Appendix XIV – Payment of Pension to Railway Pensioners
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Appendix XIV – Payment of Pension to Railway
Pensioners
Note: As per
GSPR 2018, no separate category of pension account will be opened from
18.12.2019 and
all existing pension accounts are to be treated / converted as normal PO
Savings Account,
if the pensioner has no other PO Savings Single Account.
1. A Railway
employee about to retire and opting for this scheme will have to furnish a letter
of authority and undertaking in form at Annexure-1 in favour of the Postmaster concerned
to receive his/her monthly pension for credit in his/her Savings account to
his/her pension sanctioning authority (FA&CAO/Divisional/Workshop Accounts
Officer) along with the application for pension. The letter of authority and
undertaking will indicate the name of the post office through which the
pensioner wishes to draw his/her pension after retirement. It will also contain
an undertaking by the pensioners that any excess payment made towards his/her
pension and credited to his/her Savings account may be recovered or withdrawn
from the Savings account by the
Postmaster/Sub Postmaster.
2. After the
pension is sanctioned and the PPO is issued, the FA&CAO/Divisional/Workshop
Accounts Officer will forward to the concerned Director of Accounts (Postal)
the following documents under intimation to the pensioner:
(i) PPO (disburser's and pensioner's portion).
(ii) Specimen signature of pensioner duly
attested.
(iii) Photograph/Joint photograph of the
pensioner duly attested. (iv) Letter of authority and under taking (Annexure
1).
The PPO will contain a note that
the pension is to be credited to the Savings Pension Accounts of the Pensioner
to the opened at __________post office.
3. The Director of
Accounts (Postal) will forward the pension documents and letter of authority
referred to above to Head Post Office concerned after keeping a record of the necessary
particulars relating to the pensioner in a register to be maintained for this
purpose in his/her office.
4. On receipt of
the PPO along with letter of authority the Postmaster will make the entries of
the PPO in a register of PPOs in form “Pension 2” to be opened separately for Railway
Pensioners. Additional columns showing the Savings Account No. and the name of the
post office where it stands will be improvised in this register. The letter of
authority will be kept in a separate guard file and will bear the serial number
of the register of the pension payment order. The guard file will be kept in
the personal custody of the Postmaster.
5. If the account
of pensioner is to stand at a Sub Post Office the Head Offices will forward the
following documents to the sub office:
(i) A copy of the PPO with endorsement thereon “made
payable at ……………. Sub office w.e.f ………………….”
(ii) A copy of the photograph/joint
photograph.
(iii) Specimen signature.
(iv) Pensioner's half of the P.P.O.
The Postmaster of HO will credit
the pension on the last working day of each month except the month of March
when it will be credited on the first working day of April. He/She will also
issue an intimation to this effect to the pensioner requesting him,
simultaneously to present himself at the Head Office or the Sub Office where
the account is to stand for the purpose of opening of the Savings account.
6. When the
pensioner attends the post office, the Head/Sub Postmaster will, on proper identification
of the pensioner, open a Savings account with a credit of a first pension payment
observing the normal procedure of opening Savings account after obtaining an application
form SB-AOF and KYC documents etc. On the pensioner's half of the PPO the Postmaster/Sub
Postmaster, will make a note of the payment of the first pension and hand over
the same to the pensioner.
6A. Further entries
in the pensioner's half of the PPO will be made only in the following
circumstances: -
(a) When a change occurs in the quantum of pension and
the relief admissible thereon due to revision of pension, increase in relief,
etc. giving reason for this variation.
(b) When the paying post office is to be changed.
(c) The pensioners will have the option to have the
entries made in their half of the PPO at the appropriate time by presenting to
the paying post office.
7. In the case of
an existing pensioner who wishes to draw his/her pension through Post Office,
the documents will be received from the Treasury Officer under his/her special
seal by the Director/Deputy Director of accounts (Postal) who will arrange
payment through the desired Post Office. The specimen of the special seal of
the Treasury Officer and his/her specimen signature will be given to the
Director/Deputy Director of Accounts (Postal) in advance for this purpose.
