afte: oh ware oa wenfort firar wren & fas dere aft / sitet ert TIT ander We... sar @ | fern & wee ue. GR) feaie : (sher vart va Frit oe} ate caftrage aenReat @ ah arma 8) Rr / TRI WAT Tr 4 chon axat/aett & ff 4 eer & fat fear era / wert Per / aT RTT am thre aera oe / Tea WER / Se Me MOR/ IPA eos A feet A ge oe wre el sera Fag voor wear /aee EAR A son PRT HT ATA) IE ow eee TR PONG {of oe wer/w WeR/ oH afta eer / ware Frere Err site / yer wa W fier wet eI foe wari chroma (oafte te ea) Fue chon ee /owl ¢ % A Gia adi fear 81 A a steed. . oF Rrare/ gifts fear 81 4 quiere Purr @ oRate ters unt we wer C/ed & ste A ose oS aioe By ares Pert } weer mega BA ort ach same faawh ¥ ga ora at ona } oer wht B wa Tit win /aeh gai feet wor a gfe o fay A aera ws S sraex far S oft aT ET / TEM Aare wen wee are & Fr wate wer Bier TT ET (orreaftat eto wt wre %) Ter BETA / MRR Tee SET .., TF.ANNUAL LIFE CERTIFICATE L. Certified that | have seen the pensioner. (Name of the pensioner) ,holder of Pension Payment Order No. and that he/she is alive on this date. Signature of Offic Name. Designation of the Authorized Officer. Pensioner signature Address (Seal) Mobile No. E-Mail addres Dated: (List of Authorities of Authorized Officer is Attached ) 2. Declaration of Non-employment/Re-employment | declare that | am not serving in any capacity rather in a Government Depart ment/Office/Company Corporation/Autonomous Body or Society of the central/State/UT/Local body OR | declare that | have been employed/Re-employed in the office of with effect from n which is partially/fully financed by the Central/State/UT/Local Body. 3. Declarat \n of Non Martiage/Non Remarriage (For Family Pensioners Only} thereby declare that | am not married/Re-married oR | have got married/Re-married on With Spouse and address) (Name of Declaration by Family Pensioners Only am getting Family Pension from DoT and 4 will declare amount of family pension to Income Tax Department as income from other sources for computation of Income Tax. | shall be personally responsible for any default in this respect to the Income Tax Department. | certified to the best of my knowledge and belief that the above declaration is correct. (Please score out un related declaration) Signature of Pensioner/Family Pensioner. Place Dateof A thay onan oe Petes ateat ger shor wa a Raft axe sae & fe al) ADs BL RS ee wh ere fo A eafdeora war Yue wee A pensioner who produces a life certificate signed by any person specified hereunder is exempted from personal appearance : Sw aft ot RATE Mey aE xe o aaa GfSRae ute S wT F ake Ahi a person exercising the powers of a Magistrate under the Criminal Procedure Code; ae ae ot fe anda vorewt we & awe err or waren & we wrk Vii a Registrar or Sub-Registrar appointed under the Indian Registration Act; 7 ae cafe it wane were get Rett AOA er ras ty a Group A or B Government servant; a ‘gfe fart or sifted at oa—fatee & uz 8 Ara a et ste ort S wa 4 ge waft aL iv apolice officer not below the rank of sub-Inspector-in-charge of a police station; Swe tur chee mee eg wa eae aT grey Roe Aer B oT A ae eh v a Postmaster, a departmental Sub-Postmaster or an Inspector of Post Offices; ard fied te S wer oh & oittart, ada Re te wd ond weraw Bat Swot we fee ay afer vi a Class | Officer of the Reserve Bank of India, an officer (including Grade I! officer of the State Bank of India or of its subsidiary; Bae dah aT ot aaah} wea VUE APR! B we A ara TI vii pensioned officer who, before retirement, exercised the powers of a Magistrate; a aReT site tre viii a Justice of Peace; ix A Block Development Officer, Munsif, Tehsildar or Naib Tehsildar; weds, ae Carer wa aT Claret gee sterar aT seat aoetarftoh RA a ree (wrt aA 3 one) x head of a Village Panchayat, Gram Panchayat or an Executive Committee of a Village. ( to be verified). Feet - Fae, Peers war, Ae aia Tos sera weer aed WaT aE ; xi Members, of Parliament, of State Legislature, or of legislatures’ of Union Territory Government / Administrations, a ‘cat Brent Xi Treasury Officer. aft aig der urdatie da o to & ter ora ae ver at ches war os oe ae S ae S fra aareorey & rer Fok Roar ot wera &1 cafe hg there tte ae er 8 / x8) & we At ore ted are aif aretha Rod ae aR tose @ fetta oma A fe wa at S ere tes era oe er e/a EA has WAM ua oe de S Pratfte ater & ere Pte Rear aT aA 8 ae wg tee ot fee A were a oe wes aT ET We a fat aforete /aet/ae arog ar sree erates AMAT rer Aras MeN Ta MRT AEH eT at A wa mafaerrea Sone EE wre 8 | In the case of a pensioner drawing his pension through a public sector bank, the life certificate may be signed by an officer of a public sector bank. In the case of a pensioner residing abroad and drawing his pension through any other bank included in the Second Schedule to the Reserve Bank of India Act, 1934, the life certificate may be signed by an officer of that bank. A pensioner not resident in India in respect of whom his duly authorized agent produces a life certificate signed by a Magistrate, a Notary, a Banker or a Diplomatic Representative of India is exempted from personal appearance.