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Life Cert (Bank Local)

This document is a life certificate form for pensioners receiving payments through Mauritius' Civil Service Family Protection Scheme. The form requires certification that the pensioner's spouse or minor children are still alive, unmarried or under age, and residing in Mauritius. It must be signed annually by authorized persons such as judges, medical practitioners, or police officers, and submitted to verify the pensioner's continued eligibility for payments under the scheme.

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Youvraj Seeam
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161 views

Life Cert (Bank Local)

This document is a life certificate form for pensioners receiving payments through Mauritius' Civil Service Family Protection Scheme. The form requires certification that the pensioner's spouse or minor children are still alive, unmarried or under age, and residing in Mauritius. It must be signed annually by authorized persons such as judges, medical practitioners, or police officers, and submitted to verify the pensioner's continued eligibility for payments under the scheme.

Uploaded by

Youvraj Seeam
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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CIVIL SERVICE FAMILY PROTECTION SCHEME

FORM A7
LIFE CERTIFICATE (bank local)
PENSION NO: ………………..

To :
The General Manager,
Civil Service Family Protection Scheme Board,2nd Floor Mutual Aid Building
5,Guy Rozemont Square, Port Louis – Tel :2121781,2101032,2103503.

I,………………………………………………………………………….hereby certify that

To the best of my knowledge and belief Mr/Mrs………………………………………. ……..

the widow/widower of the late ……………………………………………………… is on

this …………………………..day of ……………………………………………20……….

still in Mauritius,alive and not remarried.

MINORS (if applicable)

I further declare that to the best of my knowledge and belief :--

(1) ……………………………….(2)……………………………………

(2) ………………………………..(4) ……………………………………

the orphan(s) of Mr andMrs ……………………………………is/are,on

this ………………………………day of ………………………20…….

still in Mauritius,alive,unmarried under 18/21 years (*) of age and under the

care of …………………………………..

(*) Applies to a child under21 years who is receiving full time education.

Signature of Attestor : ………………………………..

Title :…………………………………
______________________________________________________________
Being still in Mauritius and not remarried ,I hereby claim payment of my pension

Signature or Thumbprint of pensioner :……………………………………….


Date: ……………………..
---------------------------------------------------------------------------------------------------------------------
This form must be signed by such pensioners receiving pension through
the Civil Service Family Protection Scheme Board and forwarded once
yearly (in Febuary) to this office,addressed to the General Manager.The declaration
must be signed by any of the following persons:
Judges Supreme Court Medical Practitioners
Members of National Assembly Barristers,Notaries and Attorneys
Heads /Deputy Heads of Police Seargents and above
Ministries/Departments Municipal Councillors and Members of District Council
Ministers of Religion Managers of Banks and Sugar Estates
Members of Village Councils Districts Clerks
---------------------------------------------------------------------------------------------------------------------
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2nd Floor,Mutual Aid Building,5 Guy Rozemont Square,Port Louis
Fax :(230)212-5984, Email:[email protected]
Website:http://csfpsb.gov.mu

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