First of all, there is no break in service certificate as such prescribed under EPF&MP Act 1952.
As far as PF Account is concern, there is no relevance of break in service. Whatever amount is accumulated in your account, you are liable to get it with interest. In-operative account is a separate issue.
However, in Pension Account, break in service is relevant factor. In Pension From 10C, employer has to write non-contributory service at the end of the form and in From 10D also at the end employer has to certify the non-contributory service during past 12 months of date of leaving the service.
There is no need of separate certificate of break in service. But still some offices insist for such separate certificate and we give. We don't go for confrontation with the department.
I have developed one certificate in word which is attached herewith. You can use the same or the one which is given in excel by our learned member Mr. Janardan.