A member of the APSRTC Staff Retirement Benefit Scheme submits a life certificate to confirm they are still alive and receiving benefits from the scheme. The certificate contains the member's signature and date, as well as certification from an officer verifying the member appeared before them on that date and is alive. The officer signs and places an office seal on the certificate.

1. APSRTC STAFF RETIREMENT BENEFIT SCHEME,HYDERABAD
LIFE CERTIFICATE
STAFFNO MEMBERSHIP NO
1.I
…………………………………………………………………………….E……………………………
…………………….. a member of APSRTC Staff Retirement Benefit Scheme, am still living
and receiving the benefits of the scheme. Kindly continue the same.
Place: Signature of the member
Date: S/O:
Staff No:
Designation:
2 .Certified that the member stated above appeared before me on this
…………………………..day of …….................Hence he/she is still alive as on this day.
Place:
Date: SIGNATURE OF THE OFFICER
WITH OFFICE SEAL AND DATE