CERTIFICATES TO BE SUBMITTED BY THE PENSIONERS

LIFE CERTIFICATE

(to be submitted from 1

, July onwards along with Copy of Aadhaar Number)

Valid Upto: 30-06-2025

*You may also submit your life certificate using your mobile handset. Download Jeewan Pramaan Face App*

Certified that I have seen the Pensioner Mr./ Mrs./Miss ________________________________

Son/ Daughter/Wife/Husband of_________________________________________________________

holder of P.P.O No. _____________________ and he/she is alive on this date.

(Signature of Patwari/DTO/TO/

Gazetted officer of HP/Bank Manager/Panchayat Secretary)

Date: (With Seal)

RE-MARRIAGE/NON-RE-MARRIAGE CERTIFICATE

(Only in case of Family Pensioners)

I hereby declare that I have /have not re-married during the last one year.

Signature/ Thumb impression of Pensioner

EMPLOYMENT / NON RE-EMPLOYMENT CERTIFICATE

(i). I hereby declare that I have not served in any capacity either in a Government department/office

company, Corporation, autonomous body or Society of Central or State Government or Union Territory

or a Local Fund during the last one year.

I declare that I have been employed / re-employed in the office of____________________________

which is a part of / financed by _______________________________ Government.

Further that the orders of my re-employment do/do not stipulate my pension being held in abeyance.

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

I declare that I have accepted commercial employment in India after obtaining prior sanction of the

Central / State Government and none of the conditions, if any, attached thereto by Government has

been violated.

Note:- This declaration is required to be given for a period of 2 years from the date of retirement.

I declare that I have not accepted employment under a Government outside India / an international

organization of which government of India is not a member.

I declare that I have accepted employment under a Government outside India / an International

organization of which government of India is not a member after obtaining the prior sanction of the

Central / State Government and none of the conditions attached thereto by the government has been

deviated.

Pensioner's Aadhar No. __________________

Pensioner's PAN No. _____________________

Pensioner's Mobile No. ____________________

Pensioner's Land Line No. _________________

Date: __________________________________

Place: _________________________________

(Signature of Pensioner)

Name _____________________________________

Current Address. _____________________________

City/Village. ________________________________

Patwar/Circle. ________________________________

Tehsil/Sub Tehsil. ______________ State _________

Pin.Code. ___________________________________