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FORM 6 (A) Form of Application For Final Payment of Balances in The General Provident Fund Account

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Harish Pl

This document contains a form for gazetted government officers to apply for final payment of balances from their General Provident Fund account. It requests details like the date of retirement, whether the officer opted to retain provident funds in the account, past provident fund deductions and withdrawals, specimen signature, and details of any life insurance policies purchased using provident funds. The head of the officer's department must also certify details of any previous advances or withdrawals from the provident fund account.

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FORM 6 (A) Form of Application For Final Payment of Balances in The General Provident Fund Account

Uploaded by

Harish Pl
166 views4 pages
This document contains a form for gazetted government officers to apply for final payment of balances from their General Provident Fund account. It requests details like the date of retirement, whether the officer opted to retain provident funds in the account, past provident fund deductions and withdrawals, specimen signature, and details of any life insurance policies purchased using provident funds. The head of the officer's department must also certify details of any previous advances or withdrawals from the provident fund account.

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This document contains a form for gazetted government officers to apply for final payment of balances from their General Provident Fund account. It requests details like the date of retirement, whether the officer opted to retain provident funds in the account, past provident fund deductions and withdrawals, specimen signature, and details of any life insurance policies purchased using provident funds. The head of the officer's department must also certify details of any previous advances or withdrawals from the provident fund account.

Copyright:

© All Rights Reserved
Download as PDF, TXT or read online from Scribd
Download as pdf or txt
166 views4 pages

FORM 6 (A) Form of Application For Final Payment of Balances in The General Provident Fund Account

Uploaded by

Harish Pl
This document contains a form for gazetted government officers to apply for final payment of balances from their General Provident Fund account. It requests details like the date of retirement, whether the officer opted to retain provident funds in the account, past provident fund deductions and withdrawals, specimen signature, and details of any life insurance policies purchased using provident funds. The head of the officer's department must also certify details of any previous advances or withdrawals from the provident fund account.

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FORM 6(A)

FORM OF APPLICATION FOR FINAL PAYMENT


OF BALANCES IN THE GENERAL PROVIDENT FUND ACCOUNT
(FOR GAZETTED OFFICERS)

TO,
THE ACCOUNTANT GENERAL
KARNATAKA, BANGALORE

Through __………………..________ (The head of office / Department)

Sir,

1. I am due to retire / have retired / have proceeded on leave preparatory to


retirement for months/ have been discharged / have been dismissed/ have
resigned finally from Government service and my resignation has been accepted
with effect from __________ forenoon / afternoon.

2. I have not opted for the continued retention of my provident fund money in the
Fund in terms of the (OM. No. FD 25 SPF 58, dated 15th December, 1958) as
extended from time to time. I, therefore, request that the entire amount at my
credit with interest due under the Rules may be paid to me through
……………………………………….Treasury/ sub-Treasury. My provident
Fund Account No. is ………………………._________

OR

I have opted for the continued retention of my provident fund money in Fund in
terms of the (Official memorandum No. FD. 25 S.P.F 58 dated 15th December
1958) as extended from time to time and my option has been forwarded vide letter
No. __________ dated __________ / is. attached. I request that a sum of Rupees
may be paid to me in terms of para 2 of that letter through
………………………………………..Treasury / Sub-Treasury. My provident
Fund Account no. is ……………………………

3. A sum of Rs. (Rupees ) was last deducted from Provident


Fund subscription and recovery on account of refund of advance from my pay
bill for months of …………………………. for Rs. ………………….…..for
Rs. …………..enashed on ………………………… at Treasury / sub-
Treasury.

4. My specimen signature in duplicate, duly attested by another Gazetted Officer


of Government is enclosed.

5. I certify that I have neither drawn any temporary advance not made any final
withdrawal from my provident Fund Account during the 12 months
immediately preceding the date of my quitting service / proceeding on leave
preparatory to retirement or thereafter.

OR

Details of the temporary advance drawn by me, final withdrawals made by me


from the provident Fund account during the 12 months preceding the date of the
quitting service/ proceeding on leave preparatory to retirement or hereafter are
given below:

Amount of advance Date

1.

2.

6. I hereby certify that no amount was withdrawn/ the following amounts were
withdrawn by me from my provident fund account during the 12 months
immediately preceding the date of my quitting service/proceeding on leave
preparatory to retirement or thereafter for payment of insurance premia or for the
purchase of a new policy.

Amount Date

1.

2.

7. Give details here if more than one policy has to be cited.


8. The particulars of the life insurance policies financed by me from the provident
Fund which are to be released are given below

Policy No. Name of the Company Sum assured

1)

2)

3)

4)

Yours faithfully

(Signature)

(Name and Address)


Station:
Date :

Para 4 applies only when payment is desired at a treasury other than the one at the
District headquarters when the subscriber last served otherwise it may be struck out.
CERTIFICATE BY THE HEAD OF OFFICE/DEPARTMENT

1. It is certified after due verification with reference to the records in my office that
no temporary advance/final withdrawal was sanctioned to the applicant from
his/Provident fund account during the 12 months immediately proceeding the date
of his/her quitting service/proceeding on leave preparatory to retirement or
thereafter.

OR

2. It is certified after due verification with reference to the records in my office that
the following temporary advance / final withdrawals were sanctioned to and drawn
by the applicant from his/her provident fund account during the 12 months
immediately proceeding the date of his/her quitting service/ proceeding on leave
preparatory to retirement or thereafter.

Amount of Advance/Withdrawal Date Vouchers No.

1)
2)
3)

3. It is certified that no demand/following demands of government are due for


recovery.

(Signature of the Head of office/Department)

Certificate No.3 to be furnished in the case of contributory P.F only.

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