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Coal Mines Provident Fund Organisation: (Ministry of Coal, Government of India)

This document contains forms for coal mine pensioners to submit annual certifications including: 1) A life certificate to confirm the pensioner is still alive. 2) A non-remarriage certificate for widows/widowers or age certificates for unmarried sons/daughters. 3) Details of the pensioner's bank account where their pension is deposited. Pension paying bank branches must verify and forward the life certificates to nodal branches in Dhanbad or other locations by November each year.

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Sourav Dutta
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691 views1 page

Coal Mines Provident Fund Organisation: (Ministry of Coal, Government of India)

This document contains forms for coal mine pensioners to submit annual certifications including: 1) A life certificate to confirm the pensioner is still alive. 2) A non-remarriage certificate for widows/widowers or age certificates for unmarried sons/daughters. 3) Details of the pensioner's bank account where their pension is deposited. Pension paying bank branches must verify and forward the life certificates to nodal branches in Dhanbad or other locations by November each year.

Uploaded by

Sourav Dutta
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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COAL MINES PROVIDENT FUND

ORGANISATION 
(MINISTRY OF COAL,GOVERNMENT OF INDIA)

1. Pensioner's Name Please Affix
Self­Attested
2. Father's /Husband's Name Passport Size
Photo Here
3. CMPF A/c No.
4. Pension Payment Order No. Date
Details of Pension Sanctioning
 
Authority,CMPF Regional Office,Region
5. Pension Scheme(Please Tick)  CMPS'98  CMPFS'71
6. Saving Bank Account Number
Paying
7. Branch IFSCCode
Bank
8. Mobile No. of the Pensioner­
9. Aadhar Number
10. Email­ID

1. LIFE CERTIFICATE
Certified that I am alive and putting my signature/LTI/RTI as a token of proof.
Signature /LTI/RTI of Pensioner
Name   

Present Address 

2. NON REMARRIAGE CERTIFICATE/AGE CERTIFICATE OF SON/DAUGHTER
1)      I hereby declare that I have not re­married and I undertake to report such an event promptly to the Pension Disbursing
Authority/Bank.(in case of widow/widower)
2)      I have not attained the age of 25 years(in case of son).
3)      I have not married and I have not attained the age og 25 years(in the case of daughter).
(Please ✔ in the box as applicable)
I certify to the best of my knowledger and belief that the above declaration is correct.

Signature/Left Thumb/Right Thumb impression of Pensioner

Place   
Date     
(To be submitted in Pension Paying Bank Branch only in the Month of November every Year for onward transmission to
Nodal Banks after verification of signature/thumb impression of the Pensioner by the paying bank.)

NOTE FOR BANK

BANK BRANCHES ARE ADVISED TO FORWARD THE LIFE CERTIFICATE TO THEIR RESPECTIVE NODAL BRANCHES AT DHANBAD (IN
CASE OF STATE BANK OF HYDERABAD & ANDHRA BANK TO HYDERABAD AND GODAVARIKHANI RESPECTIVELY, INDIAN OVERSEAS
BANK TO KOTHAGUDEM).

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