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wipro

The Trustees, L0ANDECLARATION FORM


Wipro PF Trust,
EC 1, 3rd Floor, Tower 4,
No 72 Keonics Electronic City,
Hosur Main Road,
Bangalore-560100.

AIBHAV
o , D/o, W/oMR
VIJAY PutANIk_ EmployeeNo 834551
VINA1kuMAEPuLANE employed at WIPRO Limited holder
of Provident Fund Account No PY BOMI0275/6XR22 applying for advance
from my PF account. for an advance of Rs.
3OO0O0_(Rupees
IHREE LAKH_ONLZ Jout of the amount
standing to my credit in my Provident Fund

1. Purchase of Dwelling Site


2. Purchase of Dwelling House/Flat.
3. Construction of Dwelling House.
Additions/Alterations to the existing house
Repayment of Housing loan
6. Marriage
7. Medical
8. Post-matriculation education of son / daughter
9. Pandemic Advance

INSTRUCTIONS:
(Tick the type of advance)

Following information are


required:
Attach cancelled Cheque Leaf/ bank statement which contains the IFSC code
a

For Sl No 5. You are required to


provide the following
Letter for outstanding balance and the details of beneficiary
Note:- Admissible loan shall be transferred to your salary account.
I hereby declare that:

(a) Particulars stated above are true and correct.


(6) The advance is required for the purpose applied for above.
c) The amount of advance shall be utilized only for the purpose applied for and not for
anything else.
(d) In case the amount is used for any purpose other than stated above, I am liable to return
the entire amount with penal interest.

Signature:. Date: 29 0 4 2022

Name: VArBHAV VfSAY PuPANIE

Wipre Technologies, HRD Company Confidential


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