Affidavit of Certificate for Non Re-Marriage

I hereby declare that I have not been re-married and I undertake to report such an event promptly to the Pension Disbursing Authority / Bank. Place: _________ Signature: _________ Date: _________ Name of the Pensioner: _________ I certify to the best of my knowledge and belief that the above declaration is correct. Place: _________ Signature of a responsible Date: _________ Officer or a well – known Person Name: _________ Designation: _______

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