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Life Certificate

The document outlines the certificates required from a pensioner, Madhu Sudan Modak, for pension verification, including a Life Certificate confirming the pensioner's status and a Non-Employment Certificate regarding any government employment. It also includes a yearly declaration for pensioners whose pensions are affected by marriage or remarriage, requiring a statement of marital status. The document specifies the necessary signatures and details for validation by an authorized officer.

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425 views1 page

Life Certificate

The document outlines the certificates required from a pensioner, Madhu Sudan Modak, for pension verification, including a Life Certificate confirming the pensioner's status and a Non-Employment Certificate regarding any government employment. It also includes a yearly declaration for pensioners whose pensions are affected by marriage or remarriage, requiring a statement of marital status. The document specifies the necessary signatures and details for validation by an authorized officer.

Uploaded by

pp
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Please tick: Pension/ Family/ Minor Pension

ANNEXURE VI
(Certificates to be submitted by Pensioner)
[Vide rule 5(3)]
Name of the Bank & Branch : Central Bank of India, Purulia Branch Account No. 124299021
PPO I.D. No. 13816 Mobile. No. 9434883473

I. Life Certificate
Certified that I have seen the Pensioner Madhu Sudan Modak

holder of Pension Payment Order No. PCC(A)(C)149264/P and that he / she is alive
on this date.
Place :
Date :
Name, Signature & Designation of
Authorised Officer with Seal
II. Non-Employment Certificate
* I declare that I have not received any remuneration for serving in any capacity in an
establishment of the Central Government or a State Government or a Government undertaking
or from a local Fund during the period from November 20 ………….to October, 20………………….
* I declare that I have been employed / re-employed in the office of
… ....................................... and was in receipt of the following emoluments during the period.
* I declare that I have accepted commercial employment after obtaining / without
obtaining sanc on of the Government. †
* I declare that I have / have not accepted any employment under any Government
outside India after obtaining / without obtaining sanction of the Government.

Place :
Date :
Signature of the Pensioner
* Delete whichever is not applicable. Name of the Pensioner- Madhu Sudan Modak
† To be specified. PPO No. PCC(A)(C)149264/P
Address- New colony Mission road, Nimtand,
Purulia, P.O.+Dist.- Purulia, WB, 723101
ANNEXURE VII
[ Vide Rule 5(3) & T.R. 4.186(4) ]
Yearly Declaration of Pensioners whose pensions are terminable on their marriage or
remarriage: (This certificate is to be submitted in November every year)

Pension Payment Order No………………………………………………………………………………..


I hereby declare that I am not married and that I have not been married during the last one
year.
Or
I hereby declare that I have not been remarried during the last one year ending on 31st October,
20............... and I undertake to report such an event promptly to the Treasury / Bank.

Signature………………………………………………………………………

Date : ………………… Widower / Widow / daughter of Late …………………………………………… (To


be signed by an authorised Officer)
I certify to the best of my knowledge and belief that the above declaration is correct.

Date:………………………. Signature of the Authorised Officer


Name & Designation of the Authorised Officer

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