ANNEXURE-I

LIFE CERTIFICATE

Certified that I have seen the Pensioner _____________________

_________________________________________________________

__________________________________(Name of the Pensioner)

_________________________________________________________

holder of Pension Pay Order No___________________________

_____________________________________________________

and that he / she is alive on this date.

Place: Name:

Date: Designation

Address for communicate

with Mobile No.
 ANNEXURE - II

Non-employment I Re-employment Certificate

1. I declare that I have not been serving in any capacity either in a Government
Departments I Office, Company, Corporation, Autonomous body or Society of
Central or State Government of Union Territory or a Local Body during the year
ended____________________

(or)

2. I declare that I have been employed I re-employed in the Office of

__________________ which is a part of financed by ______________________
Government and was in receipt of the following monthly rates of emoluments
during the year ended _____________________________of during the months of
_______________________with in the said years.

(a ) i. Pay
ii.Special Pay
iii.Allowanced (including Dearness Allowance etc.)
(or)
(b) Honorarium
Further, that the orders of my re-employment do / do not stipulate my pension
being held in abeyance during the re-employment period.

ii. I declare that I have not accepted any commercial employment in India.

(or)
I declare that I accepted commercial employment in India after obtaining
previous sanction of the Government and none of the conditions if any attached
thereto by Government has been violated I without obtaining sanction of the
Government.

Note: This declaration is require to be given for a period of two year from the
date of retirement.
 iii. I declare that I have not accepted employment under Government outside
India I an international organization of which Government of India is not a member

I declare that I have accepted employment under a Government outside India I

as International Organisation of which Government of India is not a member after
obtaining the previous sanction of the Government and none of the conditions
attached thereto by the Government has been deviated from I without obtaining
previous sanction of the Government.

Place: Signature

Date: Name of the Pensioner

Pension Pay Order No.

I certify to the best of my knowledge and belief that the above declaration is
correct.

Place: Signature of the Attesting Officer

Date: Name:

Designation:
·

ANNEXURE - III
Certificate of Non-remarriage / Non - marriage

I hereby declare that I am not married and that have not been married during the
past years.
or -
I hereby declare that I have not re-married and I under take to report such an
event promptly to the Treasury / Bank.

(Applicable only for widow receipient of family pension and to be furnnished only
Once)

Place: Signature

Date: Name of the Pensioner

Pension Pay Order No.

I certify to the best of my knowledge and belief that the above declaration is
correct.

Place: Signature of the Attesting Officer

Date: Name:

Designation: