APPLICATION FOR KARNATAKA GENERAL PROVIDENT

FUND ADVANCES
To

The

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I request an advance of Rs. 5,00,000/-( Rupees Five lakh only) from my general
provident fund account

1. It is required for the purpose of Renovation of house.

2. I shall bind myself to pay it regularly in 40 monthly instalments of
Rs.12500/- Each ( The maximum number of instalments is 40 and the amount
of each instalment should be equal and in whole Rupees throughout the gross
amount of the advance has to be fully repaid before actual retirement of the
subscriber)
3. My pay is Rs. Per month.
4. Rs. nil Is the balance unpaid of the previous advance of Rs.nil
Taken in the month of nil 2019.
5. The gross amount of this temporary advance will be fully refunded by me as
indicated above before my retirement from service, the date of birth being
29/12/1963.

Date

Station
Signature and designation of the
Subscriber
- - - - - - -----------------------------------------------------------------------------------------
Emo No

Date

Forward to
The advanced asked for may be sanctioned . It is also within the permissible, limit,
Recoveries towards GPF Subscription and Refunds of Temporary Advance have
been made during the month of application and during the month of previous there
to from the pay of the application as detailed hereunder:-

Pay for month Encashed on Subscription Refunds Total

Signature and Designation of the

Head of the office.