Certified that I have seen the Pensioner Mr./ Mrs. Miss blanks* Son/ Daughter/Wife/Husband of blank*holder of P.P.O No. Type a label* and he/she is alive on this date.
I hereby declare that I have /have not re-married during the last one year.
I thus certify that I have not served in any capacity in a government department / office company, corporation, autonomous body, or society of the federal, state, or union territory government, or a local fund in the previous year.
OR
I declare that I have been employed / re-employed in the office of Type a label* .Furthermore, my re-employment orders do not specify that my pension be placed in abeyance.
I hereby state that I have not accepted any commercial work opportunities in India.
I declare that I took commercial employment in India after getting prior approval from the Central / State Government, and that none of the government's stipulations, if any, have been broken.
Note: This statement must be made for a period of two years after the retirement date.
I declare that I have not accepted work with a government outside of India or with an international organization that is not a member of the Indian government.
I declare that I have accepted employment with a government outside India / an international organization of which India is not a member after getting prior approval from the Central / State Government and that none of the government's criteria have been violated.