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Modification of Central Government Pensioners life certificate

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.

NEW DELHI-110066

CPAO/Tech/Amdt.-Sch. Book/2015-16/1655

dated: 12.10.2015

Amendment to the Scheme for Payment of Pensions to Central Government Civil Pensioners by Authorized Banks [Fourth Edition, 3rd December, 2004)

Correction Slip-24

Modification in Life Certificate (Annexure-XVII)

 

ANNEXURE-XVII

(See para 15.1 page 11 of

CPAO’s Scheme Booklet)

Part-A (Every year)

LIFE CERTIFICATE

(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).

Name

Place:

Designation of Authorised Officer

Date: .

Seal


 

ACKNOWLEDGEMENT

           Life Certificate of Pensioner/Family Pensioner of Shri/Smt/Ms._______ _____________ _________ _________ (Name of Pensioner) holder of Pension Payment Order No.___________________ has been received.

Date:-

Signature…………………..

Name

Stamp of the receiving Bank branch

(Vijay Singh)

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.

Click to view Department of Expenditure letter No.CPAO/Tech/Amdt.-Sch. Book/2015-16/1655 dated 12.10.2015

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