ANNUAL VERIFICATION CERTIFICATE

  1. Type of Pension: Service Pension/ Family Pension
  2. Name of the Individual:

S/o, D/o, W/o, H/o:

  1. Date of Birth / Age :
  2. P.P.O No.:
  3. Name of the Bank and Branch:

OLD
NEW
  1. Bank Account No.
  1. Employment Particulars

(Applicable if Re-Employed after retirement / Appointed on Compassionate Grounds)

(a)Name of 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

  1. Re-Marriage Particulars if any

(a)Date of Re-Marriage:

(b)Name of the Spouse:

  1. Present residential Address with Phone No:
  1. PAN No. if any:

DECLARATION OF THE PENSIONER

I here by declare that:

  1. I am not drawing any other pension
  2. I am drawing other pension through PPO No.
  3. I am not drawing any D.R. on that pension.
  4. The particulars mentioned above are true to the best of my knowledge and belief.
  5. If the above particulars proved wrong at any time, Iam liable for disciplinary/ criminal action as per rule.

(OR)

Date :Left and Thumb( Signature of the Pensioner)

Place: impression of the pensioner

ACKNOWLEDGMENT

Received the Annual Verification Certificate dated of Sri/Smt. .

Holderof PPONO. .

Receiver Signature, Date & Stamp

CERTIFICATE – 1

( To be issued by the Drawing & Disbursing Officer)

Certified that Smt /Sri .

W/o of H/o of Late was appointed as .

. on compassionate grounds in this office with effect from .

She / He is being paid the Dearness Allowance eligible to her at the rates sanctioned by the Government from time to time.

As per the declaration filed by the individual ,she /he not drawing any D.R. on the family pension being drawn vide PPO No. from the Sub-treasury /Pension Payment Office.

Station:Signature and Office Seal

Date:

CERTIFICATE –II

Certified that I have seen the Pensioner as on and he /she is alive on this date.

Date:Signature of the Gazetted Officer /bank Manager

Place:( With Name and Seal )

Signature of the Treasury Officer,

i.e. STO/ATO/APPO

( with name and Seal )

Note:

  1. The pension disbursing Officer can sign the certificate if the pensioner appears personally before the pension disbursing office
  2. If pensioner does not appear personally before the pension Disbursing Officer, the Certificate shall be signed y any Gazetted Officer / Bank Manager.
  3. The annual verification Certificates are obtained from 1st November onwards.
  4. The non-receipt of the Annual Verification certificate the pension shall be stopped from 1st April onwards (i.e.) March payable on 1st April.