternatively the blanks may filled in by hand in Block letters without the use of carbon paper.

3) Signature or Thumb Impression should be duly attested by the Branch Manager 4) Pension Application & Commutation application will be required to be filled in

subsequently by all Pension Optees. ----------------------------------------------------------------------------------------------------------------------------

FOR BRANCH/ OFFICE USE ONLYCertified that we have recovered 2.8 times of basic pay components of revised pay for November,2007 Rs. (Rupees ..........................................................................................................only) from Mr./ Ms.........................................................................(PF No..................................) and date of credit to Suspense Receipt Account - Contribution towards Pension GapThe above particulars declared by the applicant are required to be checked by going through the employees personal file/service records available at the Branch level.) Signature

Name in Full

Designation

Branch / Office

PA No.

( To be attested by the Branch Manager/Departmental Head (holding Power of Attorney number with official seal after Verification of information furnished in the option form)

ANNEXURE- II ( YELLOW COLOUR)( RETIREE TO SUBMIT FIVE COPIES) )

[Option Form to be filled in by the employees who were in service of the bank prior to 29th September , 1995 and retired after the date and prior to the date of the settlement dated 27th April, 2010]

(Instruction given for filling in the forms have to be strictly followed)The Asst. General Manager (HRM)Dena Bank,Head Office, MUMBAI- 400 051.

I hereby declare that I have read and understood the terms of Settlement/ Joint Note dated 27.04.2010 for extending another option to join Pension Scheme. I have understood that the terms of the Settlement / Joint Note have been arrived at on the basis of the Unions/ Associations offering to contribute 30 % of the initial funding gap assessed for extending another option for joining the pension scheme. I am agreeable to the said contribution of 30 % towards the funding gap and hereby voluntarily opt for Bank's Pension Scheme as per the provisions of the said Settlement / Joint Note . I undertake to refund the Bank's contribution to Provident Fund together with accrued interest thereon paid to me on my retirement plus an amount equal to 56 % of the bank's contribution to Provident Fund with interest received at the time of retirement being 30% contribution towards the initial funding gap in terms of Joint Note dated. 27.04.2010 and the Settlement dated 27.04.2010.

I desire to commute 1/3 rd or ........................Part of the pension / I do not desire to commute any part of the pension ( Strike out whichever is not applicable ). [ TO BE DECLARED ONLY BY THOSE EMPLOYEES WHO WERE IN SERVICE OF THE BANK PRIOR TO 29th SEPTEMBER, 1995 AND RETIRED AFTER THE DATE AND PRIOR TO THE DATE OF THE SETTLEMENT DATED 27th April, 2010. ]Note : No medical examination shall be necessary if the application for commutation is made within one year from the date of retirement in terms regulation 41(7) of Dena Bank (Employees’) Pension Regulations, 1995. However, if such a pensioner/employee applies for commutation after one year from the date of his retirement the same will be subject to medical examination. If the pensioner/employee is declared fit by medical officer approved by the Bank or any medical officer of the rank of Civil Surgeon or Chief District Medical Officer then he/she will be entitled to commute on the date of medical certificate given by the concerned Medical Officer.


2 P.F No.

3 Designation

4. Last Branch/Department/Office where retired

5 Submitted Option Forms to Nearest Office

[**Write dates in the order day (DD), month (MM) and year (YY)

6 Date of Birth




Address 2

City

Pin Code

10 Details of Bank’s Contribution and Interest.(including any such payment subsequent to retirement settlement. Please enclose photo copies of the documents in support of the above )

…2

::2::STATEMENT OF SALARY DRAWN BY THE RETIREE FOR THE LAST 10 MONTHS PERIOD PRIOR TO THE DATE OF RETIREMENT

(WHEREVER FULL SALARY DRAWN BY THE RETIREE

YEAR & MONTH

BASIC PAY (PAID)


TOTAL

1

2

3

4

5

6

7

8

9

10

TOTAL

F.P.P. & P.Q.P. - FURNISH INCREMENT COMPONENENT ONLY (i.e. Without D.A.)

TOTAL NO. OF DAYS ON LOSS OF PAY DURING THE ENTIRE SERVICE OF THE RETIRED EMPLOYEESUSPENDED & PUNISHMENT AWARDED DURING THE ENTIRE SERVICE OF THE RETD. EMPLOYEE Date :Place : SIGNATURE OF THE APPLICANT Note : 1) Additions/alterations in the text of the above form will render the option invalid. 2) Blanks in the form have to be preferably typed, ensuring that all copies are legible.




