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[See rule 7(3)]FORM OF NOMINATIONAccount No ...................................I . ............................................................................. hereby nominate the person(s) mentionedbelow who is/are member(s) of my family as defined in rule 2 to receive the amount that may stand to my credit in the Fund as indicated below, in the event of my death before that amount has become payable or having become payable has not been paid.FORM OF NOMINATIONTABLESignature of subscriber ................................Name in block letters ...................................Signature1. .....................................................................
2. .....................................................................
Two witnesses to signatureName and address1. ..........................................................
2. ..........................................................
(Reverse of the Form)SPACE FOR USE BY THE HEAD OF OFFICE/PAYAND ACCOUNTS OFFICENomination by Shri/Smt/Kumari..........................................Designation....................................Date of receipt of nomination.......................................................................................................................................Signature of Head of Office/Accounts OfficerDesignation ..........................................................Date .......................................................................INSTRUCTIONS FOR THE SUBSCRIBER(a)Your name may be filled in.(b)Name of the Fund may be completed suitably.(c)Definition of term "family" as given in the General Provident Funds (CS) Rules, 1960 is reproduced below:Family means(i)in the case of a male subscriber, the wife or wives, parents, children, minor brothers, unmarried sisters, deceased son's widow and children and where no parent of the subscriber is alive, a paternal grand parents:Provided that if a subscriber proves that his wife has been judicially separated from him or has ceased under the customary law of the community to which she belongs to be entitled to maintenance she shall henceforth be deemed to be no longer a member of the subscriber's family in matters to which these rules relate unless the subscriber subsequently intimates in writing to the Accounts Officer that she shall continue to be so regarded.(ii)In the case of a female subscriber, the husband, parents, children, minor brothers, unmarried sisters, deceased son's widow and children and where no parent of the subscriber is alive, a paternal grand parent:Provided that if a subscriber by notice in writing to the Accounts Officer expresses her desire to exclude her husband from her family, the husband shall henceforth be deemed to be no longer a member of the subscriber's family in matters to which these rules relate unless the subscriber subsequently cancelled such notice in writing.Note-Child means legitimate child and includes an adopted child where adoption is recognised by the personal law governing the subscriber.(d)Column 4 if only one person is nominated the words "in full" should be written against the nominee. If more than one person is nominated, the share payable to each nominee over the whole amount of the Provident Fund shall be specified.(e)Column 5 death of nominee(s) should not be mentioned as contingency in this column.(f)Column 6 do not mention your name.(g)Draw a line across the blank space below last entry to prevent insertion of any name after you have signed.
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[See rules 14(3) and 17(1)]APPLICATION FOR ADVANCE /WITHDRAWAL FROM GENERAL PROVIDENT FUND1. 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 20 ...............Rs........................................(ii)Credit from .........................................................to.........................................................on, account of monthly subscription Rs ................................................................................(iii)Refunds Rs ..........................................................................................................................(iv)Withdrawals during the period from ...........................................................................toRs ........................................(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 measurements, 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 hosteler ............................................................................(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 (Items 6 and 7) and number of monthly instalments in which the consolidated advance is proposed to be repaid Rs .................................................................................................. in instalments.
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 arid belief and that nothing has been concealed by me..................................Signature of ApplicantName ................................................Designation ......................................Section/ Branch ................................Dated ...........................Recommendation/ Remarks of theCompetent Authority...........................................................Signature ..........................................Designation ......................................Dated.................................