Form to claim family pension and children allowance - Office of the ...
Form to claim family pension and children allowance - Office of the ...
Form to claim family pension and children allowance - Office of the ...
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Page 6 <strong>of</strong> 8<br />
CERTIFICATE<br />
I, Smt. ________________________________________ widow <strong>of</strong><br />
No. ________________ Rank __________________ Name<br />
______________________ certify that I am not drawing or admissible<br />
for <strong>pension</strong> from any o<strong>the</strong>r sources.<br />
ATTESTATION<br />
Signatures <strong>of</strong> <strong>the</strong> <strong>claim</strong>ant<br />
Certified that <strong>to</strong> <strong>the</strong> best <strong>of</strong> my knowledge <strong>and</strong> belief, <strong>the</strong> particulars<br />
given in respect <strong>of</strong> Smt. ______________________ widow <strong>of</strong> No.<br />
_________________ Rank _________________ Name<br />
_______________________ are correct.<br />
Station: Signatures<br />
Dated: (Name, designation <strong>and</strong> address)<br />
Station:<br />
COUNTERSIGNED<br />
Dated : Record <strong>of</strong>ficer/Assistant Record <strong>Office</strong>r<br />
This attestation may be completed by any one <strong>of</strong> <strong>the</strong> following :-<br />
• Sarpanch/ Pradhan <strong>of</strong> <strong>the</strong> Village<br />
• Army service or retired gazetted <strong>Office</strong>r, Civil or Military not<br />
below <strong>the</strong> Rank <strong>of</strong> JCO<br />
• Sub Post Master<br />
• Qanungo or Patwari<br />
• Sub Inspec<strong>to</strong>r <strong>of</strong> Police<br />
• A member <strong>of</strong> Municipal Corporation or Committee <strong>of</strong> District<br />
Board/Zila Parishad.<br />
• Village Munsif/Patel/Village <strong>Office</strong>r, Panchayat<br />
• Member <strong>of</strong> Parliament/Member <strong>of</strong> Legislative Assembly/Member<br />
<strong>of</strong> Legislative Council.
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