I request for sanction to grant of Advance (Refundable /non -refundable ) from the General Provident Fund, my particular are as under :-

1. Name of the applicant

2. Father's name

3. Designation

4. Date of joining the service

5. Date of retirement

6. Scale of pay

7. D.D.O with whom working

8. Gross pay Deducation Net Pay Basic Pay GPF Sp.Pay HBL P.Pay ML DA WL Others Others Total Total 9. GPF No. GPF A/C No. (Old) Particulars under column 1 to 9 are verified Signature of DDO 10. Amount of advance required 11. Recoverable in _______________ equal instalment @ Rs. _________ 12. Purpose for which advance is required for

(A) In case Advance is required for purchase of plot, attach permission accorded by competent authority , details of number of plots in your name and source of purchase of plot with agreement may also be supplied.
(B) In case construction of house/repair of house -Please State (i) Whether HBL was taken from the Board Yes/No (ii) If yes, amount of HBL ,Date of sanction of HBL and copy of sanction letter be attached , whether recovered and rate of recovery be intimated. (iii) In case loan is for construction of house- Please add ownership of plot/house, approved map and estimate from SDO Incharge
(C ) In case loan is required for scooter/moped etc.

(i) Whether such loan was taken previously also from Board Fund. If yes, date of sanction and amount thereof Whether recovered in full or still being recovered -balance alongwith interest Whether earlier vehicle has been disposed off-Amount of sale proceed thereof.

(ii) Whether loan was taken previously also from GPF If yes, date of sanction and amount thereof Whether recovered in full or still being recovered-balance along with interest Whether earlier vehicle has been disposed off-Amount of sale proceed thereof D. Whether advance is required for marriage of son/daughter ,if so proof of date of birth and invitation card may be added.

E. Whether advance is required for celebration of functions etc., date of ceremony with detail of ceremony be given.

13. Rule under which advance is required ,(13,14-R.A) or 13,29-NRA)

14. Whether 12 months have elapsed since the recovery of last instalment of earlier loan.

15. If 12 months have not elapsed since the recovery of last instalment of earlier advance please give cogent/compelling circumstances warranting sanction of 2nd advance.

16. Applicant's S.B.A/C No. with name of Bank.

17. Whether the pecuniary circumstances of the application are such that advance is absolutely necessary.

18. Certified that the functions/purchase of plot/const/repair of house cannot be done without this advance.

19. I also undertake to submit APR immediately after receipt of loan out of GPF.

20. I undertake to submit utilization certificate within one month from the date of receipt of loan of GPF.

Yours faithfully (Name of Applicant with designation) Endst No. Dated The application along with enclosures is forwarded to the Controller, Finance & Accounts , H. S. A. M. Board, Panchkula for further necessary action. All the above particulars given by the applicant are true , based on records and nothing has been concealed therein.

Signature of DDO/Officer

Incharge with sea

HARYANA STATE AGRIL.MARKETING BOARD (Accounts Branch)

Covering Abstract of G.P.F Schudule Month of Accounts _________________________________ ------------------------------------------------------------------------------------ S.NO.NAME OF M.C/ AMOUNT OF GPF WHETHER OTHER OFFICE DEDUCTION GPF SCHEDULES ATTACHED ----------------------------------------------------------------- TOTAL _______________________ Certified that all GPF Schedules have been attached and the total of the covering abstract tallies with the amount shown in the monthly classified abstract of expenditure by the Market Committee/other Offices ( ) Name of the Assistant