Gpf Ty.adv.proforma
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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) As per G.P.F. Account slip for the year 2006-2007
1 2
3
4
a) Regular subscription to G.P.F. From To
Rs.
b) Regular subscription to G.P.F. From To
Rs.
a) Repayment of temporary advance From To at Rs.
Rs.
b) Repayment of temporary advance From To at Rs.
Rs.
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: Date
:
:
Signature of the applicant
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 2
3
4
- 200
a) Regular subscription to G.P.F. From To
Rs.
b) Regular subscription to G.P.F. From To
Rs.
a) Repayment of temporary advance From To at Rs.
Rs.
b) Repayment of temporary advance From To at Rs.
Rs.
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
3
Designation
:
Typist
4
Pay
:
Rs. 7,015.00
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) As per G.P.F. Account slip for the year 2005-2006
:
Rs. 182,826.00
1 2
3
4
Rs. 150725.00
a) Regular subscription to G.P.F. From 03/06 To 02/07
Rs. 24000.00
b) Regular subscription to G.P.F. From 03/07 To ---
Rs. 2000.00
a) Repayment of temporary advance From To at Rs.
Rs. NIL
b) Repayment of temporary advance From To at Rs.
Rs. NIL
a)
D.A. arrears credited to G.P.F. Account vide G.O.(P) No.112 dt.05.05.06 from 07/05 to 04/06
Rs. 2685.00
b)
D.A. arrears credited to G.P.F. Account vide G.O.(P) No.139 dt.05.05.06 from 01/06 to 05/06
Rs. 965.00
c)
D.A. arrears credited to G.P.F. Account vide G.O.(P) No.19 dt.02.02.07 from 07/06 to 01/07
Rs. 2451.00
Total ::2:: 6) Amount of advance outstanding if any and the purpose for which advance was taken then:
PW
Rs. 182826.00
:
NIL
7) Amount of Advance required
:
Rs. 90,000/-
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
:
The advance now sanctioned may be recovered in 25 monthly instalments at Rs.3600/- per month.
:
To meet the medical expenses of my mother / father suffering from prolonged illness. There is no other source to meet the expenditure except applying for GPF.Ty.Advance.
10) Full particulars of the pecuniary circumstances of the subscriber justifying the application for the temporary withdrawal
Signature of the applicant
Place: Nellore Date: 10/04/2007
(V. Bhaktavathsalam) Typist. 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
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) As per G.P.F. Account slip for the year 2005-2006
:
1 2
3
4
Rs.
a) Regular subscription to G.P.F. From To
Rs.
b) Regular subscription to G.P.F. From To
Rs.
a) Repayment of temporary advance From To at Rs.
Rs.
b) Repayment of temporary advance From To at Rs.
Rs.
a)
D.A. arrears credited to G.P.F. Account vide G.O.(P) No. dt. from to
Rs.
b)
D.A. arrears credited to G.P.F. Account vide G.O.(P) No. dt. from
Rs.
c)
D.A. arrears credited to G.P.F. Account vide G.O.(P) No from
Rs.
Total ::2:: 6) Amount of advance outstanding if any and the purpose for which advance was taken then:
Rs. 0.00
:
PW
7) Amount of Advance required
:
Rs.
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
:
:
Signature of the applicant
Place: Nellore Date:
Medical Purpose.
(V. Bhaktavathsalam) Typist. SSLC & SB.Circle Office, Nellore.
athsalam
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) As per G.P.F. Account slip for the year 2006-2007
1 2
3
4
a) Regular subscription to G.P.F. From To
Rs.
b) Regular subscription to G.P.F. From To
Rs.
a) Repayment of temporary advance From To at Rs.
Rs.
b) Repayment of temporary advance From To at Rs.
Rs.
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: Date
:
:
Signature of the applicant
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 2
3
4
- 200
a) Regular subscription to G.P.F. From To
Rs.
b) Regular subscription to G.P.F. From To
Rs.
a) Repayment of temporary advance From To at Rs.
Rs.
b) Repayment of temporary advance From To at Rs.
Rs.
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
3
Designation
:
Typist
4
Pay
:
Rs. 7,015.00
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) As per G.P.F. Account slip for the year 2005-2006
:
Rs. 182,826.00
1 2
3
4
Rs. 150725.00
a) Regular subscription to G.P.F. From 03/06 To 02/07
Rs. 24000.00
b) Regular subscription to G.P.F. From 03/07 To ---
Rs. 2000.00
a) Repayment of temporary advance From To at Rs.
Rs. NIL
b) Repayment of temporary advance From To at Rs.
Rs. NIL
a)
D.A. arrears credited to G.P.F. Account vide G.O.(P) No.112 dt.05.05.06 from 07/05 to 04/06
Rs. 2685.00
b)
D.A. arrears credited to G.P.F. Account vide G.O.(P) No.139 dt.05.05.06 from 01/06 to 05/06
Rs. 965.00
c)
D.A. arrears credited to G.P.F. Account vide G.O.(P) No.19 dt.02.02.07 from 07/06 to 01/07
Rs. 2451.00
Total ::2:: 6) Amount of advance outstanding if any and the purpose for which advance was taken then:
PW
Rs. 182826.00
:
NIL
7) Amount of Advance required
:
Rs. 90,000/-
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
:
The advance now sanctioned may be recovered in 25 monthly instalments at Rs.3600/- per month.
:
To meet the medical expenses of my mother / father suffering from prolonged illness. There is no other source to meet the expenditure except applying for GPF.Ty.Advance.
10) Full particulars of the pecuniary circumstances of the subscriber justifying the application for the temporary withdrawal
Signature of the applicant
Place: Nellore Date: 10/04/2007
(V. Bhaktavathsalam) Typist. 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
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) As per G.P.F. Account slip for the year 2005-2006
:
1 2
3
4
Rs.
a) Regular subscription to G.P.F. From To
Rs.
b) Regular subscription to G.P.F. From To
Rs.
a) Repayment of temporary advance From To at Rs.
Rs.
b) Repayment of temporary advance From To at Rs.
Rs.
a)
D.A. arrears credited to G.P.F. Account vide G.O.(P) No. dt. from to
Rs.
b)
D.A. arrears credited to G.P.F. Account vide G.O.(P) No. dt. from
Rs.
c)
D.A. arrears credited to G.P.F. Account vide G.O.(P) No from
Rs.
Total ::2:: 6) Amount of advance outstanding if any and the purpose for which advance was taken then:
Rs. 0.00
:
PW
7) Amount of Advance required
:
Rs.
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
:
:
Signature of the applicant
Place: Nellore Date:
Medical Purpose.
(V. Bhaktavathsalam) Typist. SSLC & SB.Circle Office, Nellore.
athsalam
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