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PAFA-409 LIFE CERTIFICATE, LETTER OF AUTHORITY PENSIONERS NOT ABLE TO APPEAR IN PERSON TO RECEIVE PAYMENT HO/TS No…………………… Name of pensioner (No rank & name)………………………………………………………………………………….. Name of pension disbursing officer…………………………………………………………………………………….. FOR USE BY THE PENSIONER I have received Rs………………………Ps………………………….being my pension for …………………………. …………………………………………............Please hand it to ……………………………………………................ (month and year)

(Nominee’s name, rank of designation)

Address of the nominee………………………………………………………………………………………………………………

Name………………………………………………….

Signature of left hand thumb impression of Pensioner

Father/husband’s name………………………………..

(Appropriate revenue stamp be affixed if

National Identity Card No…………………………….

the amount exceeds Rs.20.00 non-commissioned

Village……………………PO………………………...

officer, men & their heirs are exempted)

Teh……………………….Distt………………………. Station…………………………………………………. Date……………………………………………………. DECLARATION “A” I declare that I am not Re-employed in (a) Govt Department, Autonomous Organizations and Nationalized Bank s ; (b) In a Military capacity on re-enrolment or re-attestation during the period for which pension is claimed on the basis of this certificate or during any period since the last declaration was given by me. (See notes 1 to 3 and 5 below)I further declare that I have not been convicted in any criminal case an offence of political nature.

DECLARATION “B” I further declare that except the pension specified in the certificate, I am neither in receipt of any family pension nor any service or disability pension in respect of previous service in any regiment or other Military formation or any other Department, Civil or Military under Government of Pakistan or any Local Government (see Notes 1to 3 below)

DECLARATION “C” I declare that I am in receipt of a second pension, full particulars of which are given below:1.Nature of Pension __________ __________________________ 2. Rate of Pension ___________ __________________________ 3.Date of commencement of Pension____________________ 4.Service or other particulars in respect of which the second pension was granted__________ __________________________ 5. Authority sanctioning the second Pension ___________ __________________________

DECLARATION “D” I declare that (a) I proceeded abroad under prior permission of Govt of Pakistan vide their No______ dated_______ I am in possession of Passport No_________ valid up to _____ Issued by__________________ (b) That I am a _____________ National and have changed my Pak Nationality to ___________ vide No_______ dated________ (c) That, I, except with the previous permission in writing of the Central Govt have not sought/taken up employment continued service as an officer or servant of a Foreign Government or a foreign agency (see Note7)

Signature or left-hand thumb impression of the pensioner Station__________________

Signature or left-hand thumb impression of the pensioner Station__________________

Signature or left-hand thumb impression of the pensioner Station__________________

Signature or left-hand thumb impression of the pensioner Station__________________

Date:___________________

Date:___________________

Date:___________________

Date:___________________

NOTES: 1. 2. 3. 4.

When a pensioner is neither re-employed nor in receipt of a second pension, he should sign at the place provided for the purpose underneath the Declaration ‘‘A’’ & ‘‘B’’. When a Pensioner is re-employed, he would sign at the place provided for the purpose underneath the Declaration ‘‘B’’ as well as P.A.F.A. 379, which will be in lieu of Declaration “A’’ When a Pensioner is in receipt of a second pension, he should sign at the place provided for the purpose underneath the Declaration “A”, further information regarding the second pension should be recorded in Declaration “C”. Female pensioners applying for pensions whose pensions are terminable by re- marriage, or marriage, should render a widowhood or non-marriage certificate in addition.

FOR USE BY THE PENSIONER’S NOMINEE I have received Rs.______________________Ps._____________being pension of ________________ _______________________________________________________to be handed over to him/her (Descriptive No. Rank and Name) Station_________________________________________Nominee’s signature___________________ Date___________________________________________ (Note:- Not applicable where payment of pension is made through MO by the CMP, Lahore Cantt). FOR USE BY THE ATTESTING OFFICER I hereby certify that pensioner ___________________________________________________________ (Descriptive No. Rank and Name) late of the ___________________________________________________________________________ (Corps. Department or Office) Or pensioner’s heir or heirs_______________________________________________widow or children (Descriptive No. and Name) Of late _____________________________________________________is or are alive on this date, and (Rank, Name and Corps or Office) is or are alive on this date and his/her signature or left hand thumb impression on this form have been taken in my presence.

Signature or left-hand thumb

____________________________

impression of the pensioner

Signature (Name)

Station_______________________

Nominee’s Signature

Date_________________________

____________________________ Rank or Designation

Notes: 1.

Life Certificate should be obtained on or after the last day of the month or quarter for which pension is due.

a. In the case of pensioners residing in Pakistan a magistrate or civil judge or (b) a registrar or sub registrar or (c) a pensioned office who before retirement exercised the power of magistrate or gazetted officer of govt. In the case of severely wounded and infirm. Pakistan Military pensioners and female pensioners who are not accustomed to appear in public, a life certificate from a responsible Govt. Officer or by some other well-known and trustworthy person i.e a Pak commissioned officer, civilian gazetted Officer, a Sub Inspector of Police sub postmaster. A Tehsildar, a village head man or the Head of the Union Council, who is an acquainted with the pensioner will be accepted by the pension paying officer, Postmaster or Treasury Officer provided he has no reason to doubt the veracity of such a certificate. 2. In the case pensioners residing outside Pakistan, life certificate signed by the head of the Pakistan High Commission/Embassy/Mission in that country or gazetted officer duly authorized by him will be treated as valid.