State of Madhya Pradesh - Act
The M.P. General Provident Fund Rules, 1955
MADHYA PRADESH
India
India
The M.P. General Provident Fund Rules, 1955
Rule THE-M-P-GENERAL-PROVIDENT-FUND-RULES-1955 of 1955
- Published on 18 January 1955
- Commenced on 18 January 1955
- [This is the version of this document from 18 January 1955.]
- [Note: The original publication document is not available and this content could not be verified.]
1. Short title and commencement.
2. Definitions.
3. Constitution of the fund.
- The fund shall be administered by the State Government and shall be maintained in rupees.4. [ [Substituted by Notification No. G-25/31/95/C/IV, dated 1-3-1996.]
All Government servants, whose conditions of service the Government of Madhya Pradesh is competent to determine, with the exception of those who are on a contract or on re-employment, shall be eligible to subscribe to the fund.Note. - For the purpose of this rule an apprentice who receives stipend shall not be a Government servant while the probations shall be government servants.5.
All Government servants who are eligible to subscribe to the fund under Rule 4, shall be compulsory subscribers to the fund :Provided that the State Government may exempt any specified category of the Government servants from the operation of this rule.Note. - It shall be the responsibility of the driving Officers to ensure that all the compulsory subscribers subscribe to the fund at a rate not lower than the minimum prescribed under these rules.]6. [ [Omitted by Notification No. G-25/31/95/C/IV, dated 15-4-1996.]
x x x]7. [ [Omitted by Notification No. G-25/31/95/C/IV, dated 1-3-1996.]
x x x]8. Nominations.
- [(1) (a) A subscriber to the General Provident Fund shall, as soon as may be after joining the Fund, send to the Head of Office, a nomination conferring on one or more persons the right to receive the amount that may stand to his credit in the fund, in the event of his death before that amount has become payable or having become payable has not been paid :Provided that if at the time of making the nominations the subscriber has a family the nomination shall not be in favour of any person or persons other than the member of his family.Note. - Sanction if accorded in relaxation of the above rule to any nomination made by a subscriber in favour of a person or persons other than members of his family (say 'mother' and 'brother' who are not included in the term 'family' as defined in these rules) when members of his family are surviving is ineffective and the nominee would not be entitled to the right conferred by sub-section (1) of Section 5 of the Provident Funds Act, 1925 (vide Controller and Auditor General's letter No. 209-A/350-53, dated the 16th February, 1954 received under Accountant-General's Endt. No. FD/14229, dated the 26th March, 1954, Regr. No. 946-R-VI-III, dated the 30th March, 1954).(b)The Head of Office shall receive and accept the nomination and a suitable entry regarding receipt and acceptance of nomination (without details of nomination) should be made in the service book of the subscriber under the dated signature of the Head of Office.(c)Nominations shall be kept in the safe custody of Head of Office along with the nominations for Death-cum-Retirement Gratuity.(d)In the event of transfer of the subscriber to another office, his nomination shall also be transmitted along with the service book and death-cum-retirement gratuity nominations to the Head of Office to which he is transferred and an entry to that effect shall be made in the service book. Acknowledgements for receipt of the nominations from the latter office shall be filed and kept in the custody of the Head of Office from where he is transferred.(e)When the balance at the credit of the subscriber becomes payable to his nominee under these rules the nomination kept by the Head of Office shall be sent in original to the Accounts Officer along with the application for final withdrawal after retaining an attested copy for further reference.]8A. [ [Substituted by Notification No. 9/12 (2)/R-II/IV/77, dated 6-6-1977 (w.e.f. 1-4-1977).]
Notwithstanding anything contained in Clause (ii) of sub-rule (1) of Rule 2, sub-rule (1) of Rule 8 and Rule 11, all Government servants including work-charged employees or members of the work-charged service, shall subscribe monthly to the fund such portion of any dearness allowance, by whatever name called, as is specified in the orders issued by the Government from time to time. No contribution shall be payable by the Government on account of this subscription.The subscription shall be in whole rupees. Fifty paise and above shall be treated as a rupee while less than fifty paise shall be omitted.] [Substituted by Notification No. F.B. 9-3/87/R-II/IV, dated 2-7-1987.]9. Subscribers' accounts.
