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THE GENERAL PROVIDENT FUND ( ANDHRA PRADESH ) RULES

APPENDIX - P

Form of application for conversion of an advance into a part final withdrawal.

1 Name of the Subscriber :

2 Designation and office to which attached :

3 Pay :

4 Name of the Provident Fund and :

Account No.
5 Balance at the credit on the date of :
applicatioon ( amount actually
subscribed by him along with
interest due therein the case of
G.P.F. Subscriber )
G.P.F. CREDITS STATEMENT
1 As per G.P.F. Account slip for the year

2 a) Regular subscription to G.P.F. Rs.

From To

b) Regular subscription to G.P.F. Rs.

From To

3 a) Repayment of temporary advance Rs.

From To
at Rs.

b) Repayment of temporary advance Rs.

From To
at Rs.

4 a) D.A.arrears credited to G.P.F. Account Rs.

vide G.O.(P) No.
from To

b) D.A.arrears credited to G.P.F. Account Rs.

vide G.O.(P) No.
from To

c) D.A.arrears credited to G.P.F. Account Rs.

vide G.O.(P) No.
from To

d) D.A.arrears credited to G.P.F. Account Rs.

vide G.O.(P) No.
from To

Total

Balance outstanding to be
6 a) converted into a part final :
withdrawal and

b) Interest due on the amount of :

advance taken

7 a) Purpose for which advance taken :

b) Date of payment of the advance :

c) Amount of the advance sanctioned :

8 Particulars of communication under :
which advance was sanctioned
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which advance was sanctioned

Whether any advance or part final
9 withdrawal has been drawn :
previously for the purpose
mentioned above, if so particulars
there of.

10 a) Total service including broken :

period if any, on the date of this
application

b) Period of service on the date of :

application for attaining the age
of superannuation

c) Date of superannuation :

Station: Signature of the applicant

Date

The above particulars have been verified to be correct.

Sanction of the Competent authority

No.
Sanction of is hereby
conveyed / accorded under rule of the General Provident Fund ( Andhra Pradesh)
Rules, for the conversion into part final with drawal of an amount of Rs.
(Rupees
only) being the outstanding balance out of the General Provident
Fund advance of Rs. sanctioned on and
drawn in Bill No of
for the purpose
to Sri
of the Office of the

Signature
Designation
Date:

No.
Copy forwarded to

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hra Pradesh)

al Provident