FORM OF APPLICATION FOR FINAL PAYMENT OF BALANCE IN THE GENERAL PROVIDENT FUNDA/C
(Referred to in note 2 below Rules 13.31 and note Rule 14.29 of C.S.R) To The Chief Administrator H.S.A.M.Board (GPF & Pension Section) C-6,Sec-6,Panchkula (Through the Head Office) Sir,

1. I am due to retire/have retired/resigned finally from service of the Board on _____________.

2. My Provident Fund Account No. is_____________.

3. I desire to receive payment through my office. Particular of my personal marks of identification left hand thumb and finger impression( in the case of illiterate subscriber) and specimen signature (in the case of literate subscriber) in duplicate attested by a gazetted officer of the Government are enclosed.

4. I request that the entire balance at my credit with interest due under the rules may be paid to me. Yours faithfully Signature Name Office Address Residential Address (For use by HEAD OF THE OFFICE) Forwarded to the Controller Finance & Accounts, HSAMBoard , Panchkula for necessary action

1. The Provident Fund Account No. of Sh./Smt/Kumari________

2. He/She is due to retire from Government service on____________

3. Certified that he/she had taken the following advances in respect of which____________ instalments of Rs.__________ are yet to be recovered and credited to the Fund Account. The details of the final withdrawal granted to him, her are also indicated below Temporary Advance Final Withdrawal 4. The last fund deduction was made from his/her pay vide office Bill No. ___ dated ______________ Rs _________ (Rupees____________________) cash voucher No. ___________________ of ______ (Head of the office with seal)