Professional Documents
Culture Documents
01 Type of Pension
(Service Pension /Family Pension)
02 Name of Individual
(S/o , W/o, D/o, H/o)
03 Date of Birth & Age
04 P.P.O No.
05 Name of Bank & Branch
06 Bank Account No Old / New
07 Employee particulars
(applicant if Re-employed after
retirement / appointed on Compassionate
Grounds)
(a) Name of the Office
(b) Date of employment/Re-employment
(c) What is the D.A being drawn on
employment
(d) Date from which D.A is drawn
08 Re-Marriage Particulars if any
(a) Date of Re-Marriage
(b) Name of the spouse
09 Present Residential Address & Phone No
10 PAN No., if any
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CERTIFICATE – I
(To be issue by the Drawing & Disbursing Officer)
As per the declaration field by the individual, she/he is not drawing any D.R on the
family pension being drawn vide PPO No _______________ from the Sub Treasury /Pension
Payment Officer.
CERTIFICATE – II
Note :
1. The pension disbursing officer can sign the certificate if the pensioner appears before
the pension disbursing officer.
2. If pensioner does not appear personally before the pension disbursing officer, the
certificate shall be signed by Branch Manager.
3. The Annual Verification certificate are obtained 1st November onwards.
4. The Non-receipt of the annual Verification Certificate the pension shall be stopped
from 1 st April onwards (i.e.,) March payable on 1 st April.
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