The Director /Deputy Director of
accounts (Postal) will address the F.A.&C.A.O./Divisional/Workshop Accounts
Officer in this regard and ask for confirmations in the proforma vide Annexure
II. In the case of existing Railway Pensioners who opt to draw pension through
Post Office Savings Bank both the halves of the PPO would be received by
the concerned Post Office through
the Director of Postal Accounts along with other documents. A note will be made
of the payment of the first pension in the Pensioner's portion of the PPO which
will be handed over to the pensioner when he presents himself for receiving the
first payment.
8. Commutation: - The pensioner
will apply to the Pensioner sanctioning authority who will sanction the
commutation and indicate also the revised amount of pension. This will be conveyed
to the Director of Account (Postal) who will suitably advise the Head
Postmaster. The Head Postmaster will make a suitable note in both the copies of
the PPO under his/her dated signature quoting the said authority. The reduction
in the amount of pension on account of commutation shall become operative from
the date of payment of commuted value of pension to the pensioner or 3 months
from the date of issue of the letter by the competent authority asking the
pensioner to collect the commutation money whichever is earlier. The commutation
money will also be paid by credit to the savings pensions account.
9. Credit of
Pension: - In
the last week of the month Head Postmaster will prepare a separate schedule
(pension-4) for such pensioners in quadruplicate with an additional column of
the number of savings account. The words 'Railway Pensioners will be written in
red ink at the top of each copy of the schedule. In the Head Post Office, the
Postmaster will sign all the four copies of the schedule and pass on the third and
fourth copies to the APM (SB) under receipt on the last working day except for
the month of March when it will be credited on 1st working day of
April. Pension credit to savings account of pensioner should be done only at head
post office. Postmaster/APM shall be responsible for correct upload of amount
of pension into pensioner’s savings account. The postmaster will also send an
intimation to this effect to the pensioner requesting him to present himself at
the Head or Sub Office for the purpose of opening of the savings account and
crediting of the first pension. An SMS alert about credit of pension will also
be sent to the pensioners mobile. The Head Postmaster of the office will charge
the amount of pension under a separate head, “Pension payment to Railway
Pensioners” in the Head Office Summary and other relevant records by per contra
credit to the Savings accounts of the pensioners under the normal procedure.
The APM(SB) will after crediting the amount in the respective saving accounts
on the last working day of the month endorse the following certificate under
his/her dated signature on both the copies of the schedule.
“Certified that the amount shown
above have been credited in the respective accounts on………”.
He/She will return one copy of
the schedule to the Pension Branch and retain the other copy for is/her record
which will be kept in a separate guard file. Entry of pension credited to SB
accounts will reflect in the LOT generated automatically in Finacle, a single pay-in-slip
may be prepared for the total amount of pension credited. and copy of the schedule
is attached to LOT in support of the entries. On receipt of the copy from APM
(SB) the Postmaster will furnish under his/her dated signature a certificate on
three copies of the schedule that the pension amount of pensioners included in
the schedule have been credited to the respective Savings Accounts of the
Pensioners. The copy of the schedule which bears the certificate of the A.P.M.
(SB) will be kept as office copy, and the original and the second copy of the
schedule will be sent to the Postal Accounts Office with the month's Cash Account.
Note:- The monthly
pension schedules should be prepared Railway wise and contain all the information
referred to in para 14.1 of the Scheme. The schedules may be sent to the Postal
Accounts Office along with the cash account in support of the charge.
10. Income Tax
Deductions: - The
pensioners may intimate to the Postmaster/Sub Postmaster the amount of income
tax, if any, to be deducted from the pension during the course of the year. The
amount of income tax will be deducted from the pension in monthly installments
or in installments as per instructions of the pensioners and shown in the
schedule of pension payment (Pen-4). In such cases net amount of pension will
be credited to the Savings Account of pensioner. The amount of income tax
deduced will also be noted in both the copies of the PPO. At the close of the
financial year the Head Postmaster will furnish a certificate in form at
Annexure III to the pensioner showing the gross amount of the pension paid in
the year and the total amount of deductions made on the account of income tax.
Note:- Normally
provisions of para 12 of the scheme will be observed by the Head Post Office
and when there is no intimation from the pensioner, total amount of income tax
will be calculated by Head Post Office
and intimated to the sub post office concerned, if the pensioner draws his/her
pension at a sub post office.
