Fixed Medical Allowance Form N-2 โ Nomination Form for payment of arrears of Fixed Medical Allowance for CG Employees governed by CCS (Implementation of NPS) Rules, 2021
(DoP&PW O.M. No. 04/07/2020-P&PW (D) dated 07.02.2025)
FMA FORM N-2
(Nomination Form for payment of arrears of Fixed Medical Allowance)
(For Government employee governed by CCS (Implementation of NPS) Rules, 2021)
I โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ hereby nominate the person/persons mentioned below and confer on him/her/them the right to receive in the event of my death, to the extent specified below amount of the arrear of Fixed Medical Allowance:
| Name, Date of Birth (DoB) and address of the nominee | Relationship with employee/ beneficiary | Share to be paid to each | If nominee is minor, name, DOB and Address of person who may receive the amount of behalf of minor | Name, DoB, Relationship and Address of alternate nominee in case of the nominee under Col (1) predeceases the employee/ beneficiary | Share to be paid to each | Name and Address of person who may receive the amount if alternate nominee in Col. (5) is a minor | Contingency on happening of which nomination shall become invalid |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
These nominations supersede any nominations made by me earlier.
Place:
Date:
Signature of Government Servant/ beneficiary
PRAN of Government employee: โฆ โฆ โฆ โฆ โฆ โฆ
Telephone/Mobile No. โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ
Note 1:- Completely strike out the benefit for which nomination is not intended to be made.
Note 2:- The government servant shall draw lines across the blank space below the last entry to prevent the insertion of any name after he/she has signed.
Note 3:- The nominee(s) /alternate nominee(s)โ shares together should cover the whole amount.
Received the nominations dated โฆ โฆ โฆ โฆ for payment of arrears of Fixed Medical Allowance:-
made by Shri/Smt/Kumari โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ
Designation โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ
Office โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ
Name, Signature and Designation of Head of Office/
authorised Gazetted Officer with seal
Date of receipt โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ โฆ
The receiving officer will fill the above information and return a duly signed copy of the complete Form to the Government servant who should keep it in safe custody so that it may come into the possession of the beneficiaries in the event of his /her death. The receiving officer shall put his/her dated signature on both pages of this Form.
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FMA-Form-N-2_page-1
FMA-Form-N-2_page-2
Fixed Medical Allowance Form N1
Fixed Medical Allowance Format N-1
Fixed Medical Allowance Format N-2
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