APPENDIX "0"

OF MONEY FROM TH
OP APPLICATON FOR PART FINAL WITHDRAWAL
PURCHASE OR REDEMPTION O
OVDENT FUND FORHOUSE BUILDING/ OR MEDICAL
EDUCATION/ PURCHASE
OSeSl HOUSE sITES/HIGHER EXPENSES

Sri MSSLN.Kumar
1. Name of Subscriber
Assistant Audit Officer.
2. Designation
3. Pay Rs.56870/-

4. Name of the Provident Fund

Account NO. 44741/GA

Rs.594911/-
5. a) Balance at the credit of the
subscriber on the date of
application.
building and marriage
final withdrawal for house
the case
In of the part all
balance at the credit of
Note:
house site the total
purpose as well as purchase of house subscriber to m o r e
than o n e
taken into account if the
provident funds should be
provident fund.
of carrying out additions
withdrawal for the purpose
bIf it is a second part-final of withdrawal
re-construction of a house acquired with the help
and alterations to or
Provident Fund.
made or which may be made in future from the
already
Amount of part final withdrawal
NIL
c)
already taken :
NIL
i Balance at credit at the time of making
The first part final withdrawal
Amount required in the case of construction:: NIL
6) of a house -
site
Of a house or for the purchase
is
The number of installments in which it
Required should be stated. NIL
7) The purpose for which the amount is
Required. NIL
A) If it is for house building or for the purpose
Of purchasing a house-site or for the purpose
Of re-payment of any loan taken under.

NIL
i) For purchasing a house
NIL
ii) For construction/reconstruction of a house
For making additions or alterations to house
NIL
ii) NIL
For addition or alteration to a house
making
iv) NIL
v For purchase of house site .
For re-payment of a loan especially taken
NIL
vi) For the purpose of house site and
For repayment of loan taken under NIL
vii)
is for higher education
B) It
 NIL
Kelationship with the person(lwho is
Actually dependent on the subscriber
For whom the withdrawal if required
11) The special course taken by the person
NIL
And the name and place of the institution

Whether the course is for more than

NIL
Three years and beyond the high school

Stage.
Whether this is the first or the secondd NIL
iv
Withdrawal for the high school stage

The date of previous withdrawals or NIL

Advance if any, taken for this purpose.

C) If it is for marriage or betrothal ceremony NIL

Expenses.
i) Whether for the marriage betrothal NIL
Ceremony of the subscriber's daughter/
Son or for any other female relation
Dependent on the subscriber who has
No daughter.

ii) Whether any advance under ordinary . NIL

Rules has been drawn in respect of the
Betrothal ceremony or marriage for
Which the present withdrawal is sought
For.
Actual date fixed for celebration of NIL
ii)
Betrothal ceremony or marriage.

8. If it is medical expenses
WIFE
i) relationship with the person who iss
actually dependent on the subscriber
for whom the withdrawal is required.
ii Amount required. Rs.400000/-

i) Total service including broken period if any : 35 years completed

9.
ii) Period of (service required on the date of .
application for attaining the age of
superannuation.
ii) The date of superannuation 31.03.2025

Actual cost of acquiring the house or house site: N.A.

9 A)
ii)Anticipated cost of house proposed to be N.A.
built/ re-built
ii) Anticipated cost of additions or alterations: N.A.
to the house site.
 iv)Actual amount required for redemptlon N.A.
of the house or house site.
v)Total amount and date of loan taken for the : N.A.

purchase of house site and the amount

B)
outstanding against that on date. N.A.
Particulars orexpenses required to be ,.

Incurred on the higher education and

C Amount required for meating marriage N.A.
Expenses, indicating the number of marriages
To be celebrated.
10) Amount of installment or installments last N.A.
Taken, if and, for house building or and
Purchase of house sites (state particulars
Of amount, dates on which taken)

11) Amount, if any, received already from Govt. N.A.

For purchase of house sites or house building
Purpose other than from the Provident Fund
Account.

Recommended / Not recommended

Signature of Head of Office
Or drawing officer.

No.
The above particulars have been verified to be correct forwarded to the
CERTIFIED THAT:
T h e part final withdrawal has been recommended under rule 15o

2.have satisfied myself that the conditions prescribed in rules

has produce to me the
rererred toabove have been fulfilled and that subscriber
necessary deeds and papers which are enclosed.
3. The applicant has signed the undertaking prescribed in rule_

and that the same is forwarded herewith.

and that the 2nd/3rd/4th
have verified the progress of construction of the house
installment of the withdrawal may be paid.
. T have satisfied myself that the applicant has not taken any loan/assistance
or from any other
under any scheme sponsored by the
made regarding the
Government source and that the necessary not has been
verification of the requirement lied down in rule in case of complete
subscriber.
repayment of loan during the service of the
6. NO part final withdrawals has been granted previously
to the subscriber for

the same and

advance has been
7. In addition to this part final withdrawals, no temporary
granted to the subscriber for the same purpose now.
(Note :Delete the certificate not applicable)

(Certificates in items and (4) above are not necessary if the part final
(2) (3)
withdrawals if for higher education or for betrothal ceremony or marriage purpose)

Signature.

Dated the Sanction of the is

No.
conveyed to the part final withdrawals of Rs.400000/-(Rupees Four Lakhs only) the
amount being drawn installments.

Signature.
Dated the. No.

Forwarded to (1) the Accounts

Officer

For necessary action.