LOSS CERTIFICATE
Certified that Pensioner’s / Disburser’s portion of Pension Payment Order No.
__________________
dated
______________
in
respect
of
Shri/Smt./Ms.________________________________ Saving Bank Account No.
_________________ has been lost / is not available and to avoid double payment a
note has been kept in the Check / Descriptive / Payment / Index register on record in
my office. The same PPO if found at a later stage will not be acted upon but will be
returned to Pension sanctioning authority for cancellation.
Signature: _____________________
Name: _____________________
Designation: _____________________
Seal: _____________________
Place: ________________
Date: ________________
Chief Manager