11. Appearance of
pensioners and furnishing of necessary certificates:- The pensioner will
appear in person at least once a year either in June or December before the
postmaster concerned. . As a Digital India initiative to facilitate Pensioners,
Ministry of Electronics & Information Technology (MeitY) has launched
Jeevan Pramaan portal. Now the pensioner may use the Aadhaar enabled Biometric
authentication mechanism to generate Digital Life Certificate. The accounts branch
of HO will view/monitor/download the Digital Life Certificate. The pensioner
will also send a non employment certificate in form at Annexure-V once a year
in the month of November each year. In case the pensioner fails either to
appear in person or send the life and non-employment certificate, the pension
will not be automatically credited to his/her account.. The DLC and
non-employment certificate will be attached to the concerned schedule which
will be sent to the Postal Accounts Office. A note of the receipt of these
certificate will be made in the remarks column of the register of PPO against
the concern pensioner under the dated initials of the Postmaster.
12. The Postmaster
will not credit the amount of pension in the savings account of the pensioner
unless the conditions laid down in para 11 are fulfilled by the pensioner. The Postmaster
concerned will send an in intimation at once to the pensioner regarding the particular
deficiency which has resulted in the stoppage of automatic credit of pension.
If the pensioner does not furnish the DLC once in year, the Postmaster/Sub
Postmaster will make enquiries above the whereabouts of the pensioner at the
address available in the post office record. In case it is found that the
pensioner had expired, the date of death will be got ascertained and noted in
the PPO under the initials of the Postmaster. Further credit of the pension of
the Savings Account will be stopped.
13. In case of
excess or wrong credit of pension because of the death of the pensioner, the amount
excess credited will be withdrawn by the Postmaster from the savings account of
the pensioner under his/her own signature on the basis of undertaking given by
the pensioner in the authority letter and credited under the GL Head” sundry
account (0324) in Finacle with suitable remarks. A remark to this effect will
be made in the PPO also. In case the balance left in the account is so small
that the full recovery is not possible, the amount of over payment will be
intimated to Director of Account (Postal) by the Head Postmaster. Besides sending
the intimation of pension which cannot be recovered, a detailed report through
the next superior Authority showing the exact circumstances in which the over
payment has been made may also be sent to the Postal Account Office within one
month.
14. Transfer of
pension: - When a pensioner applies for the transfer of his/her pension to
another post office the following procedure will be followed: -
(i) When the Savings Account of the pensioner is
transferred from one sub post office to another sub post office under the same
head office, the post office hitherto making payments will transfer the
disburser's copy of the PPO along with the documents to the Head Office. The
head office after making a note to transfer in his/her record and the
disburser's copy of the PPO will transfer the documents to the new sub post
office. No advice to the Director of Accounts (Postal) will be necessary.
(ii) If the savings account of the pensioner
is transferred from one Head Office to another under the jurisdiction of same
Postal Account Office, the Head Postmaster will transfer the PPO along with
other documents to the transferee Head Office. A note to this effect will be made
in the register of PPOs so that no-further payment is made by his/her office.
He/She will intimate the transferee Head Office as also the Postal Accounts
Office the month upto which the pension of the pensioner has been credited in
his/her account. The transferee head office will acknowledge the receipt of the
pension papers and will intimate the Postal Accounts Office the month from
which he has to commence pension payments and the case mark of the transferee
Head Office.
(iii) If the transfer of the saving account is
from one head office to another head office within the jurisdiction of another
postal Account Office, the transferring Head Postmaster will return the PPO and
other documents to the Postal accounts Office which originally issued the
authority for the payment of pension. The Director of accounts (Postal) will arrange
the payment of pension though the Director of Accounts (Postal) of the
transferee head post office.
(iv) In all cases of transfer of payment from
one post office to another the Director of Accounts (Postal) should send an
intimation to the FA&CAO, concerned.
16. Receipt of
Family Pension: - The
amount of family pension payable to the widow/widower of the deceased pensioner
is also given in the pension payment order. When she/he becomes entitled to
receive family pension, the Head Postmaster will obtain the following documents
from the Name Date of birth by Christian era Widow/ Widower
Sons Unmarried Daughters
widow/widower who will also be asked to open a Savings Account in
her/her name.
(i) Death certificate of the
pensioner
(ii) Application for the family pension in
the form at Annexure VI
(iii) A copy of the photograph and
(iv) A letter of authority and undertaking at
Annexure 1.
Note:- See note 1 under
para 2 above.
