Pensioner/family Pensioner Beneficiary Form - Annexure-I And Annexure-Ii

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ANNEXURE-I
PART-A
LIFE CERTIFICATE
[To be submitted by Pensioner/Family Pensioner once a year]
Certified that I have seen the Pensioner/Family Pensioner
Recent Passport
Thiru/Tmt./_____________________________________
Size Photo
[colour]
______________________________________________
holder of
P.P.O No.
and that he/she is alive on this date.
Specimen Signature of Pensioner/Family
Pensioner/Exgratia beneficiary
Signature of Attesting
Officer
Name:
Place:
Designation:
Date:
Office Seal :

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