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Details of Government Servant died/missing/retired on medical grounds while in Service

*No request for compassionate appointment for retirement on medical invalidation on or after 19.05.2015 to be entered in portal

Circle:
Region:
Division:
SubDivision:
Employee ID:
Employee Name:
Employee Designation:
Date of Birth:
Date of Joining as regular employee in Department:
Employee Marital Status:
Compassionate Type:
Date of Death/Date of retirement on medical grounds/Date of missing
Upload FIR and non traceable report (In case of missing) File Format : ".jpg/.jpeg"; Size upto 200 KB		Clear
Date of Application:
Reason for delay of application:
Previous UARN Number (In case of non availability, leave this field as blank)
CRC Year
CRC considered Count:
Recommendation Status:
ID Card Number (Dept. ID Card): (Aadhar card in case of non availability of ID card and if both Aadhaar/ID not available upload first 2 pages of Service book with GPF number ) File Format : ".jpg/.jpeg"; Size upto 200 KB		Upload ID Card: Clear
Aadhar Card Number: (Not mandatory) File Format : ".jpg/.jpeg"; Size upto 200 KB		Upload Aadhar Card: Clear
Dearth Certificate Number: File Format : ".jpg/.jpeg"; Size upto 200 KB		Upload Dearth Certificate: Clear
Family members certificate (CGHS/Ration card/Form-3): File Format : ".jpg/.jpeg"; Size upto 200 KB		Upload Family members Certificate: Clear

Whether any dependant family member is willing to avail compassionate posting

Please provide the following details
*Note: Amounts should be entered irrespective of the disbursement status.
DCRG Amount File Format : ".jpg/.jpeg"; Size upto 200 KB If not avaialble please enter zero (0)		Upload relevant document: Clear
CGEGIS Amount File Format : ".jpg/.jpeg"; Size upto 200 KB If not avaialble please enter zero (0)		Upload relevant document: Clear
GPF/NPS Amount File Format : ".jpg/.jpeg"; Size upto 200 KB If not avaialble please enter zero (0)		Upload relevant document: Clear
Leave Encashment Amount File Format : ".jpg/.jpeg"; Size upto 200 KB If not avaialble please enter zero (0)		Upload relevant document: Clear
Family Pension/Pension/NPS Pension(Monthly amount) File Format : ".jpg/.jpeg"; Size upto 200 KB If not avaialble please enter zero (0)		Upload relevant document: Clear
Any other payments If not avaialble please enter zero (0) File Format : ".jpg/.jpeg"; Size upto 200 KB		Upload relevant document: Clear
Immovable/movable property income (Monthly) If not avaialble please enter zero (0) File Format : ".jpg/.jpeg"; Size upto 200 KB		Upload relevant document: Clear
Immovable/movable property Value If not avaialble please enter zero (0) File Format : ".jpg/.jpeg"; Size upto 200 KB		Upload relevant document: Clear
Amount of fixed deposits/bank deposits If not avaialble please enter zero (0) File Format : ".jpg/.jpeg"; Size upto 200 KB		Upload relevant document: Clear
Amount of Investments If not avaialble please enter zero (0) File Format : ".jpg/.jpeg"; Size upto 200 KB		Upload relevant document: Clear

Please provide the following details
Upload DO/Comp Apptt/II proforma:

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Registration Details:

Employee ID of Deceased Government Servant:
Name of Deceased Government Servant:
Designation of Deceased Government Servant:
Date of Birth of Deceased Government Servant:
Date of Death of Deceased Government Servant:
Applicant Name:
Applicant Mobile Number:
Applicant email:
Applicant relationship with Government Servant:
Income from property:
Immovable/Movable property value:
Fixed deposits amount:
Amount of investment:
Whether any dependent family member Person With Disability:
Whether any dependent family member with Illness:
Present Address
Permanent Address
Whether any dependent has been appointed or applied for appointment on compassionate grounds?