ANNEXURE-XI
(See para 12.3 page 6)

SPECIMEN LETTER OF UNDERTAKING BY THE PENSIONER

Date. _ To

The Branch Manager
(Bank)

(Branch & address) Dear Sir,
Payment of pension under P.P.O. No. _ through your
office.

In consideration of your having, at my request, agreed to make payment of pension due to me every month by credit to my account with you. I the undersigned agree and undertake to refund or make good any amount to which I am not entitled or any amount which may be credited to my account in excess of the amount to which I am or would be entitled. I further hereby undertake and agree to bind myself and my heirs, successor, executors and administrators to indemnify the bank from and against any loss, suffered or incurred by the bank in so crediting my pension to my account under the scheme and to forthwith pay the same to the bank and also irrevocably authorise the bank to recover the amount due by debit to my said account or any other account/ deposits belonging to me in the possession of the bank.

Signature: Name: Address:

Witnesses:

(1) Signature: (2)
Signature: Name:
Name: Address: Address:
Date: Date:

Yours faithfully,