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Annexure-I Part-A Life Certificate: (To Be Submitted by Pensioner/Family Pensioner Once A Year)
Annexure-I Part-A Life Certificate: (To Be Submitted by Pensioner/Family Pensioner Once A Year)
PART-A
LIFE CERTIFICATE
[To be submitted by Pensioner/Family Pensioner once a year]
holder of
P.P.O No.
Signature of Attesting
Officer
Name:
Place: Designation:
4. Expansion of initial :
Exgratia Dependants
beneficiary of Exgratia
beneficiary
9. Branch Name :
District
Pin Code
a) Received Date :
b) Entered Date :
Place: Name:
Date: PPO.No.
ANNEXURE-III
I hereby declare that I have not married and that I have not been
married during the past year.
OR
Place: Name:
Date: PPO.No.