"Proforma for Application for Advance From Provident Funds Form" - India

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Download "Proforma for Application for Advance From Provident Funds Form" - India

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PROFORMA FOR APPLICATION FOR ADVANCE FROM PROVIDENT FUNDS
Ministry ……………………………./
Department of …………………/Office
(Application for withdrawal from………………………………………………
Here enter the name of the Fund).
1.
Name of the subscriber
:
2.
Account Number (with departmental suffix) :
3.
Designation
:
4.
Pay
:
5.
Balance at credit of the subscribed on the
:
date of application as below :-
(i)
Closing balance as per statement for
The year ______________________
Rs.
(ii)
Credit from _________ to _________ on
Account of monthly subscription
Rs.
(iii)
Refunds
Rs.
(iii)
Withdrawals during the period from
_____________ to ____________
Rs.
(v)
Net balance at credit
Rs.
6.
Amount of advance/outstanding, if any and the
Purpose for which advance was taken by them :
Amount of advance taken
Balance Outstanding as on
Rs.__________________
Rs.____________________
7.
Amount of Advance required
:
8.
(a) Purpose for which the withdrawal
:
is required
(b) Rule under which the request is
:
covered.
(c) If advance is sought for House Building
etc. following information may be given :
(i)
Location and measurement of the plot
:
(ii)
Whether plot is freehold or on lease
:
(iii)
Plan for construction
:
(iv)
If the flat or plot being purchased is from
A H.B.Society, the name of the Society, the
Location and measurements etc.
:
(v)
Cost of construction
:
(v)
If the purchase of flat is from DDA or any
Housing Board etc., the location, dimension
etc., may be given
:
(d) If advance is required for education of children,
:
following details may be given
(i)
Name of the son/daughter
:
(ii)
Class and institution/College where
Studying
:
(iii)
Whether a day scholar or a hosteler
:
PROFORMA FOR APPLICATION FOR ADVANCE FROM PROVIDENT FUNDS
Ministry ……………………………./
Department of …………………/Office
(Application for withdrawal from………………………………………………
Here enter the name of the Fund).
1.
Name of the subscriber
:
2.
Account Number (with departmental suffix) :
3.
Designation
:
4.
Pay
:
5.
Balance at credit of the subscribed on the
:
date of application as below :-
(i)
Closing balance as per statement for
The year ______________________
Rs.
(ii)
Credit from _________ to _________ on
Account of monthly subscription
Rs.
(iii)
Refunds
Rs.
(iii)
Withdrawals during the period from
_____________ to ____________
Rs.
(v)
Net balance at credit
Rs.
6.
Amount of advance/outstanding, if any and the
Purpose for which advance was taken by them :
Amount of advance taken
Balance Outstanding as on
Rs.__________________
Rs.____________________
7.
Amount of Advance required
:
8.
(a) Purpose for which the withdrawal
:
is required
(b) Rule under which the request is
:
covered.
(c) If advance is sought for House Building
etc. following information may be given :
(i)
Location and measurement of the plot
:
(ii)
Whether plot is freehold or on lease
:
(iii)
Plan for construction
:
(iv)
If the flat or plot being purchased is from
A H.B.Society, the name of the Society, the
Location and measurements etc.
:
(v)
Cost of construction
:
(v)
If the purchase of flat is from DDA or any
Housing Board etc., the location, dimension
etc., may be given
:
(d) If advance is required for education of children,
:
following details may be given
(i)
Name of the son/daughter
:
(ii)
Class and institution/College where
Studying
:
(iii)
Whether a day scholar or a hosteler
:
(e) If advance is required for treatment of
:
ailing family members, following details
may be given :
(i)
Name of the patient and relationship :
(ii)
Name of the Hospital/Dispensary/
Doctor where the patient is under-
Going the treatment
:
(iii)
Whether outdoor/indoor patient
:
(iii)
Whether reimbursement available
or not
:
NOTE :
In case of advance under 8(c) to 8(e), no certificate or documentary evidence would
be required.
9.
Amount of the consolidated advance (item 6 and 7) and
Number of monthly instalments in which the consolidated
Advance is proposed to Rs.___________ in be repaid
____________ instalments.
10.
Full particulars of the pecuniary circumstances of the
Subscriber, justifying the application for the advance
____________________
I certify that particulars given above are correct and complete to the best of my knowledge
and belief and that nothing has been concealed by me.
Signature of Applicant
Dated :
Name………………………………..
Designation …………………………
Section/Branch………………./Office
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