Employees' State Insurance Corporation (General Provident Fund) Rules, 1995
SCHEDULE II:
Application for Advance / Withdrawal from General Provident Fund
[Rules 14(3) and 17(1)]
1. Name of the subscriber......................
2. Account number ...............................
3. Designation .................................
4. (1) Pay Rs
....................................
(2) Monthly subscription Rs
...........
5. In case of withdrawal
(i) Date of birth
.............................
(ii) Date of appointment .............................
(iii) Date of
superannuation.........................
Balance at credit of the subscriber on the date of application
as below:-
(i) Closing balance as per statement
for the year 19....... Rs......
(ii) Credit from ...........to........ on account of monthly
subscription Rs ............
(iii) Refunds Rs.............................
(iv) Withdrawals during the period from..... to..... Rs.........
(v) Net balance at credit Rs.....................
6. Amount of advance outstanding, if any, and the purpose for
which advance was taken by them-
Amount of advance taken Rs
.....................
Balance outstanding as on date Rs
............
7. Amount of advance required Rs
8. (a) Purpose for which the advance is required..............
(b) Rules under which the request is
covered...............
(c) If advance is sought for house building,
etc. following information may be given:-
(1) Location and
measurement of the plot .................
(2) Whether plot is
freehold or on lease....................
(3) Plan for
construction .........................................
(4) If the flat or plot being purchased is
from a H.B. Society, the name of the society, the location and measurement,
etc...............
(5) Cost of
construction ...................
(6) If the purchase of flat is from DDA or any
Housing Board; etc. the location, dimension, etc, may be
given..................
(d) If advance is required for education of
children, following details may be given:-
(1) name of the son /
daughter................
(2) Class and
institution / college where studying.............
(3) Whether a
day-scholar or a hosteller.................
(e) If advance is required for treatment of
ailing family members, following details may be given:-
(1) Name of the
patient and relationship........................
(2) Name of the Hospital/ Dispensary/ Doctor
where the patient is undergoing treatment .....
(3) Whether outdoor /
indoor patient .............
(4) Whether
reimbursement available or not............................
Note: In case of advance under 8(c) to 8(e), no
certificate or documentary evidence would be required.
9. Amount of the consolidated advance (Item 6 and 7) and number
of monthly installments in which the consolidated advance is proposed to be
repaid Rs. ____ in installments.
10. Full particulars of the pecuniary circumstances of the
subscriber, justifying the application for the advance.
I certify that the particulars given above are correct and
complete to the best of my knowledge and belief and that nothing has been
concealed by me.
Signature of Applicant
Name
_____________________
Recommendation / remarks of the
Designation
________________
competent authority
Section
/ Branch ____________
Dated_____
Signature
__________________
Designation ________________
