CERTIFICATE OF NON-MARRIAGE / MARRIAGE

Category of Pension: Central Civil / Defence / Railway / Telecom / TN State Govt /
Other State Govt (Mention State) :
I hereby declare that I have not got re-married and I undertake to report such any
event promptly to the Pension Disbursing Authority / Bank
(Applicable only for widow recipient of family pension and to be furnished only once)
Or
I hereby declare that I am not married/I have not got married during the past six
months
(To be submitted by widower and unmarried daughters in May and November)
Signature
Place: Name of the Pensioner:
Date: PPO No
S.B.No:
I certify to the best of my knowledge and belief that the above declaration is correct
Signature of a responsible
Officer or a well -known Person
Place: Name:
Date: Designation: