Declaration Form by MPs for drawal of Pension

DECLARATION BY MPs FOR DRAWAL OF PENSION(To be furnished by the former member of Parliament with his first pension bill and thereafter once a year inthe month of November)
(A)I declare that -
(i)I am not elected to the office of the President/Vice-President or appointed to the Office of the Governor of any State or Administrator of any Union Territory
Or
(ii)I am not a member of Council of State (Rajya Sabha) or House of the People (Lok Sabha),any Legislative Assembly or Legislative Council of a State or Metropolitan Council of Delhi constituted under Section 3 of Delhi Administration Act, 1966,
Or
(iii)I am not employed on salary under the Central Govt. or any State Govt. or any Corporation owned or controlled by the Central Govt. or any State Govt. or any Local Authority or I am not otherwise entitled to any remuneration from such Govt. or Corporation or Local Authority.
Or
(iv)I am not receipt of any pension from Central Govt./State Govt./and Local Authority/Corporation owned or controlled by the Central Govt. or any State Govt.
Or
(B)(i)I am holding the Office of or Member of or employed asIn*and the total remuneration received by me is Rs.
Or
(ii)I am in receipt of Rs.Pension drawing from*
Station:
Date:
Signature
Name of Pensioner
Address
*Here mention the name of Office of the Central Goverment/State Government/Local Authority/ Corporation ownedor controlled by the Central or State Government.