- An account shall be opened in the name of each subscriber, in which shall be shown :-10. [ [Substituted by Notification No. G-25/31/95/C/IV, dated 1-3-1996.]
11.
[(1) The amount of subscription shall be fixed by the subscriber, subject to the following conditions-(a)It shall be expressed in whole rupees.(b)It may be any sum so expressed, but it may not be less than twelve percent of the emoluments and not more than his emoluments :Provided that the Government may by order direct for a higher amount to be deposited in subscriber's fund.] [Substituted by Notification No. G-25-2-2000-C-IV, dated 25-2-2000 (w.e.f. 1-4-2000).]11A.
Notwithstanding anything contained in Clause (b) of sub-rule (1) of Rule 2, Rule 5 and sub-rule (1) of Rule 11, all Government servants including work-charged employees or members of the work-charged service shall subscribe monthly to the Fund [such portion of any dearness allowance and arrears of pay] [Substituted by Notification No. 2339-4361 (98)-99-C-IV, dated 28-12-1999.] by whatever name called, as is specified by the Government, in the orders issued from time to time.For this purpose subscription shall be in whole rupees. Fifty paise and above shall be treated as a rupee while less than fifty paise shall be omitted.Note. - The above amendment shall be deemed to have come into force with effect from 1st April, 1977.12.
When a subscriber is transferred to foreign service or sent on deputation out of India, he shall remain subject to the rules of the Fund in the same manner as if he were not so transferred or sent on deputation.13. [ Realization of subscriptions. [Substituted by Notification No. G-25/31/95/C/IV, dated 1-3-1996.]
14. Interest.
14A. [ [Substituted by Notification No. G-25/31/95/C/IV, dated 20-3-1996 (w.e.f. 1-4-1996).]
The State Government may, by order, grant incentive bonus to those subscribers who do not withdraw any money from the amount standing to their credit in the fund during a year or a block of a year as may be prescribed by the order at such rates as may be prescribed by that order.]Notes. - [Omitted.]Advances from the Fund15. [ [Substituted by Notification No. G-25/31/95/C/IV, dated 1-3-1996.]
16. [ [Substituted by Notification No. G-25/31/95/C/IV, dated 1-3-1996.]
16A.
16B.
16C. [ Conversion of an advance into a withdrawal. [Inserted by Notification No. 2588-IV-R/71, dated 6-12-1971 and-No. 1060-R-1892-IV-R-II/72, dated 24-5-1972.]
- Subject to eligibility for part final withdrawal a subscriber who has already drawn or may draw in future an advance for any purpose [specified in Clauses (a), (b), (c), (d), (e) and (k) of sub-rule (1) of Rule 15] [Inserted by Notification No. F. 5-5-2002-C-IV, dated 25-1-2003 (w.e.f. 31-1-2003).] may convert at his discretion by written request addressed to the Accounts Officer through the sanctioning authority, the balance outstanding against it into a final withdrawal on his satisfying the conditions laid down in Rules 16-A and 16-B.]17. Payment towards insurance policies and family pension funds.
- Subject to the conditions hereinafter contained in Rules 17-A to 27,-17A.
18.
19.
20.
21.
22.
The subscriber shall not during the currency of the policy draw any bonus the drawal of which during such currency is optional under the terms of the policy, and the amount of any bonus which under the terms of the policy the subscriber has no option to refrain from drawing during its currency shall be paid forthwith into the Fund by the subscriber or in default recovered by deduction from him emoluments in one sum [x x x] [Omitted by Notification No. G-25-31-95-C-IV, dated 1-3-1996.].23.
24.
25.
If the interest of the subscriber in the family pension fund referred to in Clause (a) (i) of Rule 17 ceases, in whole or part, from any cause whatsoever, the provident fund account of the subscriber shall forthwith be reimbursed by the amount of the refund secured by the subscriber from the family pension fund, which amount shall, in default of reimbursement, be deducted from the subscriber's emoluments in [x x x] [Omitted by Notification No. G-25-31-95-C-IV, dated 1-3-1996.].26.
If the policy lapses, or is assigned, otherwise than to the Governor of Madhya Pradesh under Rule 21, or is charged or encumbered, the provisions of sub-rule (4) of Rule 21 applicable to a failure to assign and deliver a policy shall apply.27.
