FORM GPF - 10-B Application for Final Payment/Transfer to Corporate Bodies/Other Government of Balance in the Provident fund account. To The Chief Accounts Officer, Telecom Accounts, Patna. Through: The Head of the office. Sir, 1. I am to retire have retired have proceeded on leave-preparatory to retirement for month/ have been discharged/ dismissed/ have been permanently transferred to resigned service under Govt. to take up appointment with and and my resignation has been accepted with effect from 2. My Provident Fund Account No. is I desire to receive payment through my office/ through the3. / treasury/ Sub-treasury. Particulars of my personal marks of identification, left hand thumb and finger impression (in the case illiterate subscribers) and specimen signature (in the case of literate subscribers) in duplicate. Duly attested by a gazetted officer of the Govt. are enclosed. GOVERNMENT OF JHARKHAND PART - I (To be filled in when the application for final payment is - submitted up to one year prior to retirement.) 4. I request that the amount of Rs. attending to the credit in my G.P.F account as indicated in the Accounts - Statement issued to me for the year ledger account being maintained by you , may please be arranged to be paid to me as first installment of final payment . Published on National Portal of India (india.gov.in) /- I join my service with forenoon afternoon forenoon afternoon Treasury Sub-treasury Head of office Time ( HH:MM ) have resigned finally from the Govt. service/ have on (enclosed)/as appearing in my Department of Finance 5. The under mentioned Life Insurance Policies were being finalized by me from my Provident Fund Account: Policy Number Name of Company Sum Isured 1. 2. 6. After payment of first instalment of my Provident Fund balance I will apply for the Payment of subsequently in Part-II of the form immediately on retirement. Your's faithfully Signature Name Address Station : Date : (This applies only when payment is desired through the head of the office.) (FOR USE BY HEAD OF OFFICE) 1. Forwarded to the C.A.O. for N/Action. 2. The Provident Fund Account No. Shri/Smt./Miss (as verified from the statement furnished to his/her from the year to year ) is 3. He/ She is due to retire from Govt. Service on 4. Certified he/ she had taken following advance in respect of which instalments of are yet to be recovered and credited to the Fund Account. The details of the final withdrawal granted to him/ her are also indicated below : Temporary Advances Final Withdrawal 1. 2. Published on National Portal of India (india.gov.in) /- /- /- /-/- Rs. Rs. Rs. Rs. Rs. /- /-Rs. Rs. 5. Certified that the following amounts were withdrawn from his/ her account to finance the Life Insurance Policy: 1. 2. Signature of the Head of the Office PART - II ( To be submitted by the subscriber immediately after his retirement. This Part is also applicable in the case of subscribers who apply for final payment for the first time after the date of superannuation, discharged, resignation etc.) In continuation of my earlier application dated for the first time after the date of Provident Fund balances. I request the entire balance at my credit with interest due under the rules may be paid to me. or I request that the entire amount at my credit with interest due under the rules may be paid to me transferred to Signature Name Address (FOR USE BY HEAD OF OFFICES) 1. Forwarded to the Chief Accounts Officer 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 finally from Govt. Service/ has resigned service under with and his/ her Resignation has been accepted with effect from He/ She joined service with on Published on National Portal of India (india.gov.in) HH:MM Rs. Rs. /- /- Govt. to take up appointment forenoon afternoon Time HH:MMforenoon afternoon Time PART - III 3. The last fund deduction has been made from his/ her pay in this office Bill No. dated for Rs. /- (Rs ) cash voucher No. of recovery on account of refund of advance Rs. /- 4. Certified that he/ she was neither sanctioned any temporary Adv. or any final withdrawal from his/ her Provident Fund Account during the 12 months immediately proceeding the date of his/ her quiting service under Govt./ Proceeding on the or Certified that the following temporary advance/final withdrawals were sanctioned to him/her and drawn from him/ her provident fund account during the 12 months immediately proceeding the date of his/ her quiting service under Govt./ Proceeding on leave. Amount of advance withdrawal Date Voucher No. 1. 2. 5. Certified that no amount was withdrawn/ following amounts were withdrawn from his/ her provident fund account the 12 months immediately proceeding the date of his/ her quitting service under Govt./ proceeding on leave preparatory to retirement or thereafter for payment of Insurance premium or for the purchase of new policy. Amount of advance withdrawal Date Voucher No. 1. 2. 6. It is certified that no demands/ following demands of Govt. are due for recovery. 7. Certified that he/ she has not resigned from Govt. service with prior permission of the Central Government to take up an applintment in another department of the Central Government or under a state Govt. or under a body corporate owned or controlled by the State. Published on National Portal of India (india.gov.in) /- leave- preparatory to retirement or thereafter. Rs. Rs. /- /- Rs. Rs. /- /-
