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LIFE INSURANCE CORPORATION OF INDIA

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LIFE INSURANCE CORPORATION or INDIA

ShrilSmt. SR No. _
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FILE No.

CERTIFICATE OF EXISTENCE

As on 1 stAugust every year


I, hereby certify that the
Pensioner ShrilSmt. SR No. _
son/daUghter of / spouse name in case of family pension _
personally appeared before me on and has signed in my
presence and his/her signature is attested by me. I am fully satisfied about his I her identify.

Dated at this day of _

Signature of the Pensioner Counter signature of Certifying Authority


Phone I Cell No.
-----------------
E-maillD if any: _ SR No. _
PermanentAddress: Designation _--'- _
Address _

SEAL:

Note: This Certificate should be signed by a Class I Officer of the L.I.C. or a Gazetted
Officer or a Registered Medical Practitioner, Employees of the Corporation in the cadre of
HGA I Development Officer with five years of service or an officer of any Bank where an
account is maintained by the pensioner. .•

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