PAFA-409

LIFE CERTIFICATE, LETTER OF AUTHORITY PENSIONERS NOT ABLE TO

APPEAR IN PERSON TO RECEIVE PAYMENT

HO/TS No……………………

Name of pensioner (No Rank & Name)…………………………………………………………………………………..

Name of pension disbursing officer……………………………………………………………………………………..

FOR USE BY THE PENSIONER

I have received Rs………………………Ps………………………….being my pension for the month of ………….

…………Please hand it to ……………………………………………........................................................................

(Nominee’s name, rank of designation)

Address of the nominee;- Village & post office Naka Kahut Tehsil Talagang District Chakwal

Name…………………………………………………. Signature of left hand thumb impression of Pensioner

Father/husband’s name……………………………….. (Appropriate revenue stamp be affixed if

National Identity Card No……………………………. the amount exceeds Rs.20.00 non-

commissioned Village……………………PO………………………... officer, men & their heirs are

exempted) Teh……………………….Distt……………………….

Station………………………………………………….

Date…………………………………………………….

DECLARATION “A” DECLARATION “B” DECLARATION “C” DECLARATION “D”

I declare that I am not
Re-employed in (a)
Govt
Department, Autonomous
Organizations and
Nationalized Bank s ; (b) In a
Military capacity on re-
enrolment or re-attestation
during the period for which
pension is claimed on the basis
of this certificate or during any
period since the last
declaration was given by me.
(See notes 1 to 3 and 5
below)I further declare that I
have not been convicted in any
criminal case an offence of
political nature.
Signature or left-hand
thumb impression
I further declare that except
the pension specified in the
certificate, I am neither in
receipt of any family
pension nor any service or
disability pension in
respect of previous service
in any regiment or other
Military formation or any
other Department, Civil or
Military under Government
of Pakistan or any Local
Government (see Notes 1to
3 below)
Signature or left-hand
thumb impression
I declare that I am in receipt I declare that (a) I proceeded
of a second pension, full abroad under prior
particulars of which are given permission of Govt of
below:- 1.Nature of Pension Pakistan vide their
No dated I am
2. Rate of Pension in possession of Passport
No valid up to
3.Date of commencement of Issued by
Pension (b) That I am a
4.Service or other particulars National and have changed
in respect of which the second my Pak Nationality to
pension was granted vide No dated
(c) That, I, except with the
5. Authority sanctioning previous permission in
the second Pension writing of the Central Govt
have not sought/taken up
employment continued
service as an officer or
servant of a Foreign
Government or a foreign
agency (see Note7)
Signature or left-hand Signature or left-hand
thumb impression thumb impression

of the pensioner of the pensioner of the pensioner of the pensioner

Station Station Station Station
Date: Date: Date: Date:
NOTES:

1. When a pensioner is neither re-employed nor in receipt of a second pension, he should sign at the place provided
for the purpose underneath the Declaration ‘‘A’’ & ‘‘B’’.
2. When a Pensioner is re-employed, he would sign at the place provided for the purpose underneath the
Declaration ‘‘B’’ as well as P.A.F.A. 379, which will be in lieu of Declaration “A’’
3. When a Pensioner is in receipt of a second pension, he should sign at the place provided for the purpose
underneath the Declaration “A”, further information regarding the second pension should be recorded in
Declaration “C”.
4. Female pensioners applying for pensions whose pensions are terminable by re- marriage, or marriage, should
render a widowhood or non-marriage certificate in addition.
 FOR USE BY THE PENSIONER’S NOMINEE

I have received Rs. Ps. being pension of _

to be handed over to him/her

(Descriptive No. Rank and Name)
Station Nominee’s signature
Date
(Note:- Not applicable where payment of pension is made through MO by the CMP, Lahore Cantt).

FOR USE BY THE ATTESTING OFFICER

I hereby certify that pensioner

(Descriptive No. Rank and Name)

late of the

(Corps. Department or Office)

Or pensioner’s heir or heirs widow or children

(Descriptive No. and Name)

Of late is or are alive on this date, and

(Rank, Name and Corps or Office)
is or are alive on this date and his/her signature or left hand thumb impression on this form have been taken in my
presence.

Signature or left-hand thumb

impression of the pensioner Signature (Name)

Station Nominee’s Signature

Date

Rank or Designation

Notes: 1. Life Certificate should be obtained on or after the last day of the month or quarter for which pension is due.

a. In the case of pensioners residing in Pakistan a magistrate or civil judge or (b) a registrar or sub registrar or (c) a
pensioned office who before retirement exercised the power of magistrate or gazetted officer of govt. In the case of
severely wounded and infirm. Pakistan Military pensioners and female pensioners who are not accustomed to
appear in public, a life certificate from a responsible Govt. Officer or by some other well-known and
trustworthy person i.e a Pak commissioned officer, civilian gazetted Officer, a Sub Inspector of Police sub
postmaster. A Tehsildar, a village head man or the Head of the Union Council, who is an acquainted with the
pensioner will be accepted by the pension paying officer, Postmaster or Treasury Officer provided he has no reason
to doubt the veracity of such a certificate.

2. In the case pensioners residing outside Pakistan, life certificate signed by the head of the Pakistan High
Commission/Embassy/Mission in that country or gazetted officer duly authorized by him will be treated as
valid.