GPF Withdrawal Application Form

                                                Ministry of:

                                          Department of:

Application for withdrawal from GPF

1.

Name of subscriber:

2.

Account Number:

3.

Designation :

(with departmental suffix)

4.

Pay:

5.

Date of joining service and the date of superannuation:

6.

Balance at credit of the subscriber on the date of application as below:-

(i) Closing balance as per statement for the    year 2010-2011

(ii) Credit from 2011-2012                   on account of monthly subscriptions:

(iii)Refunds made to the Fund after the closing balance vide, (i) above

(iv)Withdrawal during the period from           to

(v)Net balance at credit on date of application:

7.

Amount withdrawal required:

8.

(a) Purpose for which the withdrawal is required:

(b) Rule under which the request is covered:

9.

Whether any withdrawal was taken for the same purpose earlier. If so, indicate the amount and the year:

10.

Name of the Accounts Officer maintaining the Provident Fund Account

Signature of Applicant:

                        Name:

               Designation:

           Section/Branch: