LIFE CERTIFICATE (CERTIFICATE TO BE SUBMITTED BY THE PENSIONER) Certified that I have seen the Pensioner Mr./Mrs./Miss.____________ holder of PPO No. _________ ® and he/she is alive. PLACE:___________ SIGNATURE_______________ SIGNATURE OF SIGNATURE AND SEAL OF PENSIONER MEDICAL OFFICER/T.O./ GAZETTED OFFICER D:\pensiondata\Final-web-pgs\LIFE CERTIFICATE.doc
