CERTIFICATE OF RE-MARRIAGE/MARRIAGE

I hereby declare that I have not got re-married and I undertake to report such an event promptly to the pension Disbursing Authority/bank. (Applicable only for widow recipient of family pension and to be furnished only once) or I hereby declare that I am not married/I have not got married during the past six months. (To Be submitted by widowers and unmarried daughters once every six months in May and November) PLACE:__________________ DATE:___________________ Signature_______________________________________ Pensioners Name________________________________ P.P.O No. ______________________________________

I certify to the best of my knowledge and belief that the above declaration is correct.

Signature of a responsible officer or a well-known person

PLACE:__________________ DATE: _________________

Name__________________________________ Designation _____________________________

AXIS BANK LIMITED LIFE CERTIFICATE Certified that I have seen the Pensioner ____________________________________________ ( Name of the Pensioner) holder of the Pension Payment Order No._____________________ and that he is alive on this date

AXIS BANK LIMITED Branch ____________

Name____________________________________ Designation of authorised officer__________________

Date:

Seal

LETTER OF UNDERTAKING The Branch Manager, AXIS BANK LIMITED, CENTRAL PROCESSING UNIT, Dear Sir, Sub: Payment of Pension Ref: P.P.O No.____________________ through your office ________________ In Consideration of your having at my request agreed to make payment of pension due to me every month, by credit to my account with you, I, the undersigned, agree and undertake to refund or make good any amount to which I am not entitled or any amount which may be credited to my account excess of the amount to which I am or would be entitled. I further hereby undertake and agree to bind myself and my heirs, successors, executors and administrators to indemnify the bank from and against any loss suffered or incurred by the bank in so crediting my pension to my account under the scheme and to forth with pay the same to the bank and also irrevocably authorized the bank to recover the amount due by debit to my said account or any account/deposits belonging to me in the possession of the bank. Yours faithfully, Signature: Date: _____________________________ Name: Address: ANNEXURE K.

Signature: Witness: I Name: Address:

Signature: Name: Witness: II Address:

FORM OF CERTIFICATE OF NON-EMPLOYMENT/RE-EMPLOYMENT I I declare that i have not been serving in any capacity either in a Government department/ office or Company /Corporation/ Autonomous body / Society of Central or State Government or Union Territory or a Local Fund during that half-year ended May / November, 20__. OR I declare that I have been employed /re-employed in the office of _____________________________________________which is a part of/financed by ________________Government and was in receipt of the following monthly rates of emoluments during the half year ended May/ November, 20__or/during the months of ______________________________________________falling within the said half year. (a) Pay_______________________________________________________Special Pay/ Allowance ____________________________________ (Including D.A, A.D.A. etc.) OR (b) Honorarium Further, that the orders of my re-employment do/do not stipulate my pension being held in abeyance during the re-employment period. II I declare that I have not accepted any commercial employment in India OR I declare that I have accepted commercial employment in India after obtaining previous sanction of the Central Government and none of the conditions, if any, attached thereto by Government has been violated. NOTE: This declaration is required to be given for a period of two years from the date of retirement. III I declare that I have not accepted employment under a Government outside India/an International Organisation of which Government of India is not a member after obtaining the previous sanction of the Central Government and none of the conditions attached thereto by the Government has been deviated from. Signature_____________________________________ Name of the Pensioner__________________________ P.P.O.No. ___________________________________ Certificates at II and III are to be furnished only by-retired Group "A" Officers.

PLACE:___________________ DATE:____________________