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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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