Modification of Central Government Pensioners life certificate

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