File No.

RDDTP-ESTB0INC/21/2021-SUPDT(SUPDT)-RDDTP-VSP

CERTIFICATE
(As laid down in Govt. Memo.No.101215/A/1600/Ren.II/78)

Certified that Sri A. Santhosh Kumar, (Name and Designation) Surveyor.

basic pay is Rs. 32,340/- has already insured under Policy No.2709619-A of the

Director of Insurance Government of Andhra Pradesh, or its Regional Offices and a

monthly premium of Rs. 1150/- is being deducted from his/her salary in accordance

with the rules of compulsory Insurance Scheme applicable to Andhra Pradesh, State

Government Employees and on has proposed for at insurable of his/her life and sum of

Rs. Towards monthly premium is paid into by challan No.

Hyderabad towards compulsory Insurance Scheme applicable to the Government

Employees as per G.O.Ms.No.337 Finance and Planning (Fin.II) Department,

dt.3-8-1976.

Certified the age of Sri/Smt/Kum

(Name and Designation) has exceeded 53 years he/she cannot insured the life with the

Government Life Insurance Department.

SIGNATURE OF THE DRAWING

AND DISBURSING OFFICER.

To
The Individual concerned.
Copy to the District Treasury Office, Visakhapatnam .
Copy submitted to the Director of Town & Country Planning, A.P., Mangalagiri,
Guntur District for kind information.