Form 10 – Assessment and Authorisation of Payment of Death Gratuity: CCS (Payment of Gratuity under NPS) Rules, 2021
FORM 10
Assessment and Authorisation of Payment of Death Gratuity when a Government Servant dies while in Service
[See rules 49, 51 and 53 ]
Part I
Section I
1. Details of deceased:
| (a) Name | |||||||||||||||||||
| (b) Mother’s /Father’s name | (c) Date of birth | D | D | M | M | Y | Y | Y | Y | ||||||||||
| (d) Date of death | D | D | M | M | Y | Y | Y | Y | (e) Religion | ||||||||||
2. Post held at the time of death:
| (a) Name of the office | ||||||||||
| (b) Post held substantively | (c) Officiating post | |||||||||
| (d) Level of pay in the pay matrix | (e) Basic Pay | |||||||||
| (f) In case the last post was held outside the Government on foreign service terms- | ||||||||||
| (i) Level of pay of the post held in the parent department | (ii) Basic pay | |||||||||
| 3. Date of beginning of service | D D – M M – YYYY | . Date of ending of service | D D – M M – YYYY | |||||||
5. Service in Autonomous Body/State Government, if any particulars of service:
| (a) Name of organisation | (b) Post held | (c) Period of service | ||||||
| From | To | Total period | ||||||
| (d) Whether the above service is to be counted for gratuity in the Government | o Yes o No | |||||||
| (e) Whether the Autonomous Organisation has discharged its gratuity liability to the Central Government | o Yes o No | |||||||
| (f) Amount of any gratuity received for the previous civil service, if any | (g) Nature of any pension received for the previous civil service, if any | |||||||
6. Service qualifying for death gratuity:
| (a) Details of omission, imperfection or deficiencies in the service book which have been ignored [under rule 36 (1) ] | |||
| (b) Periods of non-qualifying service: | From | To | No. of Days |
| Interruption in service condoned under rules 18 and 19 | |||
| Extraordinary leave not qualifying for gratuity | |||
| Period of suspension treated as non-qualifying | |||
| Periods of foreign service with United Nations bodies for which no contribution for gratuity received to the Government rule 20) | |||
| Any other service not treated as qualifying service | |||
| Total Period of non-qualifying service | |||
| (c) Additions to qualifying service: | From | To | No. of Days |
| Benefit of service in an Autonomous Body | |||
| (a) Details of omission, imperfection or deficiencies in the service book which have been ignored [under rule 36 (1) ] | |||
| (b) Periods of non-qualifying service: | From | To | No. of Days |
| Interruption in service condoned under rules 18 and 19 | |||
| Extraordinary leave not qualifying for gratuity | |||
| Period of suspension treated as non-qualifying | |||
| Periods of foreign service with United Nations bodies for which no contribution for gratuity received to the Government rule 20) | |||
| Any other service not treated as qualifying service | |||
| Total Period of non-qualifying service | |||
| (c) Additions to qualifying service: | From | To | No. of Days |
| Benefit of service in an Autonomous Body | |||
| (d) Net qualifying service | ||||
| (e) Qualifying service expressed in terms of completed six monthly periods (Period of three months and above is to be treated as completed six monthly period (rule 22) | ||||
| 7. Emoluments reckoned for death gratuity | 8. Amount of death gratuity | |||
| 9. Details of Government dues recoverable out of death gratuity: | ||||
| (a) Licence fee for occupation of Government accommodation [ See rule 54] | ||||
| (b) Amount to be withheld as indicated by the Directorate of Estates [See rule 54 (i) ]. | ||||
| (c) Dues referred to in rule 54 (2) | ||||
| (d) Net amount payable as death gratuity | ||||
10. Details of the nominee(s) to whom death gratuity is payable:
| S.No. | (a) Name | (b) Date of birth
(DD/MM/YY YY) |
(d) Share in death gratuity | (e) Relationship with deceased Govt.
servant |
(f) Address | |
| 1. | ||||||
| 2. | ||||||
| 3. |
11. Details of guardian/nominee who will receive payment of death gratuity in the case of minor/ mentally disabled children
| S.N. | (a) Name of minor/mentally disabled child | (b) Name of guardian | (d) Relationship with deceased Govt.
servant |
(e) Address of guardian | |
| 1. | |||||
| 2. | |||||
| 3. | |||||
| 12. Head of Account to which death gratuity is debitable. | |||||
| Place: | DD-MM-YYYY | ||||
| Date: | (Signature of Head of Office) | ||||
Section II
Details of provisional gratuity drawn and disbursed by the Head of Office in accordance with Rule 50 of Central Civil Services (Payment of Gratuity under National Pension System) Rules, 2021.
| Death gratuity | Rs. …… …… …… …… …… …… …… …… …… …… |
| Place:
Date: (Signature of Head of Office) |
|
PART II
Account Enfacement
Section I
| Total period of qualifying service accepted for Death gratuity | |
| Net amount of death gratuity after adjusting Government dues | |
| Head of account to which death gratuity is debitable |
Section II
| Details of deceased Government servant | |||||||||||
| Name | Date of death | D | D | M | M | Y | Y | Y | Y | ||
| Amount of gratuity authorised | Amount recoverable from gratuity | ||||||||||
| Amount of gratuity withheld pending receipt of ‘No Demand Certificate’ | |||||||||||
| Amount of provisional gratuity paid, if any | |||||||||||
| Net amount of gratuity after deducting recoveries, withheld gratuity and provisional gratuity, if any | |||||||||||
| Place:
Date: DD-MM-YYYY (Signature of Account Officer) |
|||||||||||
COMMENTS