17. On receipt of
the above documents the Head Postmaster will authorize the concerned post
office to start paying family pension to the widow/widower as mentioned in the
PPO after necessary scrutiny and verification of the documents. The head post
office will also send an intimation to this regard to the Director of accounts
(Postal) in the form at Annexure VII. The Director of Accounts (Postal) will in
turn inform the Railways accounting Authority. A declaration in the form at Annexure
VIII from the pensioner whose family pension is terminable on
marriage/remarriage will be sent to the office twice a year in June and December.
The certificate contained in the
declaration will be countersigned by a responsible officer or a well-known
person.
18. The Director of
Accounts (Postal) will consolidate the total amount of pension paid to Railway
Employees from the schedule submitted by Head Post Office every month. He/She will
then raise debit for the amount against the Railway Accounts Officer concerned.
19. Procedure for
revision of pensioner benefits to Railway Pensioners/ Family Pensions:-
1) Consequent upon an amendment
to the Central Treasury Rules by the Ministry of Finacle vide their O.M. No.
23014/1634/MF/CGA/991 dated 12.3.1980, introducing para 333A, the following
revised procedure is prescribed for adoption in respect of Railway pensioners
for revision of their pensioners of one reason or the other.
(i) Payment of pensions through Treasury:- In cases where
revision of pension becomes necessary for some reason (s), the pension will be
revised by the concerted Railway Accounts Officer through a formal letter of
amendment to the Pension Payment Authority already issued, indicating revised
rate of pension and graded relief due thereon along with the date from which
the payment rate is to be made. The amendment letter will be issued under the
special seal by the Railway Accounts Officer to the Treasury Officer is all
cases where the PPOs were issued by them on and after 1.1.1979 the date from
which the work of issuing Pension Payment Orders was entrusted to the Railway
Accounts Officer. In the cases i.e. where PPOs were issued by Accountant
General prior to 1.1.1979, the amendment letters so issued will be sent to the
Treasury Officer through the Accountant General concerned. A copy of the
amendment letter on both the cases will be sent to the pensioner after noting
the said amendment in the Register of Pension Payment Orders maintained by the
Railway Accounts Officers. The amendments will also be noted in both the halves
of the Pension Payment Orders by the Treasury Officer under his/her attestation
quoting, as authority, the Railway accounts Officer's letter and Accountant
General's endorsement or both as the case may be. A note will also be kept by
him on the original amendment letter that necessary corrections have been made
in both the halves of the PPO.
(ii) Payment of pensions through Post
Offices:- (1)
The Railway Accounts Officers will forward the formal amendment letters to the
Director/Deputy Director of Accounts (Postal) concerned, who will send the same
to the Head Post Office. The Head Post Office, after carrying out the
amendments in the record, forward the same to the paying posts office, authorizing
the payment of the revised pension with graded relief. The paying post office
will carry out the amendments in both the halves of the Pension Payment Orders
quoting reference of the authority letter issued by the Railway Accounts
Officer and Director of Accounts (Postal) endorsement. A note will also be kept
on the original amendment letter that necessary corrections have been made in
both the halves of the Pension Payment Order.
(2) In case where recovery on
account of graded relief becomes due as a result of revision of pension,
payment on account of additional gratuity, if any, payable due to revision,
will invariably be indicated in the amendment letter to the Pension Payment
Order for the purpose of adjustment against any amount still remaining un
recovered may be adjusted against subsequent payments of graded relief due on
the revised amount of pension.
20. Grant of
additional relief to Railway pensioners:- It has been decided by the Ministry
of Railway(Railway Board) that in further no separate orders will be issued by
them in regard to grant of additional relief to Railway pensions. The order
issued by the Ministry of Finance granting additional relief to Central civil
pensioners may be acted upon for Railway Pensioners also. The Director/Deputy
Director of Postal Accounts will take necessary in this regard.
21. Submission of
life certificate by pensioners drawing their pension through P.O.S.B.:- (1) The
pensioners will furnish a DLC once in a year . Now the pensioner need not visit
office of Disbursing Agency for physical submission of Life Certificate and may
use the Aadhaar enabled Biometric authentication mechanism to generate Digital
Life Certificate In case a pensioner is unable to obtain a DLC from the
postmaster on account of serious Illness / incapacitation etc., an intimation
to this effect supported by a medical certificate from a registered medical
practitioner about his/her inability to appear in person may be sent by him/her
to the officer-in-charge of the paying post office so that the latter may visit
the pensioner at his/her residence/hospital for the purpose of recording the
Life Certificate.
