PROFORMA OF APPLICATION FOR WITHDRAWAL FROM THE PROVIDENT FUND Ministry of......... Department of.......... 1. Name of the subscriber : 2. Account Number : 3. Designation (with Department) : 4. Pay : 5. Date of Joining in Service and the : date of Superannuation 6. Balance at the 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 made to the fund after the : closing balance vide (a) above. (d) Withdrawal during the period : from....to..... (e) Net balance credit on the date : of application........ 7. Amount of withdrawal required : 8.(a) Purpose for which withdrawal is : required (b) Rule under which the request is : covered 9. Whether any withdrawal was taken : for the same Purpose earlier, and if so indicate the amount and the year 10. Name of the Accounts Officer : maintaining the Provident Fund Account Date....... Signature of the applicant Name............ Designation........... Section/Branch.........
