BCCI-FAST Employees’ Provident Fund Attachment Checklist:

1. Copy of approval of resignation letter

Provident Fund Release Application Form 2. Copy of completed clearance certificate
3. Copy of last salary slip
(EPF-Form-02) 4. Copy of PF member account statement

1. To be filled by Applicant
I declare that I have fulfilled all the official requirements and that I have no financial liability against me. I
hereby request the Trustees to release my provident fund.
Campus: __________________ Designation: _______________ Emp. No: _______________

Name: ____________________ Signature: _________________ Date: ___________________

2. To be filled by Admin/HR Office

Total service period excluding Leave Without Pay is (tick one) Proper Notice Served (tick one)
Less than 5 years Equal to/More than 5 years Yes No

Name: ____________________ Signature: __________________ Date: ___________________

3. To be filled by Accounts Office

Financial Liability outstanding on part of the applicant is Rs. _____________________________________

Name: ____________________ Signature: __________________ Date: ___________________

4. To be filled by Director/Registrar
The applicant has fulfilled all the official requirements. His/Her provident fund may be released.

Name: ____________________ Signature: __________________ Date: ___________________

5. To be filled by Data Entry Staff

Total Balance: Zakat Deducted: Reserve Amount (if applicable)
___________________________ ___________________________ ___________________________
Amount Released Cheque No. Cheque Date
___________________________ ___________________________ ___________________________

6. To be filled by Trustees
Trustee 1 Trustee 2
Name:____________________________________ Name:____________________________________

Signature and Date:__________________________ Signature and Date:__________________________

(Ver. 2015-Jan 22)