PAFA-409

LIFE CERTIFICATE, LETTER OF AUTHORITY PENSIONERS NOT ABLE TO

APPEAR IN PERSON TO RECEIVE PAYMENT

HO/TS No……………………
Name of pensioner (No rank & name)…………………………………………………………………………………..

Name of pension disbursing officer……………………………………………………………………………………..

FOR USE BY THE PENSIONER
I have received Rs………………………Ps………………………….being my pension for ………………………….
…………………………………………............Please hand it to ……………………………………………................
(month and year) (Nominee’s name, rank of designation)
Address of the nominee………………………………………………………………………………………………………………

Name…………………………………………………. Signature of left hand thumb impression of Pensioner

Father/husband’s name……………………………….. (Appropriate revenue stamp be affixed if

National Identity Card No……………………………. the amount exceeds Rs.20.00 non-commissioned

Village……………………PO………………………... officer, men & their heirs are exempted)

Teh……………………….Distt……………………….

Station………………………………………………….

Date…………………………………………………….

DECLARATION “A” DECLARATION “B” DECLARATION “C” DECLARATION “D”

I declare that I am not
Re-employed in (a) Govt
Department, Autonomous
Organizations and Nationalized
Bank s ; (b) In a Military capacity
on re-enrolment or re-attestation
during the period for which
pension is claimed on the basis of
this certificate or during any
period since the last declaration
was given by me. (See notes 1 to
3 and 5 below)I further declare
that I have not been convicted in
any criminal case an offence of
political nature.
I further declare that except the
pension specified in the
certificate, I am neither in
receipt of any family pension
nor any service or disability
pension in
respect of previous service in
any regiment or other Military
formation or any other
Department, Civil or Military
under Government of Pakistan
or any Local Government (see
Notes 1to 3 below)
I declare that I am in receipt of a
second pension, full particulars
of which are given below:-
1.Nature of Pension __________
__________________________
2. Rate of Pension ___________
__________________________
3.Date of commencement of
Pension____________________
4.Service or other particulars in
respect of which the second
pension was granted__________
__________________________
5. Authority sanctioning the
second Pension ___________
__________________________
I declare that (a) I proceeded
abroad under prior permission of
Govt of Pakistan vide their
No______ dated_______ I am in
possession of Passport
No_________ valid up to _____
Issued by__________________
(b) That I am a _____________
National and have changed my
Pak Nationality to ___________
vide No_______ dated________
(c) That, I, except with the
previous permission in writing
of the Central Govt have not
sought/taken up employment
continued service as an officer or
servant of a Foreign Government
or a foreign agency (see Note7)

Signature or left-hand Signature or left-hand Signature or left-hand Signature or left-hand

thumb impression of thumb impression of thumb impression of thumb impression of
the pensioner the pensioner the pensioner the pensioner
Station__________________ Station__________________ Station__________________ Station__________________

Date:___________________ Date:___________________ Date:___________________ Date:___________________

NOTES:

1. When a pensioner is neither re-employed nor in receipt of a second pension, he should sign at the place provided for
the purpose underneath the Declaration ‘‘A’’ & ‘‘B’’.
2. When a Pensioner is re-employed, he would sign at the place provided for the purpose underneath the Declaration
‘‘B’’ as well as P.A.F.A. 379, which will be in lieu of Declaration “A’’
3. When a Pensioner is in receipt of a second pension, he should sign at the place provided for the purpose underneath
the Declaration “A”, further information regarding the second pension should be recorded in Declaration “C”.
4. Female pensioners applying for pensions whose pensions are terminable by re- marriage, or marriage, should render
a widowhood or non-marriage certificate in addition.
 FOR USE BY THE PENSIONER’S NOMINEE

I have received Rs.______________________Ps._____________being pension of ________________

_______________________________________________________to be handed over to him/her

(Descriptive No. Rank and Name)
Station_________________________________________Nominee’s signature___________________
Date___________________________________________
(Note:- Not applicable where payment of pension is made through MO by the CMP, Lahore Cantt).

FOR USE BY THE ATTESTING OFFICER

I hereby certify that pensioner ___________________________________________________________
(Descriptive No. Rank and Name)
late of the ___________________________________________________________________________
(Corps. Department or Office)
Or pensioner’s heir or heirs_______________________________________________widow or children

(Descriptive No. and Name)

Of late _____________________________________________________is or are alive on this date, and
(Rank, Name and Corps or Office)
is or are alive on this date and his/her signature or left hand thumb impression on this form have been taken in my presence.

Signature or left-hand thumb ____________________________

impression of the pensioner Signature (Name)

Station_______________________ Nominee’s Signature

Date_________________________ ____________________________

Rank or Designation

Notes: 1. Life Certificate should be obtained on or after the last day of the month or quarter for which pension is due.

a. In the case of pensioners residing in Pakistan a magistrate or civil judge or (b) a registrar or sub registrar or (c) a
pensioned office who before retirement exercised the power of magistrate or gazetted officer of govt. In the case of
severely wounded and infirm. Pakistan Military pensioners and female pensioners who are not accustomed to
appear in public, a life certificate from a responsible Govt. Officer or by some other well-known and
trustworthy person i.e a Pak commissioned officer, civilian gazetted Officer, a Sub Inspector of Police sub
postmaster. A Tehsildar, a village head man or the Head of the Union Council, who is an acquainted with the
pensioner will be accepted by the pension paying officer, Postmaster or Treasury Officer provided he has no reason
to doubt the veracity of such a certificate.

2. In the case pensioners residing outside Pakistan, life certificate signed by the head of the Pakistan High
Commission/Embassy/Mission in that country or gazetted officer duly authorized by him will be treated as valid.