DEATH CASE

FACE SHEET FOR GRANT OF FINANCIAL ASSISTANCE.

1. Name of Deceased Govt. Employee: ______________________________________
2. CNIC No. ___________________ 3. Father Name: ___________________________
4. Designation: ___________ BPS: ______________ Regular/Contract/Adhoc: _______
5. Date of Birth: __________________ (Attach SSC/First Page of S/Book):___________
6. Office/Institution: ______________________________________________________
7. Dated of appointment,
in Govt. Services: _____________________ Present Grade / BPS No: ___________
8. Date of Posting at
Last Station: _________________________ 9. Claims Rs: ____________________
10. Dated of Expiry/Attach Death Certificate: __________________________________
11. Detail of Total Service:
Sr.
No.

Name of Office/Institution

From

To

BPS
No.

Designation

12. List of Family/Families Members of Deceased:

Sr.
No.

i)
ii)

Name

Relation

Age

%age/Ratio of
Share.

CNIC. No.

Certified that the above particulars are correct and verified with the office record.
In case of any false / bogus / fake & fictitious / particulars / entry detected
subsequently the undersigned will be responsible for the consequences.

No. _______________ Dated __________

No. _______________ Dated __________

Countersigned and forwarded please.

Signature _____________________

Signature _____________________

Name of DDO __________________

Name of EDO __________________

Designation/Official Stamp.

Official Stamp.

Dated

Jerjees Haider Shah