GPF form

OFFICE OF THE DIRECTOR GENERAL OF AUDIT (CENTRAL),

LEKHA PARIKSHA BHAVAN, 361, ANNA SALAI, CHENNAI 600018

APPLICATION FOR FINAL WITHDRAWAL FROM GENERAL PROVIDENT FUND FOR THE MONTH OF

MODE OF PAYMENT /ECS

1

NAME OF THE SUBSCRIBER

2

G.P.F. ACCOUNT NUMBER

3.

DESIGNATION & SECTION / PARTY NAME/NO.

4.

PAY / GRADE PAY

5.

DATE OF SUPERANNUATION

6

DATE OF JOINING SERVICE

7

BALANCE AT CREDIT OF THE SUBSCRIBER ON THE DATE OF APPLICATION AS BELOW:

i)

C B as per statements for the yer 2019-20

₹

ii)

Subscription from Mar.20 to Oct 20

₹

iii)

Refund of advance from Mar. 20 to June 20

₹

iv)

Withdrawals from Mar.20 to June 20

₹

v)

Net balance at credit as on date

₹

8

Amount of withdrawal required

₹

9

1. Purpose for which the withdrawal is required

2. Rule under which the request is covered

3. If PFW is sought for House Building, etc., the following information may be given.

i)

Location & Measurement of Plot

ii)

Whether the plot is free hold or lease.

iii)

Plan for construction

iv)

If the flot or plot being purchased is from M B Society , the name of the society, the location and Measurement etc.

v)

Cost of construction

₹

vi)

If the purchase of flat is from DDA or any Housing Board etc., the Location, Dimension may be given.

vii)

Amount f HBA sanctioned

₹

viii)

Amount of any other assistance received in this regard from any other Government source.

₹

10

Whether any withdrawal was taken for the same purpose earlier, if so indicate the amount / year

11

Name of the Accounts Officer maintaining the Provident Fund

PAO /IAD, CHENNAI 600018.