my knowledge and the advance applied for is not for the correspondence

and/or Distance Learning and it will be liable for disciplinary action, if they
are found to be false.

I also authorize the Company to deduct the amount of outstanding advance

and interest thereon in case of my retirement / resignation / exit due to
other reasons from terminal benefits i.e. Gratuity, Additional Gratuity (if
any), Encashment of unutilized Privilege Leave, GSLI, GTIS, Term Assurance, if
any.

I hereby agree and authorize Providence Fund Trust of the Company to

deduct the amount of outstanding advance and Interest thereon from my
contributions and interest thereon at the time of settling my Provident Fund
Account and pay such amount to the Company in settlement of their clalm
against the advance granted to me (applicable to those who joined the
services of the Company prior to 01" April, 2010).

I hereby agree and authorize the Pension Fund trust of employees of

the Company to deduct the amount of outstanding advance and
interest thereon from pension/commuted value payable to me as
per General insurance (Employees] Pension Scheme, 1995 and pay
such amount to the Company in settlement of their claim against the
Advance 8 rdntd to me (applicable to those who are tension
optees).

I hereby agree and authorize the Pension Fund Trust of employees of the
Company to deduct the amount of outstanding advance and interest
thereon at the time of settling proceeds from the defined Contribution
Pension Scheme and pay such amount to the Company In settlement of
their claim against the advance granted to me (applicable to those who
joined the services of the Company on or after 01 April, 2010).

This authorization shall not be revoked by me until the advance sanctioned

to me and interest thereon is completely settled by repayments.

Signature of Witness:

Name . Name
SR No. Office
Address: Designation:
SR No.
Department :
Office