Modification in Life Certificate (Annexture- XVII): CPAO

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GOVERNMENT OF INDIA
MINISTRY OF FINANCE
DEPARTMENT OF EXPENDITURE
CENTRAL PENSION ACCOUNTING OFFICE
TRIKOOT-Il, BHIKAJI CAMA PLACE.
NEW DELHI-110066

CPAO/Tech/Amdt.-Sch. Book/2015-16/1655
dated: 12.10.2015

Amendment to the Scheme for Payment of Pensions to Central Government Civil Pensioners by Authorized Banks [Fourth Edition, 3rd December, 2004)

Correction Slip-24

Modification in Life Certificate (Annexure-XVII)

ANNEXURE-XVII
(See para 15.1 page 11 of
CPAO’s Scheme Booklet)
Part-A (Every year) 
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. 

1. Present address of the pensioner/ family pensioner.

2. Telephone/Mobile number (if any).

3. E-mail Address (if any).

Name:
Place: 
Designation of Authorised Officer 
Seal
Date: 

ACKNOWLEDGEMENT 

Life Certificate of Pensioner/Family Pensioner of Shri/Smt/Ms._______ _____________ _________ _________ (Name of Pensioner) holder of Pension Payment Order No.___________________ has been received. 

Date:- 
Signature............................... 

Name....................................................... 
Stamp of the receiving Bank branch

sd/-
(Vijay Singh)
Sr. Accounts Officer (Tech)
Source:- Correction Slip- 24 of Life Certificate

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