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State of Andhra Pradesh - Section
Section 39 in Andhra Pradesh Municipalities (Pension-cum-Gratuity Fund) Rules, 1969
39. Gratuities. - (1) The Secretary shall not pay any gratuity except on an authority received from the Audit Officer. The Secretary shall require to payee to produce the copy of the order by which the sanction to the gratuity was communicated to him, and shall record the fact of payment on the copy of the order so produced.
| Class of pension and date of order sanction it | Date or approximate date of birth | Section | Residence showing village and taluk | Amount of monthly pension | |
| (1) | (2) | (3) | (4) | (5) | |
| {| | |||||
| Office of the | |||||
| No. | the | 19 |
| Reverse of Pensioner's HalfAmount of pensionRs............................................[in words]Every separate payment is to be recorded belowby the Secretary | |||||||||||
| Month for which pension is due | 19 | 19 | 19 | 19 | 19 | 19 | 19 | 19 | 19 | 19 | Remarks |
| Date of payment | Secretary's initials | Date of payment | Secretary's initials | Date of payment | Secretary's initials | Date of payment | Secretary's initials | Date of payment | Secretary's initials | ||
| (1) | (2) | (3) | (4) | (5) | (6) | (7) | (8) | (9) | (10) | (11) | (12) |
| MarchApril | |||||||||||
| Blank Space For Folding | |||||||||||
| MayJuneJulyAugustSeptemberOctoberNovemberDecemberJanuaryFebruary |
| Blank SpaceFor Folding | |||||||||||
| Month for which pension is due | 19 | 19 | 19 | 19 | 19 | 19 | 19 | 19 | 19 | 19 | Remarks |
| Date of payment | Commissioner's initial | Date of payment | Commissioner's initial | Date of payment | Commissioner's initial | Date of payment | Commissioner's initial | Date of payment | Commissioner's initial | ||
| (1) | (2) | (3) | (4) | (5) | (6) | (7) | (8) | (9) | (10) | (11) | (12) |
| MarchAprilMayJuneJulyAugust | |||||||||||
| Blank Space for Folding | |||||||||||
| SeptemberOctoberNovemberDecemberJanuaryFebruary |
| Reverse of Disburser's HalfAmount of pensionRs......................................[in words]This document is to be retained by theSecretary so long as the authority remains in force in suchmanner that pensioner shall have no access to it. Every separatepayment is to be recorded below. | |||||||||||
| Month for which pension is due | 19 | 19 | 19 | 19 | 19 | 19 | 19 | 19 | 19 | 19 | Remarks |
| Date of payment | Commissioner's initial | Date of payment | Commissioner's initial | Date of payment | Commissioner's initial | Date of payment | Commissioner's initial | Date of payment | Commissioner's initial | ||
| (1) | (2) | (3) | (4) | (5) | (6) | (7) | (8) | (9) | (10) | (11) | (12) |
| MarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberJanuaryFebruary |
| Month for whichpension is due | 19 | 19 | 19 | 19 | 19 | 19 | 19 | 19 | 19 | 19 | Remarks |
| Date of payment | Commissioner's initial | Date of payment | Commissioner's initial | Date of payment | Commissioner's initial | Date of payment | Commissioner's initial | Date of payment | Commissioner's initial | ||
| (1) | (2) | (3) | (4) | (5) | (6) | (7) | (8) | (9) | (10) | (11) | (12) |
| MarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberJanuaryFebruary |
| Disburser's HalfPlace for signature of Pensioner onthe........................................................firstpayment made hereon. | ||||||
| Head of charge superannuation Allowance andpension | ||||||
| Class of pension and date of order sanctioning it | Personal identification | Height (Metres) | Date or Approximate date of birth | Section | Residence showing village and taluk | Amount of monthly pension |
| (1) | (2) | (3) | (4) | (5) | (6) | (7) |
| {| | ||||||
| Office of the | ||||||
| No. | ||||||
| Sir, | ||||||
| Until further notice and on the expiration of every month, payto.......................................the sum ofRupees....................................(less income taxbeing)...............................amountof............................... pension as ...........upon theproduction of the counterpart hereof, taken from the claimant areceipt for the amount according to usual form. The paymentshould commence from................................19 | ||||||
| (Signature) | ||||||
| (Designation) |
| Thumb | 1st finger | 2nd finger | 3rd finger | Little or 4th finger |
| Station : | Signature |
| Dated :.......19....... | Designation |
| Pay Rs. | |
| Contents received. | Secretary |
| Signature of the Messenger. |