FORM OF AFFIDAVIT

Declaration to be sworn in by the pensioner who had retired

voluntarily for purposes of restoration of commuted portion of his

pension in the presence of any gazetted officer of the Andhra

Pradesh State Government , on a stamped paper for Rs. 5/- [Rupees

five].

I ………………………………….son /daughter of …………………

……………………who worked as ………………………………(designation)

in the office of the ……………………………..solemnly declare that I

have retired voluntarily on . . . . . . . . . . . . . . . . . . . . . .(date and

order). ……………………………… and was not re-employed since the

date of my voluntary retirement up to the………………………. the date

on which I would have retired on superannuation, had I continued

in service.

Signature of the Pensioner and date.

Before me:

Gazetted officer