Download Form of application for conversion of an advance into a final withdrawal

Form of Application for conversion of an advance into a final withdrawal 1. Name of Subscriber. --------------------- 2.Designation and office to which attached --------------------- 3. Pay --------------------- 4. Name of the Provident Fund and Account Number ---------------------- 5. Balance at credit on the date of application (amount actually subscribed by him along with interest due thereon in the case of GPF subscriber ) ----------------- 5 (a) Balance outstanding to be converted into a final withdrawal ---------------- (b) Interest due on the amount of advance taken ---------------- 7 (a) Purpose for which advance taken ----------------- (b) Date of payment of the advance ----------------- © Amount of advance sanctioned ----------------- 8. Particulars of communication under which advance was sanctioned --------------- 9. Whether any advance or final withdrawal has been drawn previously for the purpose mentioned above. If so, particulars thereof ----------------- 10. (a) Total service,including broken periods,if anyone date of this application --------------------- (b) Period of service left on the date of application for Attaining the age of superannuation --------------- (c) The date of superannuation ---------------------- Place Signature of the Applicant Date: - No.---------- Dated The above particulars have been verified to be correct. Signature and designation of Recommending authority.