If the Accounts Officer receives notice of,-27A. Restrictions relating to financing of insurance policies.
- The provisions of Rules 17 to 27 shall apply only to subscribers who, before the date of publication of this rule, have been substituting in whole or in part payment towards policies of life insurance for subscription to the Fund or making withdrawals from the Fund for such payments :Provided that such subscribers shall not be permitted to substitute such payments for subscriptions due to the Fund or to withdraw from the Fund for making such payment in respect of any new policy.28. Recovery of moneys drawn, withheld or withdrawn from the fund for improper use.
- Notwithstanding anything contained in these rules, if the sanctioning authority is satisfied that money drawn as an advance from the Fund under sub-rule (1) of Rule 15 or withheld or withdrawn from the Fund under Clause (a) or Clause (b) of Rule 17 has been utilized for a purpose other than that for which sanction was given to the drawal, withholding or withdrawal of the money, the amount in question, shall, forthwith be repaid or paid, as the case may be, by the subscriber to the Fund, or in default, be ordered to be recovered by deduction in one sum from the emoluments of the subscriber, even if he be on leave. If the total amount to be repaid or paid, as the case may be, be more than half the subscriber's emoluments, recoveries shall be made in monthly instalments of moieties of his emoluments till the entire amount recoverable to be repaid or paid, as the case may be, by him :[Provided that, if the sanctioning authority has reason to doubt that money drawn as an advance from the Fund under Rule 13, has been utilized for a purpose other than that for which sanction was given to the drawal of the money the said authority shall communicate to the subscriber the reasons for his doubt and require him to explain in writing, and within fifteen days of the receipt of such communication, whether the advance has been utilized for the purpose for which sanction was given to the drawal of the money. If the sanctioning authority is not satisfied with the explanation or no explanation is furnished by the subscriber within the said period of fifteen days, sanctioning authority shall enforce the repayment in the maimer prescribed in this rule.] [Inserted by Notification No. F.B. 9/1/87/R-II/IV, dated 31-3-1987.]Note. - The term "emoluments" as used in this rule does not include subsistence grant.29. Final withdrawal of accumulations in the fund.
- When a subscriber quits the service, the amount standing to his credit in the Fund shall become payable to him :Provided that a subscriber who has been dismissed or removed from the service and is subsequently reinstated in the service, shall, if required to do so by Government, repay any amount paid to him from the Fund in pursuance of this rule, with interest thereon at the rate provided in Rule 14 in the manner provided in the proviso to Rule 30. The amount so repaid shall be credited to his account in the Fund.Note 1. - A subscriber, re-employed in Government service after retirement, is considered to have quitted service from the date of retirement, even though his re-employment may have been in continuation of his service without break.Note 2. - A subscriber cannot be considered to quit Government service finally when he resigns service under one Government to take up service under another or when he transfers his service from one branch of Government to another. Consequently, a subscriber to any Provident Fund is not entitled to the refund of his deposits in such circumstances if the rules governing the Provident Fund do not permit of the final withdrawal of deposits until he has quitted Government service. [In such cases interest shall be calculated under Rule 14 (4) and the amount together with interest shall be transferred.] [Inserted by Notification No. 9/3/74/R-II/IV, dated 18-6-1974.]Note 2-A. - In respect of calculation of interest and final payment of General Provident Fund money at his credit, the Government servant resigning Government service to take up appointment under a body corporate, owned or controlled by Government, will be subject to the provision of Note 2 above, if that body maintains a fund and agrees to such transfer.Note 3. - When a non-gazetted subscriber retires, resigns, dies or is dismissed or removed from service or proceeds on leave preparatory to retirement, the head of the office should immediately report the fact to the Accounts Officer and submit the claim for final payment in Provident Fund money at his credit to the Accounts Officer in the form prescribed in the Fifth Schedule. The same form should be used also for claims of withdrawal of Provident Fund money of a Gazetted Officer. If any of the particulars or documents required cannot be furnished at once they should be sent as early thereafter as possible but the report of the event should not be delayed on that account.30.
When a subscriber :-31.
