FORM-I PROFORMA FOR APLICATION FOR ADVANCE FROM PROVIDENT FUNDS Ministry of............. Department of........./Office Application for Advance from.......................... 1. Name of the subscriber :- 2. Account Number(with Departmental suffix) :- 3. Designation :- 4. Pay :- 5. Balance at credit of the subscriber on the date of application as below :- a) Closing balance as per statement for the :- Year_____________________________ b) Credit from.......to...... :- on account of monthly subscription c) Refunds :- d) Withdrawal during the period :- from......to........ e) Net balance at credit :- 6. Amount of advance/outstanding, if any, and the :- purpose for which advance was taken then 7. Amount of advance required :- 8. (a) Purpose for which the advance is required :- (b) Rules under which the request is covered :- 9. Amount of the consolidated advance (items 6&7) :- and number of monthly installments in which the consolidated advance is proposed to be repaid. 10. Full particulars of the pecuniary circumstances :- of the subscriber, justifying the application for the advance. Signature of applicant Name___________________ Designation______________ Date: Section/Branch____________
