LTA Nomination Form

ENCLOSURE - E

NOMINATION FOR PAYMENT OF LIFE TIME ARREAR OF PENSION

(To be furnished by the Employee)

Pension Disbursing Authority / Head of Office

Employee Details

Name of the Employee (Mandatory):

Address (Mandatory):

Circle Name (Mandatory):

Place of Circle (Mandatory):

District Name of Circle (Mandatory):

Original Nominee

Name of Original Nominee (Mandatory):

Relationship (Mandatory):

Date of Birth (Mandatory):

If Nominee is Minor, Name and Address of Guardian (Optional):

Alternate Nominee(s)

Name of Alternate Nominee (Optional):

Relationship (Mandatory if Name is Filled):

Date of Birth (Mandatory if Name is Filled):

Name and Address of Guardian if Minor (Optional):