On the death of a subscriber before the amount standing to his credit has become payable, or where the amount has become payable, before payment has been made-(i)When the subscriber leaves a family-(a)if a nomination made by the subscriber in accordance with the provisions of Rule 8 or of the corresponding rule heretofore in force in favour of a member or members of his family subsists, the amount standing to his credit in the Fund or the part thereof to which the nomination relates shall become payable to his nominee or nominees in the proportion specified in the nomination;(b)if no such nomination in favour of a member or members of the family of the subscriber subsists, or if such nomination relates only to a part of the amount standing to his credit in the Fund, the whole amount or the part thereof to which the nomination does not relate, as the case may be, shall notwithstanding any nomination purporting to be in favour of any person or persons other than a member or members of his family, become payable to the members of his family in equal shares:Provided that no share shall be payable to-32.
33.
34.
If a subscriber to the Fund is subsequently admitted to the benefits of the Contributory Provident Fund (Madhya Pradesh), the amount of his subscriptions, together with interest thereon, shall be transferred to the credit of his account in the Contributory Provident Fund (Madhya Pradesh).Note 1. - Procedure to be adopted when a will is left by a deceased subscriber, which purports to dispose of his accumulations in the Fund or any part of these. - The Government desire that references should be made to them except in the following cases :-(a)when the Accounts Officer, after taking legal opinion, if necessary, is satisfied that the person or persons entitled to receive the money in the Fund, according to the will and the declaration made under the rules are the same, no reference need be made to the Government;(b)when a subscriber dies leaving no family as defined in the rules and without having made any declaration under the rules, the Accounts Officer may make payment, after the advice of the Law Secretary has been taken, without a reference to the Government, to any person, claiming on the authority of a will of which probate has been granted by a competent Court, provided that where the amount involved does not exceed Rs. 500, no probate need be insisted upon and the amount may be paid to such person or persons as the officer making the payment considers to be the proper person or persons to receive it.Note 2. - Payment of deposits on the basis of the award given by a Civil Court. - A doubt was raised whether in the case of a subscriber who died without leaving a nomination, a decree obtained on the basis of the award by a Civil Court directing the payment of the deposits at credit of the subscriber otherwise than in accordance with the provisions of Rule 31 of the Madhya Pradesh General Provident Fund Rules is binding. It has been held in consultation with the Law Secretary to Government of Madhya Pradesh that such a decree has no effect and that the payment has to be made in accordance with the provisions of the Provident Funds Act and rules thereunder.Note 3. - Payment of a provident fund money due to a minor beneficiary of a deceased subscriber. - (a) A guardian appointed by the Court to receive payment on behalf of a minor beneficiary should alone be recognised even where the amount involved does not exceed the limit of Rs. 5,000 specified in Clause (b) of sub-section (1) of Section 4 of the Provident Funds Act, 1925. But if the party pleads inability to incur expenditure for obtaining the guardianship certificate from the Court, the orders of the Government should be obtained for making any payment.(b)Payment may, however, be made without requiring the production of a guardianship certificate from the Court if the share of a minor beneficiary does not exceed Rs. 100-(i)to the natural guardian of such minor beneficiary, or(ii)in the absence of a natural guardian to the person considered fit by the head of the office to receive payment on behalf of such minor beneficiary on such person executing a bond (See Appendix F) signed by two sureties agreeing to indemnify the Government against any subsequent claim which might arise :Provided that the natural guardian may, if it is considered expedient, be required to execute a bond signed by two sureties agreeing to indemnify the Government against subsequent claim which might arise before the payment is made:Provided further that, in cases governed by the Hindu law, payment may be made, without requiring the production of a guardianship certificate from the Court to a Hindu widow of a deceased subscriber on behalf of her minor children other than step-children irrespective of the limit of Rs. 100 specified above. She may, if considered expedient, be required to execute a bond signed by two sureties agreeing to indemnify the Government against any subsequent claim which might arise before the payment is made.Note 4. - Right of a posthumous child to a share in the balance at the credit in the general provident fund of his father. - A man's posthumous child is a member of his family at the time of his death, and, if born alive, should be treated in the same way as surviving child born before the subscriber's death. The case of a posthumous child already born when the case is taken up by the disbursing officer will present no difficulty. For the rest if the existence of a posthumous child is brought to the notice of the disbursing officer, the amount which will be due to the child in the event of its being born alive should be retained, and the balance distributed in the normal way. If the child is born alive payment of the amount retained should be made as in the case of a minor child; but if no child is born or a child is still born, the amount retained should be distributed among the family.Note 5. - (a) (1) It is inconsistent with Section 3 (1) of the Provident Funds Act, 1925, for Government to deduct any amount due to it by a subscriber from his accumulations in the General Provident Fund at the time of his retirement, or from undisbursed General Provident Fund accumulations payable to a subscriber's nominee in the event of the subscriber's death in service or after retirement, as the case may be, even though the consent of the subscriber or nominee may have been obtained.35.
