FORM GPF-10(8) Form of application for final payment/Transfer to corpoare/Bodies other Governments of Balance in the ----------------------------------Provident Fund Account. To, Pay and Accounts Officer, Accountant General, _____________________ (Through the Head of Officer) Sir, I have retired/have proceeding on leave preparatory to retirement for __________ Months/ have been discharged/dismissed have been permanently transferred to _________have resigned Permanently transferred to ____________ have resigned finally from Govt. Service under Govt. have resigned Service/to take up appointment, with effect from ______________forenoon/afternoon. 1. Joined service with __________on _____________fornoon/afternoon. 2. My Provident Fund No. is ________________. 3. I desired to receive payment through my office/through the _______________Treasury/ Sub Treasury. Particulars of my personal ma marks of identification, left hand thumb and impressions. (in case of illiterate subscribers) and finger specimen signatures(in case of literate subscribers) in duplicate, duly attested by a Gazetted Officer of the Government are enclosed. Part-I (To be filled in when the application for final payment is submitted upto one year prior to retirement. 4. I request that the amount of Rs. _________ standing to the credit in my. GPF account as indicated in the Accounts statement issued to me for the year ________________enclosed as appearing in my ledger account being maintained by you____________Treasury/Sub-Treasury/Head of Office, may please be arranged to be paid to me as first instalment of final payment. 5. The undermentioned life insurance policies were being finalized by me from my provident fund account: Policy No. Name of the Company Sum assured. 1. 2. 3. 6. After payment of the first instalment of my G.P.F. Balance. I will apply for the payment of subsequent in part-II of the Form immediately on retirement. Yours faithfully, Station___________ Address_____________ Dated ___________ This applies only when payments is not desired through the Head of Office. (For Use By Head of Office) Forwarded to the Accountant General _____________________ for necessary action. 2. The Provident Fund Account No. __________ of Sh. /Smt./Kumari _______________ as verified from the statements furnished to his/her from year to year) is __________________. 3. He/She is due to retire from Govt. Service on ____________. 4. Certified that he/She had taken the following advances in respect of which ____________ instalments of ____________ are yet to be recovered and credited to the fund Account. The details of the final withdrawals granted to him/her after the period covered by the aforesaid accounts Statements are indicated below: Temporary Advances Final Withdrawals 1. 2. 3. 4. 5. Certified that the following amounts were withdrawn from he/her account to finance the life Insurance Policy. 1. 2. 3. 4. 5. (Signature of the Head of Office) PART-II In continuation of my earlier application dated___________for the final payment of P.F. Balance, I request that the entire Balance at my credit with interest due under the may be paid to me OR I request that the entire amount at my credit with interests due under the rules may be paid to me /Transferred to Signature _____________ Name_______________________ Address_____________________ (For use by Head of Offices) Forwarded to the pay and Accounts Officer/Accountant General ___________ for necessary action/in continuation of Endorsement No. ________________dated__________. 2. He/She has finally retired/will proceed on leave Preparatory to retirement for_____________months/has been discharged /dismissed/has been permanently transferred to __________ has resigned service under finally from Govt. service has resigned service under Government to take up appointment with___________ and his/her resignation has been accepted with effect from__________fornoon/afternoon. He joined service with_____________on __________ fornoon/afternoon. 3. The last fund deduction was made from his/her pay in this office bill No. __________dated_______for Rs.______________Rupees_______________ ) cash vouchers No.__________ Treasury, the amount of deduction being Rs.____________and recovery on account of refund of advance Rs.___________ and recovery on account of refund of advance Rs.____________. 4. Certified that he/she was neither sanctioned any temporary advance or any final withdrawl from his/her provident funds account during the 12 months immediately proceeding the date of his/her quitting service under___________Govt./proceeding on the leae preparately to retirement. OR Certified that the following temporary advances/final withdrawls were sanctioned to him/her and drawn from his/her provident fund account during the 12 months immediately proceeding on leave preparatory to retirement or thereafter. Amount of Advance/withdrawl Date Voucher No. 1. 2. 3. 4. 5. Certified that no amount was with drawn /the following amounts were withedrawn his/her provident fund account during the 12 months immediately preceding the date of his/her quitting service under____________Govt./proceeding on leave preparatory to retirement or thereafter for payment of Insurance Premia of the purchase of new policy. Amount Date Voucher No. 1. 2. 3. 4. 5. 6. It is certified that no demands/following demands of Government are due for recovery. 7. Certified that he/she has not resigned from Govt. service with prior permission of the Central Govt. to take up an appointment in another Department of the Central Govt. Or under a State Govt. or under a body corporate owned or controlled by the State. Signature Head of Office/Deptt. *Certificate No. 6 to be furnished in the case contributory provident fund. * Please score out if not necessary.
