INDIAN INSTITUTE OF SCIENCE

Bangalore – 560012

FINANCE & ACCOUNTS

LIFE CERTIFICATE

(to be submitted by PENSIONER* once in a year in November)

*Superannuation / Voluntary / Invalid/Compulsory Retirement

1. Name of the Pensioner / 6. PPO No
2. Date of Birth / 7. PAN No.
3. Date of Retirement / 8. Bank A/c No. /
4. Address for Communication:
______
______
______/ 9. SBI/ Canara Bank:
5. E mail ID (if any) / 10. Telephone No

Place:

Date: Signature / Thump Impression of the

Pensioner

Certified that I have seen the Pensioner Mr./Ms. holder of

Pension Payment Order (PPO No and that he / she is alive on this date
Signature
Name
Designation of the authorized Officer #
Place:
Date: / Seal

# The life certificate should be got signed by the pensioner by any of the following authorized persons:

  1. The Chairman (of the Department from which employee has retired)
  2. Gazetted Officer
  3. Branch Manager (of the Bank from which pensioner drawn his/her pension)
  4. Inspector-in-charge of a Police Station (of the locality in which pensioner resides)
  5. Member of the Legislative Assembly/Council
  6. Tahsildar
  7. Pension disbursing authority.

INDIAN INSTITUTE OF SCIENCE

Bangalore – 560012

FINANCE & ACCOUNTS

LIFE CERTIFICATE

(to be submitted by FAMILY PENSIONER* once in a year in November)

1. Name of the Family
Pensioner / 6. PPO No / FP
2. Date of Birth / 7. PAN No.
3. Date of Death of Pensioner / 8.Bank A/c No. /
4. Address for Communication:
______/ 9. SBI/ Canara Bank:
5. E mail ID (if any) / 10. Telephone No
  1. CERTIFICATE OF RE-MARRIAGE/MARRIAGE

I hereby declared that I have not got re-married and I undertake to report such an event promptly to the Institute.

(Applicable to widow /widower recipient of family pension)

OR

I hereby declare that I am not married / I have not married during the past one year.

(Applicable to unmarried daughter recipient of family pension)

  1. CERTIFICATE OF NON EMPLOYMENT

I hereby declare that I am not employed and not earning more than Rs. 3,500/- per month and I undertake to report such an event promptly to the Institute. (Applicable to family pensioner whose age is between 18-25 years)

Place:

Date: Signature / Thump Impression of the

Family Pensioner

Certified that I have seen theFamily Pensioner Mr./Ms. holder of

Pension Payment Order (PPO) Noand that he/she is alive on this date
Signature
Name
Designation of the authorized Officer #
Place:
Date: / Seal

# The life certificate should be got signed by the family pensioner by any of the following authorized persons:

  1. The Chairman (of the Department from which employee has retired)
  2. Gazetted Officer
  3. Branch Manager (of the Bank from which pensioner drawn his/her pension)
  4. Inspector-in-charge of a Police Station (of the locality in which pensioner resides)
  5. Member of the Legislative Assembly/Council
  6. Tahsildar
  7. Pension disbursing authority