CEREEBA) REVISED 1. D.No. GERERA GOVERNMENT OF ANDHRA PRADESH ANNUAL VERIFICATION CERTIFICATE (As per Govt. Memo No. 240/PSC/2013, Did 26-10-2013) 4.) Type of Pension 1 Service Pension / Family Pension Recent Photo of il) Name of Individual the individual (To ii) S/o., Dlo., Wio,, Hilo. . be attostog by the iv) AADHAAR Number Bank Manager 2, Date of Birth / Age : DOMMYY VY or Notary) 3. P.P.O.No. 4, Name of Bank 5. Name of the Branch 6. 1) Bank Account No. (Mandatory): Ce (in 9/11/1418 digit formate) ii) MICR Code ili) IFSC Code 7. Employment Particulars: a) Name of Office b) Date if Employment / +" Re-employment ) What is the D. A. being drawn on employment @) Date from which D. A. is drawn : Applicable it Re-omployed after reticement and Employed pensioners only) 6. Re-marriage particulars if any a) Date of Re-marriage b) Name of the spouse 8. i) Present residential address with phone No. / Mobile. No. ji) E-mail address 40. Income Tax PAN No. (Mandatory/if Monthly Pension exceeds 15,000/-) DECLARATION OF THE PENSIONER Ifiereby declare that : i. am not drawing any other pension Ji. | am drawing other pension through P. P.O. No. and PPO .D. ii, 1am not drawing any D. R. on that pension, iv. The patticulars mentioned above are true to the best of my knowledge and belie. Ifthe above particulars proved wrong at any time, | am liable for disciplinary / criminal action as per rules. Date Place : ‘Left hand thumb impression (Signature of the Pensioner) of the Pensioner ACKNOWLEDGEMENT Received the Annual Verification Certificate dated. of Sri/Smt . Holder of P. P.O. No. . LD.No: Receiver Signatur, Date & StampCERTIFICATE - 1 (To be ‘issued by the Drawing & Disbursing Officer) Certified that Smt. Sri. Wio.of H/o. of late, 1-oeeeWas appointed as. ‘on compassionate grounds in this office with effect from ., She / He is being paid the Dearness Allowance eligible to her at the rates sanctioned by the Government from time to time. ‘As per the declaration filed by the individual, she/he is not drawing any D. R. on the family pension being drawn vide P. P.O. No. ss from the Sub Treasury / Pension Payment Office. Signature & Office Seal Station : Date CERTIFICATE - II Certified that I have seen the pensioner as on alive on this date. Signature of the Gazetted Officer / ' Bank Manager (With Name and seal) Date Place Signature of the Treasury Officer, ise., STO / ATO / APPO (With Name and seal) NOTE |. The Pension Disbursing Officer can sign the Certificate if the pensioner appears personally before the Pension Disbursing Officer. |I. . If Pensioner does not appear personally before the Pension Disbursing Officer, the Certificate shall be signed by any Gazetted Officer / Bank Manager. |. The Annual Verification certificates are obtained Form 1st November onwards. IV. To the event of Non-receipt of the Annual Verification Certificate the pension shall be stopped Form ‘1st April onwards (i.,) March payable on 1st April.