NO DEMAND CERTIFICATE

It is certified that nothing is outstanding against Mr. ________________________________

____________________________ ex ____________________________________ of this
department except following

COUNTERSIGNED SIGNATURE

DECLARATION UNDER ARTICLE 911 OF CSR

I ___________________________________ S/o ________________________________

retied ___________________ of ____________________________________________
hereby declare that, I have neither applied nor received any pension, gratuity or commutation
as for granted by the government.

COUNTERSIGNED SIGNATURE

ARTICLE UNDER ARTICLE 920 OF CSR

I hereby declare that if the amount of pension gratuity of commutation granted to me is in

excess afterwards, I shall be bound to refund the same.

Signature ___________________________

Name ______________________________

Designation _________________________

1
 SPECIMEN THUMB IMPRESSION OF:
Mst. _____________________________________________________________________
who has claimed pension/ gratuity & other funds etc on the death of her husband noted
below:-

Name of deceased Govt. servant ______________________________________________

Parentage ________________________________________________________________

Designation in the Department

At the time of death _______________________________________________________

Date of Death ____________________________ Copy attached ___________________

Department in which he was serving __________________________________________

Or thumb impression

_____________________________

_____________________________

_____________________________

ATTESTED
_____________________________

2
 PENSION CASE
LIST OF FAMILY MEMBERS
WHO ARE ENTITLED TO THE PENSION OF A DECEASED GOVERNMENT
EMPLOYEE:

S.No NAMES AGE Relationship with the deceased

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Further it is submitted that there is no family member except the members noted
above.

Dated: ________________________ Signature of the claiming

Person or T.I

Village __________________________

P.O._____________________________

Tehsil ___________________________

Distt: ___________________________

3
 CERTIFICATE OF NON-EMPLOYMENT CST 922
I declare that I have not received any remuneration for serving in any capacity, either
under government or local fund during the period for which the amount of pension claimed in
this bill is due.

Signature______________________

Name ________________________

Designation ___________________

COUNTERSIGNED SIGNATURE

NON INDULGENCE IN POLITICS

I hereby certify that I will not take part in politics within two years after the date of
my retirement.

Signature______________________

Name ________________________

Designation ___________________

COUNTERSIGNED SIGNATURE

CERTIFICATE UNDER ARTICLE 470 OF CSR

Certified that the service of _____________________________________ S/O
________________________________ retired from Government service w.e.f
_________________ have been verified and all entries/certificates are duly signed and the
service rendered by him is hereby approved for pension.

Signature______________________

Name ________________________

Designation ___________________

COUNTERSIGNED SIGNATURE

4
 DECLARATION OF NON-GOVERNMENT ACCOMMODATION
It is certified that non accommodation is allowed/ provided to Mr. _______________
____________ S/O ________________________ by this office or by the Estate Office & as
such no dues on account of House rent are outstanding against him.

Signature______________________

Name ________________________

Designation ___________________

COUNTERSIGNED SIGNATURE

OPTION FOR COMMUTATION

I hereby option for 50% Commutation out of gross pension as allowed by the
Government.

Signature______________________

Name ________________________

Designation ___________________

COUNTERSIGNED SIGNATURE

OPTION FOR BANK/TREASURY

I hereby option to draw my commutation & Pension from national Bank of Pakistan /
treasury Office ___________________________________.

Signature______________________

Name ________________________

Designation ___________________

COUNTERSIGNED SIGNATURE

5
 DECLARATION OF POSTAL ADDRESS

Name: _____________________________________

Father Name ________________________________

Address:____________________________________

Signature______________________

Name ________________________

Designation ___________________

COUNTERSIGNED SIGNATURE

FORM OF DESCRIPTION ROLLS

Description Rolls of mst __________________________________________ widows
of late _________________________________________________ are as under:

1. Name ___________________________________________________________
2. Cast: ____________________________________________________________
3. Residence: _______________________________________________________
4. Height: __________________________________________________________
5. Colour: __________________________________________________________
6. Age: _____________________________________________________________
7. Personal Identification Mar if any: _____________________________________
8. Place of Payment ___________________________________________________
9. N.I.C No. _________________________________________________________

Signature______________________

Name ________________________

COUNTERSIGNED SIGNATURE

6
 NON MARRIAGE CERTIFICATE

This is certified that Mst. _____________________________________________

Mother/widow of ________________________________ has not married and she is still
widow and alive this day on ____________________________________

Signature______________________

Name ________________________

Designation ___________________

COUNTERSIGNED SIGNATURE

DECLARATION UNDER ARTICLE 920 (I) OF CSR

In case of amount of Pension /Gratuity /Commutation /Increase sanctioned to me is
found to be in excess of that to which I am entitled to undertake to refund such excess, when
called upon to refund such excess.

Station: ____________________________________________________________

Dated: _____________________________________________________________

Signature ___________________________________________________________

Address: ____________________________________________________________

Signature______________________

Name ________________________

COUNTERSIGNED SIGNATURE

7
 DECLARATION UNDER ARTICLE 911 OF CSR
I Mst. _________________________________ widow of late _____________
_____________ who expired on __________________ do hereby declare that I have neither
applied for nor received any pension and gratuity so far granted by the Government.

Signature______________________

Name ________________________

Designation ___________________

COUNTERSIGNED SIGNATURE

NON INDULGENCE IN POLITICS

Certified that Mr. __________________________ who died on ________________
holder of PPO No. ____________________ has been last paid upto ____________________
at the following rate.

Signature______________________

Name ________________________

Designation ___________________

COUNTERSIGNED SIGNATURE

CERTIFICATE UNDER ARTICLE 470 OF CSR

Certified that _____________________________________ is not serving in any
Department.

Signature______________________

Name ________________________

Designation ___________________

COUNTERSIGNED SIGNATURE

8
Slip bearing Left/Right thumb and finger impression of:

Mr. ________________________________ S/O _____________________________

Left Hand Right Hand

Little Finger

Ring Finger

Middle Finger

Fore Finger

Thumb

Signature of Government Servant _________________________________________

Signature and Designation of the Head of the Office ___________________________

OR

The attesting officer with stamp __________________________________________

9
 NO ENQUIRY CERTIFICATE

Certified that there is no Judicial/Departmental enquiry pending against Mr.

________________________________ S/O _____________________________ who
retired/ is going to retire from Government Service on _______________________.

Place: _______________________

Dated: _______________________

Signature & Designation

Head of office

NO ENQUIRY CERTIFICATE

Certified that there is no Judicial/Departmental enquiry pending against Mr.

________________________________ S/O _____________________________ who
retired/ is going to retire from Government Service on _______________________.

Place: _______________________

Dated: _______________________

Signature & Designation

Head of office

10
 NO ENQUIRY CERTIFICATE

This is required both in the case of non Gazatted and Gazatted Government
servants and is to be furnished by the Government servants concerned in the following
form:

I hereby declare that I have neither applied for nor received any pension or
gratuity in respect of any portion of the service included in this respect of any portion
of the service included in this application and in respect of which pension or gratuity
is claimed herein nor shall I submit an application here after without quoting a
reference to this application and to the order which met be passed thereon.

Signature/thumb impression
of the employee

UNDERTAKING

I _____________________________________________________________
is hereby undertaking and given in that result excess amount of my pension and
commutation sanctioned to me. I shall be liable to refund/return the excess amount as
and when noted.

Dated:____________________

Signature/thumb impression
of the employee

Signature: __________________________

Head of the Office ___________________

Department ________________________

11