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Format for Revised Life Certificate – Modification in Life Certificate (Annexure XVII)
Personnel Ministry has published correction slip-24 for Modification in Life Certificate (Annexure XVII)
GOVERNMENT OF INDIA
MINISTRY OF FINANCE
DEPARTMENT OF EXPENDITURE
CENTRAL PENSION ACCOUNTING OFFICE
TRIKOOT-Il, BHIKAJI CAMA PLACE.
Amendment to the Scheme for Payment of Pensions to Central Government Civil Pensioners by Authorized Banks [Fourth Edition, 3rd December, 2004)
Modification in Life Certificate (Annexure-XVII)
(See para 15.1 page 11 of
CPAO’s Scheme Booklet)
Part-A (Every year)
(To be submitted by Pensioner once a year in November)
Certified that I have seen the pensioner Shri/Smt./Ms. ___________________________________ (Name of Pensioner) holder of Pension Payment Order No. _________________________ and that he/she is alive on this date.
1. Present address of the pensioner/ family pensioner.
2. Telephone/Mobile number (if any).
3. E-mail Address (if any).
Designation of Authorised Officer
Life Certificate of Pensioner/Family Pensioner of Shri/Smt/Ms._______ _____________ _________ _________ (Name of Pensioner) holder of Pension Payment Order No.___________________ has been received.
Stamp of the receiving Bank branch
Sr. Accounts Officer (Tech)
CGA’S Authority No. 1(7) CPAO SCI]. Book (1)/4-th Edition/2005/TA-III/566 dated-9th October, 2015.