ANNEXURE-XVII
(See para 15.1 page 11)

LIFE CERTIFICATE
(To be submitted by Pensioner once a year in November)

Certified that I have seen the pensioner Shri/SmtJMs., ___________________________ _____________ (Name of Pensioner)
holder of Pension Payment Order No. --..:and that he/she is alive on this date.
Name:
Place:
Date: Designation of Authorised Officer
Seal