FORM 52

[ See Chapter

[ To be printed on ordinary

Bill for pension chargeable to............................... paid at the

Payment			Signature pensioner to non-employment certificate	Pensioner
Date	No.	Number of Pension Payment Order	We declare that we have not received any remuneration for serving in any capacity either in a Government establishment or an establishment paid from a local fund during the period for which the amount of pension claimed in this bill is due

NOTES—(1) The non-employment certificate should

(2) In the case of pensioners who furnish officer should ascertain and report whether

XXI, paragraph 517 ]

Foolscap lengthways ]

Treasury from….........................to…........................19 .

Monthly payment		Period of claim	Amount paid		Signature of payee with stamp if payment exceeds Rs. 20
Monthly payment		Period of claim	Amount paid		We do hereby acknowledge to have received the amount set against our respective names as pensions due for the periods noted under the order quoted in our respective Pension Payment Orders.
Rs.	P.		Rs.	P.

also be printed in Hindi.

particulars of re-employment in the certificate (See paragraph 526) the disbursing the rules regarding such re-employment have been duly observed.

FORM 52

Bill for pension chargeable to

Head of Account..............

Paid at the Treasury from...........to.........19

Date of payment..........

Serial no.	No. of P.P.O.	Pensioners Name	Period of claim	Monthly rate	Total Amount paid	Certificate and Receipt with stamp	Signature of disbursing officer	Remarks
						1. We declare that we have not received any remuneration for serving in any capacity either in a Government establishment or an establishment paid from a local fund during the period for which the amount of pension claimed in this bill is due.
						2. We do hereby acknowledge to have received the amount set against our respective names as pensions due for periods noted under the order quoted in our respective pension payment orders.
1	2	3	4	5	6	7	8	9
					Rs. p.

(C. S. No. 72 date 31-7-87)

[VITTA (LEKHA) ANUBHAG FILE No. 10(1)/85]