FOR BRANCH/ OFFICE USE ONLYCertified that the details of Bank’s contribution and interest on Bank’s contribution and the salary particulars declared by the above mentioned applicant who retired on or after 29/09/1995 and prior to 27/04/2010 have been verified and found to be correct.(The above particulars declared by the applicant are required to be checked by going through the employees personal file/service records available at the Branch level.)

Signature :

Name in Full :

Designation :

Branch / Office :

PA No. :


ANNEXURE- III( BLUE COLOUR)( RETIREE TO SUBMIT FIVE COPIES)

[Option Form to be filled in by the employees who were in service of the bank prior to 29th September, 1995 and retired under VRS 2000 after putting minimum period of 15 years of service.]

(Instruction given for filling in the forms have to be strictly followed)The Asst. General Manager (HRM)Dena Bank,Head Office, MUMBAI- 400 051.

I hereby declare that I have read and understood the terms of Settlement/ Joint Note dated 27.04.2010 for extending another option to join Pension Scheme. I have understood that the terms of the Settlement / Joint Note have been arrived at on the basis of the Unions/ Associations offering to contribute 30 % of the initial funding gap assessed for extending another option for joining the pension scheme. I am agreeable to the said contribution of 30 % towards the funding gap and hereby voluntarily opt for Bank's Pension Scheme as per the provisions of the said Settlement / Joint Note . I undertake to refund the Bank's contribution to Provident Fund together with accrued interest thereon paid to me on plus an amount equal to 56 % of the Bank's contribution to Provident Fund with interest received at the time of death/retirement being 30% contribution towards the initial funding gap in terms of Joint Note dated 27.04.2010 and the Settlement dated 27.04.2010.

I desire to commute 1/3 rd or ........................Part of the pension / I do not desire to commute any part of the pension ( Strike out whichever is not applicable ). [ TO BE DECLARED ONLY BY THOSE EMPLOYEES WHO WERE IN SERVICE OF THE BANK PRIOR TO 29th SEPTEMBER, 1995 AND RETIRED UNDER VRS 2000 AFTER PUTTING MINIMUM PERIOD OF 15 YEARS OF SERVICE. ]

Note : No medical examination shall be necessary if the application for commutation is made within one year from the date of retirement in terms regulation 41(7) of Dena Bank (Employees’) Pension Regulations, 1995. However, if such a pensioner/employee applies for commutation after one year from the date of his retirement the same will be subject to medical examination. If the pensioner/employee is declared fit by medical officer approved by the Bank or any medical officer of the rank of Civil Surgeon or Chief District Medical Officer then he/she will be entitled to commute on the date of medical certificate given by the concerned Medical Officer.


2 P.F No.

3 Designation

4. Last Branch/Department/Office where retired

5 Submitted Option Forms to Nearest Office


6 Date of Birth




Address 2

City

Pin Code

….2

::2::10 Details of Bank’s Contribution and Interest.

(including any such payment subsequent to retirement settlement. Please enclose photo copies of the documents in support of the above )

STATEMENT OF SALARY DRAWN BY THE RETIREE FOR THE LAST 10 MONTHS PERIOD PRIOR TO THE DATE OF RETIREMENT

(WHEREVER FULL SALARY DRAWN BY THE RETIREE

YEAR & MONTH

BASIC PAY (PAID)


TOTAL

1

2

3

4

5

6

7

8

9

10

TOTAL

F.P.P. & P.Q.P. - FURNISH INCREMENT COMPONENENT ONLY (i.e. Without D.A.)TOTAL NO. OF DAYS ON LOSS OF PAY DURING THE ENTIRE SERVICE OF THE RETIRED EMPLOYEESUSPENDED & PUNISHMENT AWARDED DURING THE ENTIRE SERVICE OF THE RETD. EMPLOYEE Date : Place : SIGNATURE OF THE APPLICANT Note : 1) Additions/alterations in the text of the above form will render the option invalid. 2) Blanks in the form have to be preferably typed, ensuring that all copies are legible. Alternatively

the blanks may filled in by hand in Block letters without the use of carbon paper.3) Signature or Thumb Impression should be duly attested by the Branch Manager 4) Pension Application & Commutation application will be required to be filled in subsequently by

all Pension Optees.……………………………………………………………………………………………………………------

FOR BRANCH/ OFFICE USE ONLYCertified that the details of Bank’s contribution and interest on Bank’s contribution and the salary particulars declared by the applicant who retired under VRS 2000 under Special Scheme after putting minimum period of 15 years of service have been verified and found to be correct.(The above particulars declared by the applicant are required to be checked by going through the employees personal file/service records available at the Branch level.) Signature

