Form of application for final payment / Transfer to Corporate bodies/ Other Governments of balances in the General Provident Fund Account.
The Accountant General,
(Through the Head of Office)
I am to retire/have retired/have proceeded on leave preparatory to retirement for . Months /have been discharged/dismissed/have been permanently transferred to ./have resigned finally from Government service/have resigned service under . Government to take up appointment with .. and my resignation has been accepted with effect from .. forenoon/afternoon. I joined service with ... on . Forenoon/afternoon.
2. My Provident Fund Account No. is .
3. I desire to receive payment through my office / through the . Treasury/sub-treasury. Particulars of my personal marks of identification, left hand thumb and finger impressions (in case of illiterate subscribers) and specimen signature (in case of literate subscribers) in duplicate, duly attested by a Gazetted officer of the Government, are enclosed.
I request that the entire amount at my credit with interest due under the rules may be paid to me/ transferred to ..
(FOR USE BY HEADS OF OFFICES)
Forwarded to the Accountant- General .. for necessary action.
2. He/ she has finally retired/will proceed on leave preparatory to retirement for . Months /has been discharged/dismissed/has been permanently transferred to ./has resigned finally from Government service/has resigned service under . Government to take up appointment with .. and his/her resignation has been accepted with effect from .. forenoon/afternoon. He joined service with ... on . Forenoon/afternoon.
3. The last fund deduction was made from his/her pay in this Office bill no .., Dated ., for Rs . (Rupees ) cash voucher no of Treasury, the amount of deduction being Rs and recovery on account of refund of advance Rs
4. Certified that he/she was neither sanctioned any temporary advance nor any final withdrawal from his/her Provident fund account during the 12 months immediately preceding the date of his/her quitting service under ..Government/ proceeding on leave preparatory to retirement or thereafter.
Certified that the following temporary advances / final withdrawals were sanctioned to him/her and drawn from his/her Provident fund account during the 12 months immediately preceding the date of his/her quitting service under ..Government/ proceeding on leave preparatory to retirement or thereafter.
Amount of Advance/withdrawal Date Voucher No.
1 . ..
2 . ..
3 . ..
6. It is certified that no demands / following demands of the Government are due for recovery.
7. Certified that he/she has not resigned from Government service with prior permission of the Central government to take up an appointment in another department of the Central Government or under a State Government or under a Body Corporate owned or controlled by the state.
(Signature of Head of Office/ Department)
Note: - Certificate No. 6 to be furnished in case of CPF only