Certificate To be Submitted by Pensioner:Life/Non Re-Marriage Certificate | Kanpur EPFO

CERTIFICATE TO BE SUBMITTED BY PENSIONER
SELF PARTICULARS (to be completed by the pensioner)
Name of the pensioner ................................................. Date of birth ...................... .
Father's name ............................................... Mother's name ................................

II LIFE CERTIFICATE
Certified that I have seen the pensioner ........................................................... (Name of the pensioner) holder of Pension Payment Order No ..................................... and that he is alive on this date.
Signature thumb impression of pensioner
Place: Name ------------------------- Designation of authorized Officer
Date:
Seal
III CERTIFICATE OF NON RE-MARRIAGE
I hereby declare that I have not been re-married and I undertake to report such an event promptly to the Pension Disbursing Authority!Bank.
Signature _____________________
Place: Name of the pensioner ____________
Date: P.P.O. No. ______________
I certify to the best of my knowledge and belief that the above declaration is correct.
Signature of a responsible Officer or
Place: a well-known person _________________
Date: Name: -------------------------------------------
Designation ______________________
D:\VYAS\CERTIFICATE TO BE SUBMITTED BY PENSIONER.doc