Section 11(4) in Rajasthan Civil Services (Medical Attendance) Rules, 1970
(4)(i)Every retired Government servant who avails himself of these concessions under this rule shall be required to sign a declaration on each occasion before the Medical Officer incharge of Hospital/Dispensary in the following form :-"I hereby declare that-(i)I am not employed in any Government department, autonomous bodies like Municipalities, Universities etc., grant-in-aid institutions, public sector or private sector undertakings, statutory or non-statutory corporation, companies and commercial or industrial firms etc., and that I am not carrying on any business or trade to earn my livelihood.(ii)That my wife is wholly dependent upon me.SignatureDesignation of the post held atthe time of retirementP.P.O./C.P.F. A/c No.(Strike out which is not applicable)(ii)Every retired Government servant who avails himself of the concession indicated in sub-rule (1) of this rule shall be required to produce his pension payment order or a certificate from the Head of office or Department to the effect that he retired from Government service with Contributory Provident Fund Benefits, as the case may be, before Medical Officer Incharge of Hospital/Dispensary for the purpose of identification.