All sums paid into the Fund under these rules shall be credited in the books of Government to an account named the "The General Provident Fund". Sums of which payment have not been taken within [three years] [Substituted by Notification No. 9-15-79-IV, dated 25-5-1980.] after they become payable under these rules shall be transferred to "Deposits" at the end of the year and treated under the ordinary rules relating to deposits.Note. - It has been decided by the Government of India in consultation with the Comptroller and Auditor-General of India that the General Provident Fund Accounts of the Indian Administrative Service and the Indian Police Service Officers should be maintained by the Accounts Officer of the State on whose cadre the Officers are borne and that the Provident Fund transactions should be adjusted in the State section of the accounts.36.
When paying a subscription in India, either by deduction from the emoluments or in cash, a subscriber shall quote the number of his account in the fund, which shall be communicated to him by the Accounts Officer. Any change in the number shall similarly be communicated to the subscriber by the Accounts Officer.37.
38. [ [Inserted by Notification No. 1027/1224/R-II/IV, dated 26-4-1965.]
If, immediately, before the commencement of the Madhya Pradesh General Provident Fund (Extension and Amendment) Rules, 1965 there are in force in the Madhya Bharat, Vindhya Pradesh, Bhopal and Sironj regions of the State of Madhya Pradesh, any rules or orders corresponding to these rules, all those rules or orders shall stand repealed ;Provided that anything done or any action taken under the rules or orders so repealed shall, unless such thing or action is inconsistent with any of the provisions of these rules, be deemed to have been done or taken under the corresponding provisions of these rules.]First Schedule[See Rule 8 (3)]Form of NominationForm GPF 3| Please read carefully the instructions printed on the reversebefore filling in the form | For use by subscribers having Family Provident Fund AccountNo.......... |
| Name and full address of the nominee/ nominees | Relationship with the subscriber | Age of the nominee |
| (1) | (2) | (3) |
| Share payable (to each nominee) | Contingencies on the happening of which thenomination shall become invalid. | Name, address and relationship of theperson/persons, if any, to whom the right of the nominee shallpass the event of his/her predeceasing the subscriber |
| (4) | (5) | (6) |
| Name | Address | Signature |
| 1. ......................... | ||
| 2. ......................... |
| Space for use by Head ofOffice/Accountant-General's Office | |
| Nomination by Shri/Smt./Kumari........... | Signature of..................... |
| Designation ......................... | Head of Office/Accounts Officer |
| Date of receipt of nomination......... | (Designation) |
| Date............................ |
| Please read carefully the instructions printed on the reversebefore filling the forms | (Observe of the form) For use by subscribers having no familyProvident Fund AccountNo.......... |
| Name and full address of the nominee/ nominees | Relationship with the subscriber | Age of the nominee |
| (1) | (2) | (3) |
| Share payable (to each nominee) | Contingencies on the happening of which thenomination shall become invalid. | Name, address and relationship of theperson/persons, if any, to whom the right of the nominee shallpass in the event of his/her predeceasing the subscriber |
| (4) | (5) | (6) |
| Name | Address | Signature |
| 1. ......................... | ||
| 2. ......................... |
| Space for use by Head ofOffice/Accountant-General's Office | |
| Nomination by Shri/Smt./Kumari........... | Signature of..................... |
| Designation ......................... | Head of Office/Accounts Officer |
| Date of receipt of nomination......... | (Designation) |
| Date............................ |
| Station : | Signature of subscriber.......... |
| Station : | Signatures of subscriberand the joint assured. |
| YZ | XY | |
| (Signature of Accounts Officer) | ||
| (One witness who should add his designation andaddress). |
| YZ | XY | |
| (Signature of Accounts Officer) | ||
| (One witness who should add his designation andaddress). |
Part I – (Checklist for use of Head of Office)
Sub.:-Form for GPF Final payment of Shri/Smt......................GPF A/c No.............(in duplicate).In Part II, in form, reference to entries in column number :-1. to 10 have been verified and filled in properly. Death certificate/order of resignation is enclosed.
