TREASURIES & ACCOUNTS DEPARTMENT

ANDHRA PRADEH: HYDERABAD

Application for Pensioner's(Service/Family) Multipurpose I.D Card
PART-I (Applicant Details)
1

Employee Code if available before

retirement

Pensioner I.D. No*

Name of the Treasury/PPO from

where pension is being drawn*

Pensioners Name & Surname Fathers

name/Husband name

Date of Birth (dd/mm/yyyy) *

Date of death of service Pensioner in

case of Family Pensioner *

Date of Retirement of Service

Pensioner*

Date of Commencement of
pension(Sp/Fp) *

Retirement type (See Overleaf) *

10

Type of Family pension (See

Overleaf) *

11

Name of the Department from

Where Service Pensioner Retired*

12

Designation at the time of

retirement of Service Pensioner*

13

Designation grade (See Overleaf) *

14

Gender(M/F) *

15

Marital status (See Overleaf) *

16

Blood Group(Overleaf)

17

Ailments if any (See Overleaf)

18

Pensioner Category (See Overleaf)

19

Pensioner Employment Category

(See Overleaf)

20
21

P.R.C. Year*

Present Basic pension*

22
PAN. No

23

Ration Card No.

24

Aadhar Card No.

25

Present Residential Address with

Pincode*

26

Residential Phone No.

27

Cell NO.

28

E-Mail Address

PART-II DEPENDENT DETAILS (In case of Service Pensioner only)

S.No
(1)

Dependent
Name* (2)

Gender*
(M/F) (3)

Date of birth*
(dd/mm/yyyy)
(4)

Marital Status
(See Overleaf)
* (5)

Relationship
with Pensioner
(See Overleaf) *
(6)

Employme
nt status*
(7)

Signature of the Service Pensioner/Family

Pensioner.

* In case of Pensioner's drawing more than one pension need to apply for
service pension only.
** In case of employment, no need to apply under this scheme by the Family
Pensioner.

Blood
Group
(8)

Part-1(Overleaf)
Sl.no Descriptions
09.
Service-Normal/Service-Provisional/Service-Voluntary/ServiceInvalid/Service- Prorata.
10.

Family-Normal/Family-Share/Family-Minor/Family-Pcmr/Direct Family.

13.

Gazetted/Non-Gazetted/Class-IV.

15.

Married/Unmarried/Widowed/Divorced/Remarried.

16.

A+ve, A-ve, B+ve, B-ve, AB+ve, AB-ve, O+ve and O-ve.

17.

B.P/Sugar/Cardiac Problems/Neurological Problems/Kidney Problems/Others.

18.

Civil/AST/FA/Political/Others

19. State Normal/UGC/AIS/Judicial officer/UGC-Doctors/AICTC/Other States /Others

Part-II(Overleaf)
Sl.no Descriptions
5.

Married/Unmarried/Widowed/Divorced/Remarried

6.
Father, Mother, Spouse, Son Including Adopted & step sons, Daughter
including step Daughter.

NOTE:
Pensioner shall carry a soft copy of passport size photos of self and
dependents which is not more than 100kb size, which is required to be uploaded.
The extension of photo should be .JPG or. JPEG or PNG.