Notification Dated 7th April, 1975 S.R.O. 140 and S.R.O. 150 SCHEDULE-IV Department of _____________________________________________________ Office of __________________________________________________________ Application for advance from (here enter name of the fund) 1. Name of the subscriber ______________________________________________ 2. Account No. (with departmental suffix)__________________________________ 3. Designation 4. Pay 5. Balance at credit of application as below: i. Closing balance as per statement for the year. ii-a) Credit from _______________________________to _________________ ii-b) Subscription _________________________________________________ iii. Refunds __________________________________________ iv. Withdrawals during the period from ________________to ____________ v. Net balance credit 6. Amount of advance of outstanding if any, and the purpose for which advance was taken the __________________________________________________________ 7. Amount of advance required __________________________________________ 8. a) purpose for the advance is required _______________________________ b) Rules under which the advance is covered _________________________ 9. Amount of the consolidated advance (items 6 and 7) and No. of monthly installments in which the consolidated advance is proposed to be repaid _________________________________________________________________ . 10. Full particulars of the pecuniary circumstances of the subscribers justifying the application for advance. ___________________________ . Signature of applicant Name _________________ Designation _______________ Section/Branch______________