11. (A) & (B) Part final withdrawals sanctioned and paid with effect from 6-6-1972 and Temporary advance have been mentioned or list enclosed.
12. Certificate enclosed.
13. Details of DPF A/c (month-wise deduction withdrawals and Interest upto last 31st March) to transfer the balance into GPF have been enclosed.
14. In case the nomination subsists original nomination is enclosed. Nominee is a family member as per definition of M.P. GPF Rules, 1955 or out of family member has been stated in proper column.
15. Details of family members of deceased Govt, servant relationship and age have been stated.
16. In case of amount due to a minor, Indemnity Bond. Guardianship Certificate is enclosed.
17. In case subscriber has left no family and no nomination subsists, succession certificate/legal heir certificate in favour of claimant is enclosed.
18. (ii) Payment if desired through Treasury, three sets of attested specimen signature, finger and thumb impression, mark of identification and attested photographs have been enclosed.
19. In case of resignation of the subscriber to take up appointment in another department of the State Government, or under other Government or under body corporate owned or controlled by the Government details such as PF A/c No. of new Department/institution, consent of Department/Institution, designation and address to whom the Bank Draft is payable have been enclosed.
Other Required DocumentsPart II – Form for Final Payment of balance in the General Provident Fund account
(For use of Head of Office)Forwarded to the A.G. (A & E) I, II M.P., Gwalior/Bhopal with the request that balance at the credit of GPF A/c No............ at the end of as per account slip is Rs............ therefore GPF Balance may be reviewed and authorised.Necessary details are as below :-1. Name of the subscriber and designation................
2. Name of father/husband.................
3. GPF Account No./Nos..........................
4. Date of retirement/death/resignation/dismissal and date of appointment in new Department...............
5. Oder No. and date.............................
6. Name of claimant...............................
7. Address of claimant/subscriber (for further correspondence)............................
8. Date of commencement of service..........................
9. Month and year in which first deduction towards GPF was made...........................
10. Last Fund deduction towards GPF...................
11. (A) Certified that the Part Final withdrawals during the period commencing from 6-6-1972 to date were sanctioned and drawn from his/her GPF A/c :-
| Sl. No. | DDO | Major | HD | VR. No. & Dated | Treasury | Amount |
| Sl. No. | DDO | Major | HD | VR. No. & Dated | Treasury | Amount |
| Month/Yr. | Amt. Sanctioned and Paid | Amt. of Adv. recovered | Amt. interest recovered | Major Head of Account in which Amt. of interestis credited | Remarks |
| Policy No. | Premium Rs. drawn | First Premium Month/Year | Last premium Month/Year |
12. Certified that no temporary advance/Part final will be drawn without obtaining prior sanction of A.G. (A & E)-11, M.P., Gwalior after submission of form for Final Payment of Balance.
13. Certified that his/her DPF A/c has been maintained in the office. Balance at the credit of DPF A/c has not been paid. The details of deduction withdrawals and interest allowed upto 31st March are enclosed.
14. Details of the nominees alive on the date of death of the subscriber, if nomination subsists :-
| Name of nominees | Relation with subscriber | Share of the nominees | Whether nominee is out of family member or familymember of the deceased |
15. Details of family members of deceased Government servant:-
| Name | Relationship with subscriber | Age on the date of death of subscriber |
16. 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.
17. If the subscriber has left no family and no nomination subsists, the name of persons to whom the provident fund money is payable, claim should be supported by letter of probate or succession certificate.
| Name of claimant | Relationship with subscriber | Address |
18. (i) Payment is desired through office..............
