Govt. of Karnataka FORM NO. 3 APPLICATION FOR …

1 Govt. of Karnataka FORM NO. 3 APPLICATION FOR Karnataka general provident fund ADVANCES A To, The .. Sir, I request an advance of (Rupees .. only) from my general provident fund Account No .. 1. It is required for the purpose of .. 2. I shall bind myself to pay it regularly in .. Monthly instalments of Rs .. Each. [The maximum number of installments is 40 and the amount of each installment should be equal and in whole Rupees throughout. The gross amount of the advance has to be fully repaid before actual retirement of the subscriber] 3. My pay is Rs .. per month 4. Rs .. Is the balance unpaid of the previous advance of Rs .. Taken in the month of .. 20 5. The gross amount of this temporary advance will be fully refunded by me, as indicated above before my retirement from service, the date of my birth being .. Date.

2 Place : Signature and Designation of the subscriber B Memo No : Date: Forward to .. The advance asked for may be sanctioned. It is also within the permissible, limit. Recoveries towards G P F Subscription and Refunds of temporary advance have been made during the month of APPLICATION and during the month of previous thereto from the pay of the APPLICATION as detailed hereunder:- Sl no Pay for the month of Encashed on SubscriptionRefunds Total .. Signature and Designation of the Head of the Office