Fixed Medical Allowance Application for Railway Pensioners

Retired employees of the railway who are pensioners have to submit the Application form to avail of the medical allowance. In this post, you could view and download the form.

Accordingly, I hereby opt to claim a Fixed Medical Allowance of 1.00 and/or 3.00 per
month as per the prescribed rate. A necessary endorsement may please be made in my PPO in this
regard. Simultaneously, I undertake that, I will not avail of OPD facilities (except in case of
chronic diseases as mentioned in Board’s letter No.2006/H/DC/JCM, dated 12-10-2006) at
Railway Hospitals/Health Units from the day I claim Medical Allowance.

I also understand that the grant of Medical Allowance is subject to the terms and conditions specified in Board’s
letter No.PC-V/98/I/7/1/1 dated 21-04-99 and 01-03-2004 and last being letter No.PC-V/2006
/A/Med/1, dated 15-09-2009.

  1. I also declare that I have not availed of any treatment as Out Door Patient ( except in
    case of chronic diseases as mentioned in Para-2 above ) for the period from ____
    ( indicate here the date of retirement or the date of availing OPD facility on the last occasion
    or 01-12-1997, whichever is later ) to this day _____ ( indicating here the date on
    which this declaration is signed ). I may accordingly be paid arrear of Medical Allowance @
    .100 and/or.300 per month for the period mentioned above as per the prescribed rate.

The above information furnished by me is correct to the best of my knowledge and
belief. I also understand that, if at any stage, it is found that the undertaking submitted by me
is incorrect or carries false information, my FMA is liable to be stopped with immediate effect
and further suitable action could be taken to recover the excess amount paid to me.

Medical Allowance Application PDF

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