HIMACHAL PRADESH STATE ELECTRICITY BOARD LIMITED
(A State Govt. Undertaking)
Registered office Vidyut Bhawan, HPSEBL, Shimla-04(H.P.)
Number (CIN) U40109HP2009SGC031255
GST No. 02AACCH4894EHZB
Telephone Number 0177-2803600,2801675(Office)2813563(Fax)
Website address www.hpseb.com
Email
[email protected]
No: HPSEBLIF&A/PENSION-II /2020-21- {3033 Dated:-29— IP DAD
° a
juperintending Engineer (IT),
HPSEBL, Vidyut Bhawan, Shimla-4.
‘Sub: - Life Certificate.
Sir,
Enclosed please find herewith a format of Life Certificate duly modify for
uploading on the HPSEB Limited website in Pensioner Comer at the earliest please.
DA-: As above,
Yours faithfully,
wih
cs
yhes Qt 2 cela bth Sb,
nance & Accounts Wing,
B Limited, Shimla-4
Nae 4 fifate (A State Govt. Undertaking)
Registered office _Vidyut Bhawan, HPSEBL, Shimla-171004(H.P.)
Number (CIN) U40109HP2009SGC031255
GST No. 02AACCH4894EHZB
Telephone Number —0177-2809448, 2801765(Office), 2655387(Fax)
Website address www.hpseb.in
Email
[email protected]
PERSONAL INFORMATION
Pensioner’s Aadhar No. Name.
Pensioner’sPANNo._____—=—_—CurrentAddress.
Pensioner’sMobileNo,______—_—_‘#H.No,/Ward No.
Pensioner’s Land Line No. City Village. P.O.
Pensioner’s Bank A/c No. Tehsil/Sub. Tehsil.
Branch & IFSC. Distt. State.
Pin code.
LIFE CERTIFICATE
Itis certified that I have seen the pensioner Mr./Mrs./Miss. holder of the
Pension Payment Order No. HPSEB/. whose personal information is given above.
He/she is alive on this day.
Place: Name:
Date: Designation
Authorized Officer
Authorized Officers: The above certificate should be signed by any Gazetted Officer/ Panchayat Pradhan/
Bank Manager of the concerned Bank who recognizes the Pensioners /family pensioners.
(To be furnished every year in the month of November)
(TO BE FILLED IN BY ALL PENSIONER)
I declare that | have not been serving in any capacity in either Govt. Department / Offices / Company /
Corporation/ autonomous body/State or Central Govt. during the past six month.
I certify that to the best of my knowledge and belief the above declaration is correct.
(Signature of pensioner)
(To be furnished every six month in the months of May & November)
Note-: In case of non-receipt of certificate, pension from the ensuing month shall be stopped till the
receipt of certificate
CERTIFICATE OF RE-MARRIAGE/MARRIAGE /EMPLOYMENT
Ihereby declare that I have not been re-married/marriéd/employed in any capacity in either
Govt. Department / Offices / Company / Corporation/ autonomous body/State or Central Govt. during,
the half year ending during the past six months.
(To be furnished every six month in the months of May & November)
I certify that to the best of my knowledge and belief the above declaration is correct.
Place: -
(Signature of family pensioner)
