Form A – Nomination for Odisha RA Scheme 2026 | Download PDF
📄 FORM A – NOMINATION
Odisha Civil Services (Rehabilitation Assistance) Rules 2026 – For Compassionate Appointment
Form Type
Form A – Nomination
Applicable Rules
RA Rules 2026
Issuing Authority
GA & PG Dept, Govt. of Odisha
Notification Date
18th August 2026
Part A – Spouse Nomination
≥50 / Unfit
Spouse nominates eligible family member
Part B – Family Nomination
Spouse Deceased
All surviving family members nominate
Required Attachments
5+ Documents
Legal Heir, Death Certificate, Form‑C, etc.
About Form A – Nomination
- Part A – Nomination by Spouse: When the spouse is above 50 years of age OR medically unfit (certified by Medical Board in Form‑C), the spouse may nominate another eligible family member – son, daughter, widowed daughter, or widowed daughter‑in‑law – for compassionate appointment.
- Part B – Nomination by Family: When the spouse is not alive, all surviving family members collectively nominate one eligible member – son, unmarried daughter, widowed daughter, or widowed daughter‑in‑law – for compassionate appointment.
- Eligible Family Members: As per Rule 2(c) of RA Rules 2026, family members include spouse, sons (including adopted), daughters (including step‑daughters, irrespective of marriage, subject to dependency proof), widowed daughters, and widowed daughters‑in‑law residing permanently with the family.
- Mandatory Documents: Legal Heir Certificate (Tahasildar), Death Certificate of deceased, Proof of age of spouse (if applicable), Medical Unfitness Certificate (Form‑C, if applicable), Aadhaar Card of nominee, Educational certificates of nominee, Registered deed of adoption (if applicable), Death certificate of husband (for widowed daughter/daughter‑in‑law).
- Submission Timeline: Application must be submitted within one year from the date of death of the Government servant. Delay may be condoned by the concerned Administrative Department with sufficient justification.
Key Instructions for Filling Form A
- Part A: Spouse must be ≥50 years OR medically unfit – strike out the inapplicable option. Attach Form‑C if medically unfit.
- Part B: All surviving family members must sign. List each member with name, age, relationship, marital status, and signature.
- Nominee Eligibility: The nominee must be an eligible family member as defined in Rule 2(c) of the RA Rules 2026.
- Attachments: Ensure all mandatory documents are enclosed – Legal Heir Certificate, Death Certificate, proof of age, Form‑C (if applicable), Aadhaar, educational certificates.
- One Nomination Only: Only one family member can be nominated for compassionate appointment under the scheme.
- Forfeiture of Claim: If the nominee does not join the post offered, all claims under the scheme stand forfeited forever.
Preview Form A – Nomination
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Download Form A PDF Share on WhatsApp Share via Gmail Share on TelegramFrequently Asked Questions – Form A
What is Form A used for in the RA Scheme?
Form A is the Nomination Form used when the spouse of the deceased Government servant is above 50 years of age, medically unfit, or not alive. It allows the spouse or the family to nominate another eligible family member for compassionate appointment.
What is the difference between Part A and Part B of Form A?
Part A is used when the spouse is alive but is ≥50 years of age or medically unfit – the spouse signs the nomination. Part B is used when the spouse is not alive – all surviving family members collectively sign the nomination.
Who can be nominated under Form A?
Eligible nominees include: son, daughter, widowed daughter, or widowed daughter‑in‑law of the deceased Government servant. For Part B (spouse deceased), the nominee can be son, unmarried daughter, widowed daughter, or widowed daughter‑in‑law.
What documents are required along with Form A?
Mandatory documents: Legal Heir Certificate (from Tahasildar), Death Certificate of the deceased, Proof of age of spouse (if applicable), Medical Unfitness Certificate (Form‑C) if spouse is medically unfit, Aadhaar Card of nominee, Educational certificates of nominee, and Registered deed of adoption (if applicable).
What is the timeline for submitting Form A?
The application must be submitted within one year from the date of death of the Government servant. If there is a delay, the applicant must provide sufficient justification along with supporting documents. The Appointing Authority may condone the delay with the approval of the concerned Administrative Department.
Can a minor child be nominated through Form A?
Yes, a minor child of 16 years or above can be nominated, but the appointment can only be made after the child attains the age of 18 years. The child can apply immediately after turning 18, as per Rule 6(5) of the RA Rules 2026.
What happens if the nominee does not join the offered post?
If the nominee does not join the post offered, all claims under the Rehabilitation Assistance Scheme stand forfeited for all times to come. No alternative appointment or choice will be offered.
Where can I get Form C (Medical Unfitness Certificate)?
Form C is issued by the Medical Board constituted under the Chairmanship of the Chief District Medical Officer of the district of permanent residence of the deceased Government employee. The Board includes two other senior Government doctors and an Administrative Officer nominated by the District Collector.
Can I apply directly without using Form A?
If the spouse is below 50 years of age and medically fit, the spouse can apply directly using Form B (Application Form) – no nomination is required. Form A is only needed when the spouse is ≥50, medically unfit, or not alive.
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