GPF Final Payment Application
GPF Final Payment Application
GPF Final Payment Application
To
The Accountant General ( A & E),
Andhra Pradesh,
Hyderabad.
(Through the head of Office in cases of Non-Gazetted and through Head of
the Department in case of Gazetted Officers)
2 Date of Birth :
10 If payment is desired outside the place of last during enclose the following documents
11 CERTIFICATES:
I have not resigned from Government service to take up appointment in
i) another department of state Government/Central Government of under a
body corporated owned or controlled by the State or Central
Government.
NOTE:
This certificate is to be furnished only by a subscriber who resigned from Govt. Service
(if resigned to take lup appointment elsewhere the information regarding
transfer of balance may be given in the form prescribed in the Annexure.)
a) Date of Death :
( copy of death certificate is enclosed)
Place
Date Signature of the Subscriber / Claiment
13 Certified that all the particulars furnished above have been verified with
reference to office records and are found correct
14 The last fund deduction was made from his/her pay for the month of …….......
Vide this office Bill No……….dt………….for Rs………. (Rupees……........................
.....................only) cash Voucher No…….. Of Treasury the amount of deduction
twards G.P.F. Subscription being Rs…… and recovery on account of refund of
advance Rs………........
Page 3
The last fund deduction was made from his/her pay for the month of …….......
Vide this office Bill No……….dt………….for Rs………. (Rupees……........................
.....................only) cash Voucher No…….. Of Treasury the amount of deduction
twards G.P.F. Subscription being Rs…… and recovery on account of refund of
advance Rs………........
15 Details of G.P.F. deduction made from the subscriber's salary during the last 12
months immediately proceeding the date of retirement ( in the proforma
appended to G.O. Ms. No. 216 dt.4.6.1986) are enclosed.
16 Certified that he/she was neither sanctioned any temporary advance nor any
part final with drawal from his/her provident fund account during the 12 months
immediately proceeding the date of his/her quitting service / proceeding on
leave prepartory to retirement or thereafter.
or
Certified that the following temporary advance part final withdrawals wsere
17 sanctioned to him/her and drawn from his/her provident fund account during
the last 12 months immediately proceeding the date of his/her quitting
service/proceeding on leave lpreparatory to retirement or thereafter.
S.No Amount of Advance / part Date Voucher No.
final withdrawals
2 Sum Assured :
(Signature)
with date and designation with
postal address
ANNEXURE
Transfer of Balance
In case of absorption in other departments other State Government/Public
Sector Undertaking furnish the following information.
i) Date of Absorption :