APPLICATION FOR 90% PART FINAL …

1 APPLICATION FOR 90% part FINAL withdrawal FROM GENERAL PROVIDENT FUND ACCOUNT 1. Name of the subscriber : 2. Designation : 3. Provident fund Account No. : (with Deptl. Suffix) 4. Subscriber s pay at the time of sanctioning : the part - FINAL withdrawal (as defined in the FRS) 5. (i) Total service ( including broken period of : service) (ii) Date of birth : (iii) Date on which he had completed 15 years of : service (including broken periods of service) (iv) Due date of retirement on super annuation : 6.

2 Amount of 90% part FINAL withdrawal required : ( to be expressed both in figures and words) 7. Balance at credit of the subscriber as on this date (Vide figures and words) (i) GPF balance as per the Accounts slip : furnished by the Accountant General (ii) ADD subsequent deposits and refund of : withdrawals (iii) ADD Pay Commission arrears as per the : Accounts slip (PCA) 1 (iv) ADD Impounded Dearness Allowance : as per the Accounts slip (IDA) (v) ADD Subsequent Deposit of DA (IDA) : (vi) Total.

3 (vii) Deduct Subsequent withdrawals : (viii) Balance as on : 8. Purpose of withdrawal : As I am going to retire from service on superannuation on , I request that I may kindly be sanctioned 90% part FINAL withdrawal from my GPF

4 Account No. 9. Reference to rules under which the 90% part FINAL : GO Ms No. 535 Fin withdrawal is sanctioned (Allowance I) Dept dated & Govt. Lr No. 140075/Acc/93-1 dated 10.

5 Whether the sanction has been accorded by the : Yes competent authority 11 The Drawing Officer to whom the authority of : payment has to be issued by the O/O DCE, Chennai 6. 12. Treasury or sub-treasury at which the amount is : PAO (S) to be drawn Chennai-35. 13. Certified that all the conditions specified in rule : or rules quoted in the para 9 above have been satisfied. Date Signature of the subscriber