Download Application for Final Payment of Balances in the Provident Fund Account of a Subscriber to be used by the Nominees or Any Other Claimants where to Nomination Sunsists

Yes No Yes No Yes No iii. Published on National Portal of India (india.gov.in) GOVERNMENT OF JHARKHAND DEPARTMENT OF FINANCE APPLICATION FOR FINAL PAYMENT OF BALANCES IN THE PROVIDENT FUND ACCOUNT OF A SUBSCRIBER TO BE USED BY THE NOMINEES OR ANY OTHER CLAIMANTS WHERE TO NOMINATION SUNSISTS. [ONLY FOR DEATH CASE] FORM -'C' To, The Accountant General, (through the Head of Officer). Sir, It is requested that arrangements may kindly be made for the payment of accumulations in the Provident Fund Account of Shri The necessary particulars required in this connection are given below:- 1. Name of the Government servant. 2. Date of Birth. 3. Post held by the Government servant. 4. Date of death. 5. Proof of death in the form of a death certificate issued by the Municipal authorities etc. if available. 6. Provident Fund Account No. allotted to to the subscriber. Amount of Provident Fund money 7. /- standing to the credit of the subscriber at the time of his death, if known. Details of the nominees alive on the date of death of the subscriber if a nomination subsists. 8. Name of the nominee Relation with the subscriber Share of the nomination i. ii. iii. 11. In the case of amount due to a minor child whose mother(widow of subscriber ) is not a hindu, the claim should be supported by indemnity Bond or Guardianship certificate as the case may be. 9. In case the nomination is in favour of a person other than a member of the family, the details of a family if the subscriber subsequently acquired a family. Name of the nominee Relation with the subscriber Area on the date of death i. ii. iii. In case the nomination subsists, the details of the surviving members of the family on the date of 10. death of the subscriber. In case of a daughter or of a daughter of a deceases son of the subscriber, married before the death of the subscriber, it should be stated against the her name whether her husband was alive on the date of the death of the subscriber:- Name Relation with the subscriber Age on the date of death i. ii. Published on National Portal of India (india.gov.in) 14. The payment is cestred through the office of Through the Treasury/Sub-Treasury. In connection the following documents duly attested by a Gatetted Officer in Service/ Magistrate are attached. i. Personal Marks of identification ii. Left/Right hand thumb or finger impression ( in case of illiterate claimants) iii. Speciment Signatures in duplicate( in the case of literate claimants) Yours faithfully Full name Signature of claimant address Station: Date: Published on National Portal of India (india.gov.in) 12. If the subscriber has left no family and no nomination subsisted, the names of persons to whom the Provident Fund money is payable( to be supported by letter of probate or succession certificate etc.) Name Relation with the subscriber Address i. ii. iii. 13. Religion of the claimant(s) 5. Provident Fund account during the 12 months immediately presiding the date of his/her death. OR Certified that the following temporary advances/final/ withdrawals were sanctioned to him/her and drawal from his/her Provident Fund Account during the 12 months immediately. Date of Encashment Place of Encashment Amount of advances/withdrawal Voucher no. /- 1. Rs. /- Rs. 2. /- 3. Rs. 6. Certified that no amount was withdrawn/ the following amounts were withdrawn from his/her Provident Fund account during the 12 months immediately preceding the date of his/her death for payment of insurance premium or form the purchase of a new policy. 7. it is certified that no demand /following demand of Government are due for recovery. 8. Certified that no advance/following advance sanctioned in items of the Ministry of Finance Office Memorandum No. 10(3)E.V(A)/65m dated the 1st November, 1965 is due for recovery. Signature of the Head Published on National Portal of India (india.gov.in) FOR USE OF HEAD OF OFFICE/DEPARTMENT 1. Forwarded to the for necessary action, the particulars furnished above have been duly verified. 2. The Provident Fund Account No. of Shri Smt. (as verified from the annual statements(furnished to his/her death.) . A death certificate issued by the Municiapal 3. He/She died on author( there has been produces/ is not required in this case as here is no doubt about his/ her death. 4. The last fund deduction was made from his/her pay for the month of for drawn in this office will be dated (Rupees ) Rs. /- Cash voucher no. /- of Treasury, the amount of deduction being Rs. and recovery , on account /- of refund of advance of Rs. Certified that he/she neither sanctioned any temporary advance not any final withdrawal from his/her