FORM
1
Form
of application for final payment / Transfer to Corporate bodies/ Other
Governments of balances in the General Provident Fund
Account.
To,
The
Accountant General,
(Through
the Head of Office)
Sir,
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
..
Yours
faithfully,
Signature
..
Name
Address
Station
..
Date
..
(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.
Or
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