There is no statutory format for a break certificate or a certificate of non-contributory days. In the olden days, when we used to send Form 3A for each member, a form was attached to support non-contributory days. When everything became online, there was no need for such a statement. However, sometimes the EPFO will reject the application for a pension due to the lack of this statement. I think you may prepare one in the attached format and submit it. This should resolve the issue.