Name in Full

Designation

Branch / Office

PA No. :


ANNEXURE- IV( PINK COLOUR) ( FAMILY MEMBERS OF RETIREE TO SUBMIT FIVE COPIES)

[Option Form to be filled in by the family of those who were in service of the bank prior to 29th September, 1995 but retired on attaining superannuation/retired under VRS 2000 and subsequently expired, or expired while in service, before the date of Settlement / Joint Note dated 27.04.2010.]

(Instruction given for filling in the forms have to be strictly followed)The Asst. General Manager (HRM)Dena Bank,Head Office, MUMBAI- 400 051.Shri/Smt. ( Full Name) was an employee of Dena Bank last working at Branch/Office. I , the spouse/son/unmarried daughter/legally divorced daughter/guardian of the minor son/daughter of the above named deceased employee, hereby declare that have read and understood the terms of settlement/Joint Note dated 27.04.2010 for extending another option to join the Pension Scheme. I have understood that the terms of the Settlement/Joint Note have been arrived at on the basis of the Union/ Association offering to contribute 30% of the initial funding gap assessed for extending another option for joining the pension scheme. I am agreeable to the said contribution of 30% towards the funding gap and hereby voluntarily opt to become a member of the Dena Bank Employees’ Pension Scheme as per the provisions of the said Settlement/Joint Note . I undertake to refund the Bank’s contribution to Provident Fund together with interest thereon paid to Shri/Smt on his/her retirement /death while in service plus an amount equal to 56% of the Bank’s Contribution to Provident Fund with interest received at the time of retirement being 30% contribution towards the initial funding gap in terms of Joint Note dated 27.04.2010 of the settlement dated 27.04.2010 to the Dena Bank Employees’ Pension Fund.Note : Family so exercising the option would not be eligible to any benefit commutation and shall be entitled to the benefit of Family Pension only.

1 Name of the deceased employee in Full : Shri/Smt./Kumari (Delete whichever is not applicable)

Late

2 Name of the Widow/Widower,Guardian/Son/Unmarried Daughter/Legally Divorced Daughter

3 Relationship with the deceased employee

4 P.F No.

5 Last Designation

6 Last Branch/Department/Office

7 Submitted Option Form to Nearest Office


8 Date of Birth



11 Date of Death


Address 2

City

Pin


…2

::2::STATEMENT OF SALARY DRAWN BY THE RETIREE FOR THE LAST 10 MONTHS PERIOD PRIOR TO

THE DATE OF RETIREMENT (WHEREVER FULL SALARY DRAWN BY THE RETIREE

YEAR & MONTH

BASIC PAY (PAID)


TOTAL

1

2

3

4

5

6

7

8

9

10

TOTAL

F.P.P. & P.Q.P. - FURNISH INCREMENT COMPONENENT ONLY (i.e. Without D.A.)TOTAL NO. OF DAYS ON LOSS OF PAY DURING THE ENTIRE SERVICE OF THE RETIRED EMPLOYEESUSPENDED & PUNISHMENT AWARDED DURING THE ENTIRE SERVICE OF THE RETD. EMPLOYEE Date : Place : SIGNATURE/ OF THE APPLICANT Note : 1) Additions/alterations in the text of the above form will render the option invalid. 2) Blanks in the form have to be preferably typed, ensuring that all copies are legible.


3) Signature or Thumb Impression of Widow/Widower/Guardian/Son/Unmarried daughter/legally divorced daughter should be duly attested by the Branch Manager

4) Pension Application & Commutation application will be required to be filled in subsequently by all Pension Optees.

