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MADURAI KAMARAJ UNIVERSITY
PENSIONER / F'AMILY PENSIONEN. LIFE CERTIFtrCATE
P6nsiona/s
Recent Photo
with Atestation
at.top
PAN NUUBER
of the image
Name
DETAILS OF BANK
Name of the Bank
Address
Pensioner Number (in alphanumeric
A/c.No.
Phone
tFsc
Mobile
MICR
I - LIFE CERTI.FICATE
Certified that I have seen the Pensioner / Family Pensioner.
g,{ame in block letters) ofMadurai Kamaraj University and that he / she is alive on this date.
Name
Place:
Date
Signature ofthe Gazetted
:
Officer
with Office seal
Designation
II - NON-EMPLOYMENT / RE-EMPLOYMENT CERTIFICATE
:
:
I,,,,..!i,,r,.,r,r,.,
Pensioner ofMadurai Kamaraj University declare that,
i) I have not been serving in any capacity either in the State or Central Goverffnent.
(or)
ii) I have beenemployed/re-employedinthe offrce of ..
which is apart ofthe State / Central Government andhave receivedthe followingmonthly
rates ofcrnolurnents.
Basic Paypermonth :Rs.
iii)
DeamessAllowance :Rs.
0f...,....
I have received the following monthly Pension in the office
is the part ofthe State / Central Government. I) Basic Pension Rs.. . ..,.
..which
D.A.Rs.........
Place:
Date:
Signature
III
- CERTIFICATE OF NON - RE-MARRIAGE (Applicable to widows only)
University hereby declare that I have not-re-married and
I
undertake to report such an event,
if
any hoppened,
promptly to the University.
Place:
Date:
Signature
IV . CERTIFICATE OF' NON . M.{,RRIAGE
(applicable only for the wards (son/daughter) of the University deceased staff)
............
of
(Name in block letters), Family Pensiqnor
I,
Madurai
Kamaraj University hereby declarqthat Ihave not married duringthepastyearand Iam now..1.,..,.,.,!....,.,...... years of
old.
Place:
Date:
Signature
I certify that to the best of my knowledge and belief the above declarations
Place:
:
Date
Name:
Designation:
are ooxreat.
Signature of the Gazetted Officer
'with Ofiise seal