ANNEXURE – I
PENSIONER/GOVERNMENT
SERVANT'S LETTER OF AUTHORITY AND
UNDERTAKING
*I hereby authorities the
Postmaster/Sub Postmaster to receive my monthly pension on my behalf and credit
the same to my Savings Account (Pension) on the last working day or every month
as per particulars given below:-
(i) Name in full …………………………………………......…………..................…..
(ii) Particulars of Post Office/Sub Post
Office ..….…………...................................….
(iii) Particulars of Head Post Office
concerned ………………...................................…
(iv) Savings Account (Pension) No ……………………………..………......................
(v) Amount of pension per month (in words) …………………….................................
(vi) Designation, Office and Railways where
working at the time of retirement ………..…
**2. I am a Railway pensioner
drawing my pension from the Treasury at ……………. ………… I wish to draw my pension
through post office and accordingly I hereby authorize the Postmaster/Sub Postmaster to receive my
monthly pension on my behalf and credit the same to my Savings Account
(Pension) on the last working day of every month as per particular given
below:-
(i) Name in full ………………………………….......................................................……
(ii) Designation, Office and the Railway
where working at the time of retirement.............
(iii) Post Office/Sub Post Office
from where I want to draw pension in future ……………
(iv) Particulars of the Head Post
Office concerned ……………...........................................
***(v) Savings Accounts (Pension)
No …......................................……………………………
(vi) Pension Payment Order No …………………….........................................…………….
(vii) Amount of pension per month (in words) …………………....................................…….
(viii) Treasury from which it is now being drawn ………………….....................................…
3. I agree to undertake that any amount of excess/wrong
payment of pension if credited to my above Savings Account may be recovered or
withdrawn from the said Savings Account by the Postmaster/Sub Postmaster.
4. This authority shall remain in force until due
notice in writing of its revocation is given by me.
…………………………………………..
Signature
of the Government Servant / Railway Pensioner
Signature of witness
1.Name…………..............………..
Father's Name…….........…….
Address……………..........……..
Date…………………...........…….
Signature of witness
2.Name………..............………….
Father's Name.....................
Address………..............……….
Date………………..............……
*Para 1 is to be filed in by
Retiring Government Servant only.
**Para 2 is to be filled in only
by existing Railway pensioners who opt for the Scheme.
***To be filled in at the time of
first personal appearance of the pensioner before the
Postmaster/Sub Postmaster.
SB-KYC
INTIMATION
REGARDING OPTION EXERCISED BY RAILWAY PENTIONER
FOR DRAWING
PENSION THROUGH POST OFFICE INSTEAD OF THROUGH
TREASURY
From
The Director/Deputy Director of
Accounts (Postal)
__________________________________________
To
The F.A. &
C.A.O/Divisional/Workshop Accounts Officer
_______________________________________________
Subject:-Option exercised
by Railway Pensioner for drawing his/her pension through post office instead of
through Treasury.
Sir,
This is to intimate that the
Railway Pensioner named below who had been drawing his/her pension through the
Treasury has now opted to draw pension through the post office.
The details are as under:-
(i) Name of pensioner …………………………………….............……………………
(ii) Father's name …..….……………………………………………...............…………
(iii) Designation/Office and Railway from
which retired ………………….......…………
(iv) Pension Payment Order No ………………………………………………………......
(v) Pension Payment Order issued by Accountant General…………………….......…….
(vi) Pension Payment Authority No …………………………………………...........……
(vii) Pension Payment authority issued by …………………………………...........……..
(viii) Amount of pension (per month) ………………………………………............…….
(ix) Post Office from where pension is
desired to be drawn……………………........…….
(x) Particulars of treasury from where pension was drawn
hitherto…………......…..
(xi) Head Post Office concerned ………………………………………….............……
(xii) Month up to which pension was drawn from
the treasury …………........….………
(xiii) Month from which pension will be paid by
the post office……………….........…….
The Postmaster is being directed
to do the needful. Please note that debits for pension paid to the above named
Railway Pensioner will be raised against your Railway with effect from the month
of ………… The receipt of this intimation may please be acknowledged by return of
post.
