Certificate Form For Non-Employment/Re-Employment of a Pensioner

Company Name(s): 

NON-EMPLOYMENT / RE-EMPLOYMENT CERTIFICATE(To be given by pensioner once a year in November)
(A)Existed - Deleted*(A)I declare that I have been employed/re-employed in the Offices which is a part of / financed by and was in receipt of the following monthly rates of emoluments during the year ended November, 20 or during the month of within the said year:
(a)Pay
(b)Special Pay
(c)Other Allowances / Fees / Honorarium(it includes D.A., A.D.A., these to be shown clearly)
Further, that the orders of my re-employment do/do not stipulate my being held in abeyance during the re-employment period.
I declare that I have not accepted any commercial employment in India.
Or
I declare that I have accepted commercial employment in india, after obtaining previous sanction of the Central Government and none of the conditions, if any, attached thereto by Government has been violated.
Or
I declare that I have accepted commercial Employment in india without obtaining the sanction of Central Government.NOTE - This declaration is required to be given for a period of two years from the date of retirement.
(B)I declare that I have not accepted any employment under a Govt. outside India / an International Organisation of which Govt. of India is not a member.
Or
I declare that I have not accepted any employment under a Govt. outside India / an International Organisation of which Govt. of India is not a member after obtaining the previous sanction of the Central Government and none of the conditions attached thereto by the Govt. has been deviated from.
Or
I declare that I have accepted employment under a Govt. outside India / an International Organisation of which Govt. of India is not a member, without obtaining the previous sanction of the Central Government of which Govt. of India is not a member, without obtaining the previous sanction of the Central Govt.
Signature
Name of the Pensioner
P.P.O. No.
Place:
Date:
Certificate at (B) and (C) are to be furnished only by retired Group 'A' Officers in May and November
each year.