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Self Declaration for Pension Eligibility

This document is a self-declaration form for a pension applicant. In it, the applicant declares that [1] they do not have any family members employed by the government or private sector or who receive a pension, [2] they do not own any large businesses, [3] they do not own more than a few acres of land or luxury vehicles, and [4] they understand their pension can be cancelled if any of these declarations are found to be false. The applicant signs and provides contact information at the bottom.

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83 views1 page

Self Declaration for Pension Eligibility

This document is a self-declaration form for a pension applicant. In it, the applicant declares that [1] they do not have any family members employed by the government or private sector or who receive a pension, [2] they do not own any large businesses, [3] they do not own more than a few acres of land or luxury vehicles, and [4] they understand their pension can be cancelled if any of these declarations are found to be false. The applicant signs and provides contact information at the bottom.

Uploaded by

hemapagidipalli
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

SELF DECLARATION

I,……………………….……………….…………………., S/O,D/O,W/O………..………….…………………………….,

Age:…….….., year……………..Resident of [Link]……………..………………………… , Warangal Urban district,

Telangana State, INDIA, (Aadhar Card No……………………..……..………….) do hereby solemnly affirm

and state on oath as under:

1. I am not having children who are Govt. Employee / Private sector employment / Private /
Outsourced / Govt. Pensioner / Freedom Fighter pension.

2. I am not having large business Enterprise like oil mills, rice mills, petrol pumps, rig owners,
shop owner etc.

3. I am not Owners of light and/or heavy automobiles (four wheelers and big vehicles.)

4. I am not having land more than 3.0 acres wet/irrigated dry or 7.5 acres dry.

5. I am not any other criterion in which the verification officer may assess by the manner of
lifestyle, occupation and possession of assets rendering the households as ineligible.

That the above facts are true in future if it is proved false I have no objection if my sanctioned

pension is cancelled more over I shall return all the pension amount which I obtained from the

Government by my false representation.

Date:-……………………………

Signature of the applicant / Thumb impression

Mobile No.…………………………………………

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