Pensioner/family Pensioner Beneficiary Form - Annexure-I And Annexure-Ii Page 5

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ANNEXURE-III
NON-RE-MARRIAGE / NON – MARRIAGE CERTIFICATE
(To be submitted by Family Pensioner/Dependants of Exgratia beneficiary
once a year OR in the event of remarriage/marriage)
[Applicable only for Widow/Widower/Daughter/Son recipient of family
pension/Exgratia)
I hereby declare that I have not married and that I have not been
married during the past year.
OR
I hereby declare that I have not re-married/married and I
undertake to report such an event promptly to the Bank concerned.
Signature of Pensioner/ Family
Pensioner/Exgratia beneficiary.
Place:
Name:
Date:
PPO.No.

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