FORM: KVV-9/10 CHAUDHARY SARWAN KUMAR H. P. KRISHI VISHVAVIDYALAYA (See Rule 9.16 of Part-I of the Account Mannual) Form of Application for Advance From Contribution/General Provident Fund 1. Name : 2. Account No. GPF : CPF: 3. Designation : 4. Pay : 5. Balance at Credit of the subscriber on the date of application as below : i) Closing balance as per statement : ii) Credit From : To: iii) Subscription iv) Refunds : v) Withdrawals during the period from : vi) Net balance at credit : 6. Amount 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 consolidate advance (Item 6&7) and number of monthly installments in which the consolidated advance is proposed to be repaid : 10. Full particulars of the peculiarly circumstances of the subscriber, justifying the application for the advance : I certify that the amount of advance will be utilized for the purpose it has been applied for the utilization certificate will be furnished within one month from the date of withdrawal of the advance failing which I hereby undertaking to make refund of the advance forthwith. Signature of the applicant Name: ________________________ Designation:____________________ Section/Deptt.:__________________ Forwarded to the Comptroller, CSKHPKV, Palampur for necessary action, please. Signature of the Branch Officer/Head of the Deptt.
