CERTIFICATES TO BE SUBMITTED BY PENSIONER STATE BANK

CERTIFICATES TO BE SUBMITTED BY PENSIONER

STATE BANK OF INDIA ANNEXURE – A

Branch Name: ……………………………. Branch Code: …………

SB A/C No.: ……………………………. Category: Def/Central/Rail/Telecom/State

_____________________________________________________________________________________

I. Life Certificate

Certified that I have seen the Pensioner …………………………………………………………...

…………………………………….. holder of Pension Payment Order No. ………..……………. and A/c No. ……………...………. and

that he is alive on this date.

Signature with SS No.: ………………………………

Date: ………………………………

_________________________ Name: ………………………………

Signature of Pensioner Designation: ………………………………

Seal: …………..…………………..

Name:

Place:

Date:

ADDITIONAL INFORMATION

I submit herewith additional details as under:

1. Income Tax Permanent Account Number (PAN) :_________________

2. Mobile No. :_________________

3. Date of birth of the Pensioner/Spouse: ___________________

(Proof of Date of Birth attached)

4. Aadhar No.: …………………………………

5. e-Mail Address:--------------

_________________________

Signature of the Pensioner

Name of the Pensioner: ______________________

.Aadhar No.: ………………………………….

Savings Bank Account No. ___________________

II. Non Employment Certificate

*I declare that I have not received any remuneration for serving in any capacity in the establishment of the Central Government or a

State Government or a Government undertaking or from a Local Fund during the period November to April 20……, May to October

20……

*I declare that I have been employed/re-employed in the office of ……………………………….

and was in receipt of the following emoluments during the period (to be specified).

*I declare that I have not accepted any employment under any Government outside India or Commercial Employment after

obtaining/without obtaining sanctioning of the Director/CSIR (to be furnished by Class I Officer only).

* Strike out whichever is not applicable

Place: ……………………… ___________________

Date: ……………………… Signature of Pensioner

III. Certificate of Re-marriage/Non-marriage

I hereby declare that I am not married/I have not been re-married during the past six months and shall inform the Bank as soon as I

marry/re-marry.

Place: ……………………… ___________________

Date: ……………………… Signature of Pensioner

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

_____________________________

(Signature of the responsible officer

or a well-known person)

Place: ……………………… Name: ………………………

Date: ……………………… Designation: ………………………