NRI Pensioners: Consolidated life certificate

CONSOLIDATED LIFE CERTIFICATE/NATIONALITYCERTIFICATE FOR NRI PENSIONERSLIFE CERTIFICATECertified that Shri / Smt. ……………………………………………………………holder of PPO No. …………………… is alive on this date i.e. ………….Signature of PensionerH.O. No. : …………………………………PPO No.: ………………………………….(Signature of authorisedsignatory of IndianEmbassy withdesignation And Stamp)Name of The PDA: …………………….NATIONALITY CERTIFICATEI certify that I was an Indian National at the time of retirement andhave not thereafter changed my nationality and become anaturalised citizen of a Foreign state. Power of Attorney has beenexecuted in favour of …………………………………………………………………(Name & address of bank) and NRI A/C No. ……….has been opened.ORI have changed my nationality and become a citizen of…………………………….(name of country) with effect from ……………(CTC/Xerox copy of Nationality Certificate attached). Power ofAttorney has been executed in favour ofPage 1 of 2

………………………………………………… (Name & address of bank) and anNRI A/C No. ……………. has been opened.Countersigned by authorisedsignatory of Indian EmbassySignature of pensionerH.O. No. …………………with designation stamp.NOTE :1. Delete whichever is not applicable.2. In case where the pensioner continues to be anIndian National, certificate is to be countersigned byan official of Indian Embassy.Page 2 of 2