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ACCOUNTANT GENERAL’S DEPARTMENT |
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PUBLIC BUILDING WEST |
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KING STREET |
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KINGSTON, JAMAICA W.I. |
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LIFE CERTIFICATE |
Name in Full: |
__________________________________________ |
Address: |
__________________________________________ |
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__________________________________________ |
Office: |
__________________________________________ |
Nature of Claim (Salary/Pension) _________________________________________
Period ending: |
__________________________________________ |
Signature of Claimant: |
__________________________________________ |
I hereby certify that Mr./Miss /Mrs. ______________________________________
whose signature is affixed above, appeared before me this day.
___________________________________ |
___________________________ |
Name of Person Certifying (please print) |
Signature of Person Certifying |
____________________________________________________________________
Address
Qualification: ___________________________________ Date: _______________
Note:
a.This Certificate should not be completed before the last day of the period for which salary or pension is claimed; quarter periods end on 31st March, 30th June, 30th September and 31st December;
b.This form may be obtained at the Office of the Crown Agents, London; Accountant General’s Department, Jamaica; Jamaica Consulates and High Commissions;
C. The Certificate may be signed by any of the following: Magistrate, Minister, Notary Public or Banker.