A. And T. No.

260
Mize
Pensioners
Whose left Certified that pensioner
Who Hand thumb and finger impression
is taken has signed the bill in my below
is alive on the _____/_____/20___
Presence
Name __________________
Designation __________________
The thumb and finger impression need
not be taken in the case of India princes
European ladies, person who have been
gazetted officers persons who hold
government titles and pre-sons who
have be specially exempted by
government.
The certificate may be signed by any
official or non-official mentioned in
articles 945 and 948 C.R. As the
provision or one or the other articles
apply to the pensioner concerned.
If the pensioner is a female not as
cushioned to oper in public or male who
is unable to appear at the treasury in
come sequence of bodily bill ness
osenufirmity. The not should bestation
in the file.
Health of Account __________________
PPO No. ___________ Vr. No. ______
Received from the _________________
treasury the some of rupees _________
_______________________________________________
_______________________________________________
Being the amount of my pension as ___
________________________________
For the period from
_____/____/20__ to _____/____/20__
Pensioner
The _____/_____/20___
Pay rupees ______________________
_______________________________________________
Examined
Treasury Officer
Print Size =5.5 x 8.5 J erjees Haider/*****
THI S CERTI FI CATE I S NOT REQUI RED FROM PENSI ONER
THE STRAI TS STATEMENT AND HONG KONG GOVERNMENT
I declare that I have not received any remuneration for serving is any capacity either
in a government establishment or on establishment paid from local fund during the
period for which the amount of pension claimed in the bill is due
. / . . - , . : . . : . .
. : . - . .
Dated _____/_____/20___ signature of pensioner
(Certificate required from service pensioners if Re-Employed)
I declare that I am at present employed of ________________________ working on
permanent/temporary basis on a pay of Rs _____________________________ ensem
and that the pay of the appointment I held immediately before my bank pensioned
was Rs ________________________ per-month.
. . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . .
. . . _ . . . . . . . . . . . . . . . . . . . . . . . . . _ : . _ , ' . /
. . . . . . . . . . . . . . . . . . . . . . . . . .
Dated _____/_____/20___ signature of pensioner
Print Size =5.5 x 8.5 J erjees Haider/*****