(Name of the office)19. Certified that subscriber has resigned/not resigned Government service to take up appointment in another department of the State Government or under other Government or under a body corporate owned or controlled by Government (In case of resignation made to take up appointment in other Department/Institution as mentioned above, the balance at the credit of GPF A/c will be transferred to New Provident Fund A/c allotted him/her with consent of the Department/Institution). Therefore, consent of new Department/ Institution and new Account No. allotted to him/her is enclosed.
| Date................. | Signature of DDO |
| Place................ | Designation (Rubber seal to be affixed) |
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 the subscriber...............................
7. Amounts of provident fund money standing to the credit of the subscriber at the time of his death, if known....................
8. Details of the nominees alive on the date of death of the subscriber, if a nomination subsists....................
| Name of nominee | Relationship with the subscriber | Share of the nominee |
| (1) | (2) | (3) |
| 1.2.3.4. |
9. In case the nomination is in favour of a person other than a member of the family the details of family if the subscriber subsequently acquired a family.
| Name of nominee | Relationship with the subscriber | Age on the date of death |
| (1) | (2) | (3) |
| 1.2.3.4. |
10. In case no nomination subsists, the details of the surviving members of the family on the date of death of the subscriber. In the case of a daughter or of a daughter of a deceased son of the subscriber, married before the death of the subscriber, it should be stated against her name whether her husband was alive on the date of death of the subscriber.
| Name of nominee | Relationship with the subscriber | Age on the date of death |
| (1) | (2) | (3) |
| 1.2.3. |
11. In the case of amount due to 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.
12. If the subscriber has left no family and no nomination subsists; the name of persons to whom the provident fund money is payable (to be supported by letters of probate or succession certificate etc.).
| Name of nominee | Relationship with the subscriber | Address |
| (1) | (2) | (3) |
| 1.2.3. |
13. Religion of the claimant (s).................
14. The payment is desired through the office of....../through the.......... Treasury/Sub-treasury.* In this connection the following documents duly attested by a Gazetted Officer in service/Magistrate are attached :-
2. The Provident Fund Account No............ of Shri/Shrimati/Kumari.............. (as verified from the annual statements furnished to him/her) is...........
3. He/She died on........ A Death Certificate issued by Municipal Authority has been produced/is not required in this case as there is no doubt about his/her death.
4. The last fund deduction was made from his/her pay for the month of..... drawn in this office Bill No...... dated....... for Rs..... (Rupees......) Cash Voucher No....... of....... Treasury the amount of deduction being Rs.......... and recovery on account of refund of advance Rs.........
5. [ Certified that he/she was not sanctioned any temporary advance from his/her Provident Fund Account during the 12 months immediately preceding the date of his/her death.
ORCertified that the following temporary advances were sanctioned to him/her and drawn from his/her Provident Fund Account during the 12 months immediately preceding the date of his/her death :-| Sl. No. | Amount of Advances | Date and place of encashment | Voucher No. |
| 1.2.3.4. |
5.
-A. Certified that part-final withdrawals were sanctioned to him/her and drawn from his/her Provident Fund Account during the period commencing from 6-6-1972 till the date of his/her death as per details of the part-final withdrawals granted to him/her indicated below :-| Sl. No. | Name of Treasury | Vr. No. & Date | Amount of withdrawn | Designation of Drawing/ Disbursing officer bywhom drawal was made |
| (1) | (2) | (3) | (4) | (5) |
| 1.2.3. |
5.
-B. Certified that a statement of recoveries/drawals made by the deceased Government servant Shri/Smt........... during the last 12 months prior to his/her death in the following proforma is appended along with this application :-| Sl. No. | Major Head under which pay is drawn and name oftreasury. | Name of month for which subscription relates. | Voucher No. & date | Gross amount of the bills(Rs.) |
| (1) | (2) | (3) | (4) | (5) |
| 1.2.3. |
| Amt. of regular subscription(Rs.) | Refund of drawal(Rs.) | Total subscription(Rs.) | Designation of drawing/ disbursing officer bywhom pay is drawn |
| (6) | (7) | (8) | (9) |
| 1.2.3. |
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 to payment of insurance premia or for the purchase of a new policy :-
| Policy number and name of the company | Amount | Date | Voucher No. |
| (1) | (2) | (3) | (4) |
| 1.2.3. |