Beruflich Dokumente
Kultur Dokumente
(Please ensure that all the relevant Particulars are given with certificates where necessary
to avoid delay in settlement of claim)
2. Designation :
4. Date of birth :
7. EVENT NECESSITATING :
CLOSURE OF ACCOUNT
A. Retirement Date :
i) Date of absorption :
11. Details of Advances / withdrawals in the last 12 months period to stoppage of subscription
to General Fund.
Nature withdrawal Amount Date and place of Vr, No :
Temporary Advance :
15. I hereby undertake to refund any excess payment arising out of clerical errors in the
Settlement of G.P.F. claims
For USE BY HEAD OFFICE / DEPARTMENT certified that all the particulars furnished
above have been fully verified with reference to office records and are found correct.
Certified that no advance / withdrawal from General Provident Funds was granted during
the last 12 months except those detailed in item (11) above.