Application for Issuance of Life Certificate

To,
The Branch Manager,
__________ (Name of Bank) Bank,
__________ (Branch)

Date: DD/MM/YYYY

Subject: Issuance/Attestation of Life Certificate

Sir/Madam,

I, _______ (Pensioner Name) holding a _______ (Savings) account bearing account number __________ (Account Number) in your _________ (branch address). I am pensioner of __________.

I request you to kindly issue/certify a duly filled life certificate as per the specified format and also attest my signature as per Bank records.

Thanking you,

Kind regards,

____________ (Signature)
____________ (Name)
____________ (Address),
____________ (Contact Number)


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