[Translator’s notes appear in square brackets]

[Personal information has been redacted.]



Islamic Republic of Iran

The Order of Amendment or Increase of the Retirement Fund and Disability Grant


Form A-57 (39-1) Department of State for Administration and Employment Affairs


  1. Ministry/Institute: Ministry of Education 156
  2. Personnel Number [redacted]
  3. Retirement Number [redacted]
  4. Particulars of the Personnel of Level One of Shiraz:

Name: Mirza Khalil, Surname: Yazdani; Father’s name: Khajeh Hoseini; Date of birth: day - month -  year - ; Birth certificate number [redacted], Place of issuing birth certificate; County , City, [redacted]; Province: Fars / Governorate:-------; Gender: male or female

  1. Employment Status: retirement work related disability non-work related disability
  2.  Date of retirement or disability: 1 Aban 1358 [23 October 1979]
  3. Employment Status of the Personnel

A: Subject to Public Services Employment Act dated 1301

B: Subject to Public Services Employment Act dated 31 Khordad 1345 [21 June 1966]

C: Subject to other regulations (with description of the type of regulations)

8:  Description of the order: According to the final order number 1231, dated 16 Bahman 1365 [5 February 1987] of the Preliminary Commission for the Investigation of the Employment Offences of Fars Province and the order number 2605, dated 24 Farvardin 1366 [13 April 1987], regarding the permanent dismissal from government services issued by the Department of Education, area 3 of Shiraz, according to paragraph 2, section 30 of the Investigation of Employment Offences Act, you are condemned to permanent dismissal. Therefore, the amount of your retirement fund which was determined in order number 71560/4, dated 12 Aban 1358 [3 November 1979], will be cut off as of 5 Farvardin 1366 [4 April 1987].  This order is enforceable after the approval of the National Pension Fund—The Management of Legal Affairs.

9.    Date and number of the final order:

Date: 12 Aban 1358 [3 November 1979] – number 71560/4

10.  Retirement pension or disability pension according to the last order------- rial

11.  Current retirement pension or disability pension-------rial

12.  Increase ------- rial

13.  Retirement deductions:

Type of deductions, the amount of deductions (in rial) the first installment (in rial), the monthly installment (in rial), the number of installments, date of depreciation of the deductions of the first month: day, month and year.

14.  Retirement pension or disability pension is payable after deduction of the pending deductions from the relevant source.

15.  Date of the execution of the order: 15 Farvardin 1366 [4 April 1987]

16.  Date and issue number:  22 Ordibehesht 1366 [13 May 1987] – number 3818/5 BN

17.  Name and surname of the responsible authority: The last organizational position: [Signature]

Deputy Chairman of Administrative Affairs



Copy: The Employee

Address: [redacted] to be sent