FINAL PAYMENT OF BALANCE IN THE PF USED BY THE NOMINEE

Form of application for Final Payment of Balance in the Provident Fund Account of subscriber to be used by the nominee or any other claimant (s) where no. nomination Subsists (Death case) (Referred to in note 2 below Rules 13.31 and note 2 below Rule 14.29 of CSR Vol II) To The Chief Administrator H.S.A.M.Board (GPF Section) C-6, Sector 6, Panchkula Sir, It is requested that arrangement may kindly be made for payment of the accumulation in the _________________________________ General Provident Fund account of late Sh/Smt ________________________ The necessary particulars in this connection are given below 1. Name of the employee 2. Date of Birth 3. Post 4. Date of Death 5. Proof of death in the form of a death certificate issued by the municipal authorities 6. Provident Fund Account No. allotted to the subscriber 7. Amount of Provident Fund money standing to the credit of the subscriber at the time of his/her death 8. Details of the nominees alive on the date of death of the subscriber if a nomination subsists Name of nominee Relationship with Subscriber Share of nominee 9. In case the nomination is in favour of a person other than a member of the family, the details of the family, if the subscriber subsequently acquired a family Name of nominee Relationship with subscriber Share of nominee 10 In case nomination subsist, the details of the surviving members of the family on the date of death of the subscriber. In case of daughter of a deceased son of the subscriber married before the death of the subscriber, it should be stated against her name whether husband was alive on the date of death of subscriber Name Relationship with subscriber Shareof nominee 11 In case of amount due to a minor child whose mother(widow of subscriber) is not a Hindu, the claim should be supported by indemnity bond or guardian certificate, as the case may be 12 If the subscriber has left no family and no nomination subsists the name of person to whom the P.F money is payable Name Relationship with subscriber Share of nominee 13 The payment is desired through the office of the _________ In this connection the following documents duly attested by the Gazetted Officer (i) Personal marks of identification (ii) Left/right hand thumb & finger impression. (iii) Specimen signature (iv) Photograph Yours faithfully Station: Signature of claimants