FORM B (See Rule 16 and 40) Form of Application for Temporary Advances against deposits in General Provident Fund

(Kerala) 1. 2. 3. 4. 5. 6. 7. Name and Account No. of the Subscriber Monthly Pay, Dearness Pay and Designation Purpose for which it is required Number of instalments of recovery proposed Date of complete repayment of the previous loan: Details of advances pending recovery (1) the amounts of previous advances (2) dates of drawal of each advance (3) balance outstanding against each advance Name of Treasury at which payment is desired : : : : : : : : :

Amount of Advance required (both in figures and words):

8. 9.

I hereby declare that the above statements are true and that I agree to abide by the

General Provident Fund (Kerala) Rule in force. I also promise to repay the above advance in equal monthly instalments according to rules.

Place Date .. 10. Enquiry Certificate

Signature of Subscriber with Name and designation.

Place .. Date 11. 12. 13. 14.

Signature of Head of Department or Office

VERIFICATION REPORT Total amount at credit of the applicant : Amount of advane admissible Number of instalments of repayment Any other fact requiring consideration : : : (Head of Office /Department)