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L.I.C. HOUSING
Area Office :

FINANCE
,

LTD.

EMPLOYER'S CERTIFICATE
CONFIDENTIAL

(This form should normally be typed in the Employer's

letterhead. If letterhead is not available, this form may be used).

Shri/Smt. Office address:

Father's/Husband'sName

Phone: 1. Date of joining service

details of his/her services The and emoluments for the month : 200

2. Date of Birth as per service records & Quotations 3. Date ofretirement 4. Whether confirmed 5~ Designation / Department / Roll No. 6. Scale of pay, if any 7. PRESENT GROSS SALARY PER MONTH # Other items Nature 1. 2. 3. 4. Total Rs. Amount paid monthly Basic D.A. H.R.A. C.C.A. #Others items payable monthly GROSSTOTAL P.F. Balance Instalments P.F.Loan *Housing Loan Society Loan InsurancePremium
..

Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. pm pm p.a. p.a. pm

8. MONTHLYDEDUCTIONS Liabilities Balance Loan Rs. Housing Loan P.F.Loan Society Loan Other Loans

Income Tax Other Items

TOTALDEDUCTIONS Rs. NET PAY 9. Other Annual monetary benefits, if any such as Bonus, incentive, etc, specify Nature & Amount (a) (b) Rs. Rs. Rs. Rs.

10. If eligible for pension, approximate pension at the current rates 11. Total earings during each of the last three Assessment years ended:

*If the employee has availed Housing Loan / Advance, furnish details such as Property Address, area
31/3/20 Rs 31 /3/20 Rs 31/3/200 Rs

of the building / flat etc. separately. Certified that the above particulars are true and correct according to our records and to the best of our knowledge and belief, Authorised Name Place: Date: Seal with Full Address: Signatory : :