---------------------------------------------------------------------------------------------------------------------------FOR BRANCH/ OFFICE USE ONLY

Certified that the details of Bank’s contribution and interest on Bank’s contribution and the salary particulars declared by the applicant’s who was in service of the bank prior to 29th September, 1995 but retired subsequently and expired, or expired while in service, before the date of Settlement / Joint Note dated 27.04.2010 have been verified and found to be correct.(The above particulars declared by the applicant are required to be checked by going through the employees personal file/service records available at the Branch level.)

Signature

Name in Full

Designation

Branch / Office

PA No.

............................................Note : Additions/alterations in the text of the above form will render the option invalid.( To be attested by the Branch Manager/Departmental Head (holding Power of Attorney number with official seal after Verification of information furnished in the option form)

ANNEXURE- V(GREEN COLOUR)( FAMILY MEMBERS OF RETIREE TO SUBMIT FIVE COPIES)

[Option Form to be filled in by the family of those who were in service of the bank prior to 29th September, 1995 but retired subsequently and expired, or expired while in service, after the date of Settlement / Joint Note dated 27.04.2010.]

(Instruction given for filling in the forms have to be strictly followed)The Asst. General Manager (HRM)Dena Bank,Head Office, MUMBAI- 400 051.Shri/Smt. ( Full Name) was an employee of Dena Bank last working at Branch/Office. I , the spouse/son/unmarried daughter/legally divorced daughter/guardian of the minor son/daughter of the above named deceased employee, hereby declare that have read and understood the terms of settlement/Joint Note dated 27.04.2010 for extending another option to join the Pension Scheme. I have understood that the terms of the Settlement/Joint Note have been arrived at on the basis of the Union/ Association offering to contribute 30% of the initial funding gap assessed for extending another option for joining the pension scheme. I am agreeable to the said contribution of 30% towards the funding gap and hereby voluntarily opt to become a member of the Dena Bank Employees’ Pension Scheme as per the provisions of the said Settlement/Joint Note and cease to be a member of Contributory Provident Fund Scheme. I undertake to refund the Bank’s contribution to Provident Fund together with interest thereon paid to Shri/Smt on his/her retirement / death while in service plus an amount equal to 2.8 times of revised pay for the month of November,2007 representing 30% contribution mentioned above from the arrears paid on account of Wage Revision in terms of Bipartite Settlement/Joint Note dated 27.04.2010 to the Dena Bank Employees’ Pension Fund.Note : Family so exercising the option would not be eligible to any benefit of commutation and shall be entitled to the benefit of Family Pension only.

1 Name of the deceased employee in Full : Shri/Smt./Kumari (Delete whichever is not applicable)

Late

2 Name of the Widow/Widower,Guardian/Son/Unmarried Daughter/Legally Divorced Daughter

3 Relationship with the deceased employee

4 P.F No.

5 Last Designation

6 Last Branch/Department/Office

7 Submitted Option Form to Nearest Office


8 Date of Birth



11 Date of Death


Address 2

City

Pin


…2

::2::STATEMENT OF SALARY DRAWN BY THE RETIREE FOR THE LAST 10 MONTHS PERIOD

PRIOR TO THE DATE OF RETIREMENT (WHEREVER FULL SALARY DRAWN BY THE RETIREE

YEAR & MONTH

BASIC PAY (PAID)


TOTAL

1

2

3

4

5

6

7

8

9

10

TOTAL

F.P.P. & P.Q.P. - FURNISH INCREMENT COMPONMENT ONLY (i.e. Without D.A.)TOTAL NO. OF DAYS ON LOSS OF PAY DURING THE ENTIRE SERVICE OF THE RETIRED EMPLOYEE

SUSPENDED & PUNISHMENT AWARDED DURING THE ENTIRE SERVICE OF THE RETD. EMPLOYEE

Date : Place : SIGNATURE OF THE APPLICANT Note : 1) Additions/alterations in the text of the above form will render the option invalid. 2) Blanks in the form have to be preferably typed, ensuring that all copies are legible.




FOR BRANCH/ OFFICE USE ONLYCertified that we have recovered 2.8 times of basic pay components of revised pay for November,2007 Rs. (Rupees ..........................................................................................................only) from Mr./ Ms.........................................................................(PF No..................................) and date of credit to Suspense Receipt Account - Contribution towards Pension Gap(The above particulars declared by the applicant are required to be checked by going through the employees personal file/service records available at the Branch level.) Signature

Name in Full

Designation

Branch / Office

PA No.


Option forms for pention

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