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~W'/MobileNumber{IRt;r~~ ~/For OfficeUse Only1U1IT~ .. ~iftFfq~ ~104l(iI;:lf:~.)APPLICATIONFORMONTHLYPEN SIONFORM-IO-D( )~mt~.11l96(EMPLOYEES'PENSIONSCHEME,1995 )~ IN'JIcm ~ if 1I1f ~~/(ReadINSTRUCTIONS beforefillingIn this Form) 'et; &m WrI<PT ~~mn t ?By whomthe Pensionis claimed?2. GT<Il~ 'l{ ~<PT W/iRTypeof PensionClaimed(q) \jfi'<J~/3mj/Dateof Birth/Age(dd/rnmlyyyy)11111111113.(C/i) ~</iT "'fl1f~'lI1l'Rf1l) Member'sName(1nBlockLetters)(<if) 1Wr/ SEX: T) ~~/MaritalStatus@") furr/'lFct</iT "lJ1'I/Father's/Husband' "If. Wffi"ffi:lm/ >PT "' ~<PT ffiCIT" ' ~</iT 'Wl" q ' IT v ~&'<f-l( ~ Addressof the Establishmentin whichthe memberwas last ~~ ~ / DateofleavingService(dd/mmlyyyy):1 I 111 111 1 I 1~--~~==~==~~ ~</iT <IiR"T/ Reasonof leavingService'l?! ~~ 'lOT/ Addressfor communication(a)In case ofreducedpension(opteddatefor commencementof pension.}}
(TO BE FILLED UP BYTHE EMPLOYER! AUTHORISED OFFICER OF THE ESTABLISHMENT) lIJ!IfiIRr Fcmrr \lJJill ~ ~ / Certified that: 1. ~<IiT~mlHI Theparticulars ofthemember arecorrect. 2. ~ ~ q\\ ~ ~ ~ ~ 12 ~ q\\ ~ <liT~ ~ iWt ~ <liT~ I
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