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Life Certificate

201- 325 Howe Street
Vancouver, B.C. Canada V6C IZ7
Phone: 604-662-8811
Fax: 604-609-2031
Website: www.cgivancouver.gov.in
Email: indiavisa@telus.net

Life Certificate Registration Form

S. No. Description Details
1 Name as in passport/ OCI card/ pension order
2 Date/place of birth (mm/dd/yyyy)
3 Nationality
4 Father/ Husband’s name
5 Address in Canada
6 Phone number (landline)
7 Phone number (mobile)
8 Email ID
9 Passport particulars
Country :
Number :
Date of issue (mm/dd/yyyy) :
Place of issue :
Valid Till
10 Pension payment order/ book number
11 Signature/ thumb impression of the applicant  
12 Place of issue of this certificate


Life Certificate of Pensioner, Shri/Smt/ Ms holder of pension payment order no. has been received.