FORM-III

PROFORMA FOR APPLICATION FOR WITHDRAWAL FROM GPF.

1.Name of the Applicant :-

2.Account Number :-

3.Designation :-

4.Pay :-

5.Date of joining in the service ,

and 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 :-

ii. Credits from

to on a/c of

monthly subscriptions :-

iii. Refunds made to the

fund after closing

balance vide (i) above :-

iv. Total :-

v. Withdrawal during the

period from :-

vi. Net balance as credited

on date of application :-

7. Amount of withdrawal required :-

8. a. Purpose for which the

withdrawal 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 The Director of the Accounts

maintaining the PF account :- ( Postal), Hyderabad.

Signature of the Applicant

Name & Designation.

Section/ Branch,

Certified that the above particulars have been verified and found correct.

Postmaster,