AFFIDAVIT

Resident of
ged Yyears son of-
0o hereby solemnly affim and declare as under

1 That I have retired as from the office of the

from Punjab Government service W.e..
That my GPF account No. is
3. are as
nar t e detail of refundable/non-refundable GPF advance drawn by me during the service
under
DETAIL

Sr. No. Amount of Advance (in Rs.) Month/Year of Advance drawn

3
5. hathave not taken any refundable/non-refundable advance from my GPF other than shown
above from the date of my appointment till the date of my retirement. if any other advance
comes to the notice of the department of any exces payment is made to me, land, in case of
bound retum same with tne
ny deatn my nomineeiegal beirs shal be to the interest to
be my or my egal heirs personal responsibility. In case,failure to do s0,
deparment and t will
the excess amount alongwith interest will be recovered from me or my nominee/legal heirs gven
below:-
Sr. Name Relation Marital Status Remars
No.

o. That I will be responsible for any wrong statement.

DEPONENT

DECLARATION:
Verified that the contents of my above affidavit are true and correct to the best
of my knowledge and belief and nothing has been concealed therein.

DEPONENT