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FORM D FORM OF APPLICATION FOR TEMPORARY …

1 Name and Account number of the subscriberand the reference number of the AnnualStatement received from the AccountantGeneral, indicating section number &branch2 DesignationandPermanentEmployeeNumber (PEN)3 Basic Pay4 Amount of advance required(both in figures and words)5 Purpose for which it is required6 number of Instalments of recovery proposed7 Date of complete repayment of the previousloan8 Details of advances pending recovery(1) number and date of the order grantingprevious advance(2) the amount of previous advance(3) date and drawal of previous advance(4) balance outstanding9 Amount of consolidated advance[sum of items 4 and 8 (4) and the number and amountof monthly instalments in which the consolidatedadvance is proposed to be repaid]10 Name of Treasury for which payment isdesired1112 Enquiry Certificates13 Total amount at the credit of the applicant14 Amount of advance admissible15 number of instalments or repa

1 Name and Account Number of the subscriber and the reference number of the Annual Statement received from the Accountant General, indicating Section number &

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Transcription of FORM D FORM OF APPLICATION FOR TEMPORARY …

1 1 Name and Account number of the subscriberand the reference number of the AnnualStatement received from the AccountantGeneral, indicating section number &branch2 DesignationandPermanentEmployeeNumber (PEN)3 Basic Pay4 Amount of advance required(both in figures and words)5 Purpose for which it is required6 number of Instalments of recovery proposed7 Date of complete repayment of the previousloan8 Details of advances pending recovery(1) number and date of the order grantingprevious advance(2) the amount of previous advance(3) date and drawal of previous advance(4) balance outstanding9 Amount of consolidated advance[sum of items 4 and 8 (4) and the number and amountof monthly instalments in which the consolidatedadvance is proposed to be repaid]10 Name of Treasury for which payment isdesired1112 Enquiry Certificates13 Total amount at the credit of the applicant14 Amount of advance admissible15 number of instalments or repayment16 Any other facts requiring considerationPlace(Head of Office or Department)DateSignature of the subscriber with Name and designationSignature of Head of Department or OfficeVERIFICATION REPORTFORM D[See Rule 14 & 37 (1)]

2 ]FORM OF APPLICATION FOR TEMPORARY ADVANCE AGAINST DEPOSITS IN general PROVIDENT FUND (KERALA)PlaceI hereby declare that the above statements are true and that I agree to abide thegeneral provident Fund (Kerala) Rules in force. I also promise to repay the aboveadvances in equal instalments according to from of SubscriberADepositsMonthly SubscriptionRefund of advanceTotal deducted for the month (3+4)Date of encashment of the billGross amount of the billNet amount of the billName of TreasuryRemarks`````13456789102Sl NoMonth & YearSTATEMENTS OF DEPOSITS AND WITHDRAWALS FOR THE PERIOD AFTER THE LAST CREDIT CARD TILL THE DATE OF APPLICATION FOR.

3 FROM GPF ACCOUNTFORM E[See Rule 14,20 & 37 (1) ]GPF Account Nodowloaded from TOTAL000dowloaded from Credited to PFGross amount of the billNet amount of the bill```14567812345 Amount`TOTALC Details of withdrawals made after the Last Credit CardNo and Date of sanctionDate of DrawalName of TreasuryNature of advance TA or NRAB Details of Credited to GPF After Last Credit CardNo and Date of as per which the DA arrears was credited to PFPeriod to which the arrear relatesName of Treasury23Sl NoDate of encashment if the billPurposedowloaded from `3451`2`3`4`5`6`7`Total amount of advance drawn after the issuance of the last credit card (Vide details furnished under C above)

4 Total amount of DA Arrears and Pay revision arrears if any not due for withdrawal as per existing Government OrdersGrand total (4+5 above)Net Balance ate credit of the subscriber (3-6) on the date of APPLICATION Certified that the particulars furnished above have been verified with reference to pay abstract, acquaintance roll, PF Pass Book and other connected records and found correctSignature of DDO or Subscriber (in the case of Gazetted Officer)TOTALTA or NRAIf there is no withdrawal since the Last Credit Card that fact should be specifically stated in the proformaD AbstractTotal amount at credit as per Last Credit Card for the year amount credited to PF Account after last Credit Card (Total of A&B above)Grand Total (items 1+2 above)126 PlaceDateSignature of DDO or Subscriber (in the case of Gazetted Officer)DesignationNamedowloaded from (a)(b)(c) (d)567891011121314(Office Seal)Name Designation(Office Seal)Name DesignationToThe Accountant general , Kerala, ThiruvananthapuramThe District Treasury/ Sub Treasury OfficerTheShri[See Rule 14 & 37 (2)]

5 ]FORM FName of the subscriberDesignation and permanent Employee number (PEN)Special circumstances for granting the advanceunder Rule 14 number of instalments in which the advances is tobe recoveredAmount of previous TEMPORARY advanceDate of drawal of the previous TEMPORARY advanceFORM OF SANCTION FOR TEMPORARY ADVANCES FROM general PROVIDENT FUND (KERALA) A TEMPORARY advance from the general provident Fund )Kerala) as particularised below is sanctioned by the undersigned under the rules regulating that FundBasic PayProvident Fund Account NumberReference number of the annual Statementreceived from the Accountant general , indicatingsection number and BranchNumber and date of order granting Previoustemporary advanceAmount of consolidated advances (items 5 & 9)

6 And the number of instalments in which theconsolidated advances is to be recoveredAmount of each such instalmentSignature of Sanctioning authoritySignature of Drawing and Disbursing OfficerAmount of advanceObject of advanceRule or rules under which the advance issanctionedBalance at credit of the subscriber on this date(as verified from the account last rendered by theAccounts officer/Head of Office/department)Balance of previous advance, if any outstandingagainst the subscriberDate of repayment of previous advance, if anydowloaded from


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