Director/Dy. Director Accounts
(Postal) --------------------------------------------
ANEXURE-III
CERTIFICATE OF
DEDUCTION OF INCOME TAX
Certified that following amount
have been recovered on account of Income Tax and
Surcharge on Income Tax from the
amount of pension credited to the Savings Account
(Pension) of the pensioner named
below:
1. Name of the pensioner
2. Financial year
3. Amount of pension 4. Income Tax
5. Surcharge on Income Tax.
Postmaster
Date……....……… …………… Head Post
Office
ANNEXURE-IV
CERTIFICATE TO
BE SUBMITTED BY THE PENSIONER
Certified that I have seen the
pensioner Shri/Smt…………….(Name of the pensioner) holder of Pension Payment Order
No…………………..and that he/she is alive on this date.
Place…………………………
Date………………………..
Signature & Name…………………………
Designation of Authorized Officer (with
seal)
(Those who cannot produce DLC,
annexure IV may be collected manually).
ANNEXURE V
NON-EMPLOYMENT
CERTIFICATE
I declare that I have not
received any remuneration for serving in any capacity in an establishment of
the Central Government or State Government or a Government Undertaking or from
a local Fund during the period of December to May, 20 ………….June to November, 20………
I declare that I have been employed/re-employed in the Office of ……………and was in
receipt of the following emoluments during the period*……………………. I declare that
I have / have not accepted any employment after obtaining/without obtaining
sanction of the Government (to be furnished by Central Service Class 1 Officer during
first two years from the date of retirement). I declare that I have/have not
accepted any employment under any Government outside India after
obtaining/without obtaining sanction of the Government (to be furnished by
Central Service Class 1 Officer only).delete whichever is not applicable *to be
specified.
Place………........…. Signature
………………………………
Date……….........…. Name
of the Pensioner …………………
P.P.O. No………....…………………….
ANNEXURE VI
FORM OF
APPLICATOIN OF FAMILY PENSION
Form T.R. 40 A (Modified)
(Family Pension Scheme for
Central Government Employees 1964)
Application for a family pension
for the family of the Shri/Smt……………………
Designation……………………….….. in the
office of …...............…………………………..
1. Name of the applicant
2. Relationship to the deceased Government
servant/pensioner.
3. Date of retirement, if the deceased was a pensioner.
4. Date of death of Government Servant/Pensioner.
5. Names and ages of surviving Kids of the deceased.
Name Date of birth by Christian
era Widow/ Widower Sons Unmarried
Daughters
6. Name of the Head Post Office and its sub post office
through which the deceased pensioner was drawing his/her pension and his/her
option of Post Office at which payment is desired.
7. Name of post office at which Payment is desired.
8. Signature or left thumb impression in the case of
those who are not literate enough To sign their names.
9. Descriptive roll of ……… widow/widower/guardians of
the minor children of late………..
(i) Date of birth………......................…………..
(ii) Personal marks, if any, on
hand or face…..
(iii) Left hand thumb &
finger impressions
Small finger/Ring finger/middle
finger/index finger.
10. Full address of applicant ……………………………
Attested by
Witness by
1. 1.
2. 2.
ANNEXURE-VII
FORM OF
INTIMATION (Form
T.T. 40-B (modified)
From, Postmaster …………………………PO
To,
The Director of Accounts (Postal)
…………………………………..
No………………………………… Date ……………………………….
Sir,
I am to inform you that Shri/Smt.
……………..holder of Pension Payment Order No……………. who was drawing his/her pension
from this post office through Savings Account No…………….died on…………… The first
payment of family pension @ Rs…………..Rupees…………….only)
per month has been made to Shri/Smt. For the period from…………..to …………….through his/her
Savings Account No………………Before making the said payment the death certificate
the application form and the other documents prescribed have been obtained from
the claimant and accepted after necessary scrutiny. I have also personally
satisfied myself about the identity and title of the claimant.
Your faithfully,
(Postmaster)
ANNEXURE VIII
CERTIFICATE OF
RE-MARRIAGE/NON-MARRIAGE
I hereby declare that I am not
married/I have not been married during the past six/twelve months.
Place………………. Signature…………………….....................
Date………….……. Name
of the Pensioner…….......................
P.P.O. No………………….......................
I certify to the best of my
knowledge and belief that the above declaration is correct.
Signature of a responsible officer
Or a well-known person
Name…………………………………..
Designation…………………………
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