FORM “C” ANNEXURE-XVII
LIFE CERTIFICATE
(To be submitted by Pensioner once a year in November)

Certified that I have seen the pensioner Shri/Smt/Ms ____________________________
____________________________ (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