FORM D [See paragraph 10] Application form for a loan under the Public Provident Fund Scheme, 1968 To The Agent/Manager State Bank ......... I wish to take a loan from Public Provident Fund Account No......... of a sum of Rs........ (Rupees .............................) which I undertake to repay with interest within the period of thirty six months as prescribed in paragraph 11 of the Public Provident Fund Scheme, 1968. 2 I had taken a loan of Rs..... (Rupees .....................) on ......... (date) which has been repaid in full with interest on ......... (date) *3 Certified that the amount for which loan is applied for is required for the use ........ .................... who is alive and is still a minor. 4 The passbook is enclosed Date Signature or thumb impression of Subscriber/guardian * To be given only when a loan is sought from a minor's account TO BE USED BY THE ACCOUNTS OFFICE Date of initial subscription ............ Amount available in the Public Provident ............ Fund Account Amount available for loan in ............ accordance with para 10 of PPF Scheme Amount of loan actually sanctioned ............ Date ........ Signature of Accounts Officer Received a sum of Rs...... (Rupees ............. ..............) by way of loan from Public Provident Fund Account No......... Date Signature or thumb impression of Subscriber/guardian
