APPENDIX -I

FORM (1)
(See rule 14)
Application for sanction of temporary advances from General Provident Fund.

1 Name of the Subscriber :

2 Account Number :

3 Designation :

4 Pay :

5 Balance at credit of the Subscriber on the :

date of application
G.P.F. CREDITS STATEMENT
(Vide item No.5(above) of G.P.F. Application)
1 As per G.P.F. Account slip for the year 2006-2007

2 a) Regular subscription to G.P.F. Rs.

From To

b) Regular subscription to G.P.F. Rs.

From To

3 a) Repayment of temporary advance Rs.

From To
at Rs.

b) Repayment of temporary advance Rs.

From To
at Rs.

4 a) ………..arrears credited to G.P.F. Account Rs.

vide G.O.(P) No…………………dt……………….
from………………………..to……………………….

b) ………..arrears credited to G.P.F. Account Rs.

vide G.O.(P) No…………………dt……………….
from………………………..to……………………….

c) ………..arrears credited to G.P.F. Account Rs.

vide G.O.(P) No…………………dt……………….
from………………………..to……………………….

Total

6) Amount of advance outstanding :

if any and the purpose
for which advance was taken then:

7) Amount of Advance required :

8) Purpose for which the advance is required

:

::2::
9) Amount of the consolidated advance :
(Items 6 & 7) and number
(and amount) of monthly instalments
in which the consolidated
advance is proposed to be repaid

10) Full particulars of the pecuniary :

circumstances of the subscriber
justifying the application for the
temporary withdrawal

Place: Signature of the applicant

Date
 G.P.F. CREDITS STATEMENT
(Vide item No.5 of G.P.F. Application)
Statement showing the credits available in the G.P.F. A/c.No.………………….………… of
Sri……………………………………………………………………………………………………………

1 As per G.P.F. Account slip for the year 200 - 200

2 a) Regular subscription to G.P.F. Rs.

From To

b) Regular subscription to G.P.F. Rs.

From To

3 a) Repayment of temporary advance Rs.

From To
at Rs.

b) Repayment of temporary advance Rs.

From To
at Rs.

4 a) …...………..arrears credited to G.P.F. Account Rs.

vide G.O.(P) No…………………dt……………….
from………………………..to……………………….

b) ………..arrears credited to G.P.F. Account Rs.

vide G.O.(P) No…………………dt……………….
from………………………..to……………………….

c) ………..arrears credited to G.P.F. Account Rs.

vide G.O.(P) No…………………dt……………….
from………………………..to……………………….

Total

Rs………………..(Rupees…………………………………………………………………….
……………………only)

Signature of the applicant

APPENDIX -I
 FORM (1)
(See rule 14)
Application for sanction of temporary advances from General Provident Fund.

1 Name of the Subscriber :

2 Account Number :

3 Designation :

4 Pay :

5 Balance at credit of the Subscriber on the

:
date of application

6) Amount of advance outstanding :

if any and the purpose
for which advance was taken then:

7) Amount of Advance required :

8) Purpose for which the advance is required

:

9) Amount of the consolidated advance :

(Items 6 & 7) and number
(and amount) of monthly instalments
in which the consolidated
advance is proposed to be repaid

10) Full particulars of the pecuniary :

circumstances of the subscriber
justifying the application for the
temporary withdrawal

Place:
Date Signature of the applicant
available in the G.P.F. A/c.No.………………….………… of
 APPENDIX -I
FORM (1)
(See rule 14)
Application for sanction of temporary advances from General Provident Fund.

1 Name of the Subscriber : V.Bhaktavathsalam

2 Account Number : 67027 PW

3 Designation : Typist

4 Pay : Rs. 7,015.00

5 Balance at credit of the Subscriber on the : Rs. 182,826.00

date of application
G.P.F. CREDITS STATEMENT
(Vide item No.5(above) of G.P.F. Application)
1 As per G.P.F. Account slip for the year 2005-2006 Rs. 150725.00

2 a) Regular subscription to G.P.F. Rs. 24000.00

From 03/06 To 02/07

b) Regular subscription to G.P.F. Rs. 2000.00

From 03/07 To ---

3 a) Repayment of temporary advance Rs. NIL

From To
at Rs.

b) Repayment of temporary advance Rs. NIL

From To
at Rs.

4 a) D.A. arrears credited to G.P.F. Account Rs. 2685.00

vide G.O.(P) No.112 dt.05.05.06
from 07/05 to 04/06

b) D.A. arrears credited to G.P.F. Account Rs. 965.00

vide G.O.(P) No.139 dt.05.05.06
from 01/06 to 05/06

c) D.A. arrears credited to G.P.F. Account Rs. 2451.00

vide G.O.(P) No.19 dt.02.02.07
from 07/06 to 01/07

Total Rs. 182826.00

::2::

6) Amount of advance outstanding : NIL

if any and the purpose
for which advance was taken then:
7) Amount of Advance required : Rs. 90,000/-

8) Purpose for which the advance is required

: Medical Purpose.

9) Amount of the consolidated advance : The advance now

(Items 6 & 7) and number sanctioned may be
(and amount) of monthly instalments recovered in 25
monthly instalments at
in which the consolidated
Rs.3600/- per month.
advance is proposed to be repaid

10) Full particulars of the pecuniary : To meet the medical

circumstances of the subscriber expenses of my
justifying the application for the mother / father
suffering from
temporary withdrawal
prolonged illness.
There is no other
source to meet the
expenditure except
applying for
GPF.Ty.Advance.

Signature of the applicant (V. Bhaktavathsalam)

Place: Nellore Typist.
Date: 10/04/2007 SSLC & SB.Circle Office,
Nellore.
athsalam
 APPENDIX -I
FORM (1)
(See rule 14)
Application for sanction of temporary advances from General Provident Fund.

1 Name of the Subscriber : V.Bhaktavathsalam

2 Account Number : 67027 PW

3 Designation : Typist

4 Pay :

5 Balance at credit of the Subscriber on the :

date of application
G.P.F. CREDITS STATEMENT
(Vide item No.5(above) of G.P.F. Application)
1 As per G.P.F. Account slip for the year 2005-2006 Rs.

2 a) Regular subscription to G.P.F. Rs.

From To

b) Regular subscription to G.P.F. Rs.

From To

3 a) Repayment of temporary advance Rs.

From To
at Rs.

b) Repayment of temporary advance Rs.

From To
at Rs.

4 a) D.A. arrears credited to G.P.F. Account Rs.

vide G.O.(P) No. dt.
from to

b) D.A. arrears credited to G.P.F. Account Rs.

vide G.O.(P) No. dt.
from

c) D.A. arrears credited to G.P.F. Account Rs.

vide G.O.(P) No
from

Total Rs. 0.00

::2::

6) Amount of advance outstanding :

if any and the purpose
for which advance was taken then:
7) Amount of Advance required : Rs.

8) Purpose for which the advance is required

: Medical Purpose.

9) Amount of the consolidated advance :

(Items 6 & 7) and number
(and amount) of monthly instalments
in which the consolidated
advance is proposed to be repaid

10) Full particulars of the pecuniary :

circumstances of the subscriber
justifying the application for the
temporary withdrawal

Signature of the applicant (V. Bhaktavathsalam)

Place: Nellore Typist.
Date: SSLC & SB.Circle Office,
Nellore.
athsalam