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APPENDIX`O`

Form of Application for PART FINAL/FINAL WITHDRAWAL of money from the PROVIDENT FUND

for house

building,purchase or redemption of house and house sites,higher education purpose or marriage or

MEDICAL EXPENCES
1. Name of Subscriber : 2. Designation 3. Pay : :

4. Name of the Provident Fund Account Number: 5. (a) Balance at the credit of the subscriber on the date of Application.
Note :in the case of part final withdrawal for house building and Marriage purpose as well as purchage of house/house site The total balance at the credit of all the provident funds should Be taken in to account,if the subscribes to more then one Provident fund. (b) if it second part final withdrawal for the purpose or Carrying cut additions and alternations to or reconstructions Of house acquired with the help of withdrawals all ready made Or whgich may be made in future from the provident fund. i) Amount of part final withdrawal already taken. ii) Balance at a credit at the time of amking the first part Final withdrawal 6. Amount required in case of construction of a house or For the purchase of a house site the number of instalments In which is required should be started. 6. 7. (a)PURPOSE OF THE LOAN if it is house building or for purpose of purchasing a House site or for express purchase of repayment of any Loan taken under: (a) (i) For purchasing a house: ii) For constructing /reconstructing a house: iii) for redemption a house iv) For making additions of alterations to a house: v) For purchase of a house site: vi) For repayment of a loan expressly taken for the purchase of a house site and: vii) For repayment of any loan taken under------------------------------------------(if it is for higher education) b) i) Relationship with the person(who is actually dependent on the subscriber) for whom the withdrawal is required. ii) The specific course taken by the person and the place of the institution. iii) Whether the course is for more than three years and be yond the High school state. iv) Whether this is the first or the second withdrawal for the current year . v) The date of previous withdrawal of advance if any taken. c) if it is for marriage or betrothal ceremony expenses. i)Whether the marriage or betrothal ceremony of the sub scribes daughter/son or any other female relation dependent on the subscriber,who has no daughter.

contd.

i) Whether any advance under ordinary has been


drawn in respect of the betrothal ceremony or marriage for which the present withdrawal is sought for. ii) 8. Actual date fixed for celebration of the betrothal ceremony or marriage. i) Total service including broken period if any. ii) Period of service required on the date of application for attaining the age of superannuation and

iii)
9. i) ii)

The date of superannuation: Actual cost of acquiring the house or house site. Aanticipated cost of house proposed to be build/rebelled to the house.

iii) Anticipated cost of additions or alterations to be made iv) Actual amount required for redemption of the house/ house site v)Total amount and date of loan taken for the purchase of house site and the amount outstanding against that on date: vi) Particulars of expenses required to be incurred on the higher education and vii)Amount of required for meeting marriage expenses in dicating the number of marriages to be celebrated. 10. Amount of instalments list taken if any, for House building /or/ and purchase of house sites,state Particulars of amount ,dated in which taken. 11. Amount , if any,received already from Government for pur Chase of housesites or house building purchases other than From the provident fund account.

Date: Recommended/Not recommended Signature of Head of office or Drawing officer Designation: Date: The above particulars have been verified to be correct. Forwarded to the

Signature of Applicant

Contd

Certified that i) The part final withdrawal has been recommended under rule I have satisfied myself that the conditioneds prescribed in rules referred to above have been fulfilled and that the subscriber have produced to me Necessary deeds and papers which are enclosed. iii) iv) v) The applicant has signed the undertaking prescribed in rule that same Is for warded herwith. Ihave verified the progress of construction of the house and that the 2nd 3rd/4th instalment of the withdrawlal be paid. I have satisfied myself that the applicant has not taken any loan/assistance under any scheme sponsored by the or from any other Government source and that the necessary note has been made regarding the verification of the requirements said down in rule in case of compleate repayment for loan during the service of the subscriber . vi) No. part-final withdrawal has been granted previously to the subscriber for the same the purpose and.

ii)

vii) Note:

In addition to this part final withdrawal ,no temporary advance has been granted to the subscriber for the same purpose now.

Delete the certificate not applicable. (certificates in items (ii)(iii) & (iv) above are not necessary if the part-final Withdrawal is for Higher education of for betrothal ceremony or marriage Purpose)

Signature : Designation Dated No. Sanction of the Convered to the part-final withdrawal of Rs.-----------------------------------------------------------(Rupees---------------------------------------------------------------------------------------------------------------The amounting belong drawin instalments). Signature: Designation: Dated: NO. Forwarded to the Account Officer, For necessary action, : :

Signature& Designation

Forms available in www.khajarahamtulla.webnode.com

serve to teachers.

FORM-40A
(See instruction 41(i) to (111) under treasury rule 17) BILL FOR WITHDRAWAL FROM GENERAL AND OTHER PROVIDENT FUNDS ANNEXURE DISTRICT:----------------------SUB-ACCOUNT NO-------------------------------------------------VOUCHER NO -----------------------------------PF------------------------------20 STATE PROVIDENT FUND------------------------------------PROVIDENT FUND -----------------------------------OF BRANCH Bill for withdrawing provident fund. ------------------------of-------------------------------

-----------------------------------------------------------------------------------------------------------Withdrawals from the zilla praja parishad For the month of ---------------------------------------------------in the office of---------------------------------------------------------------------------------------------------------------------1.Name and designation of the subscriber 2.Z.P.P.F.No. 3.Pay 4.No.&Date of sanction of Letter of Authority 5.Nature withdrawn 1.Advance 2.Partfinal 3.Final 6.Acquittance : : : : :

1.certified that I have satisfy my self sums included in bills (form 40-A)drawn one month/two three month previous to this datein faviour of member accounts No-------------with theexception of these detailed (of which the total have been refunded by deduction in this form) have been disbursed to thr proper persons and that acquittance have taken and filed in my office with receipt stamps duly cancelled for every payment. 2.certified that the balance in the funds at the credite of the date of withdrawn covers the sum in this bill. 3.certified that the amount asked form the bill as required to meet the yearly premium due on in respect of policy No----------------------------with the company limited-------------------in policy/policies in questions has been assigned to the Government of A.P and in the custody of the ZPP for the details,of the policy/policies proposed to be taken has been communicated to and accepted by the zilla parishad.in his letter No--------------------,Date----------------------4.certified that in respect of withdrawals made in bills(form-10A)onemonth/twomonth/three months/ dates towards a payment of insurance premium the original premium receipt have been within onemonth of the date of withdrawals forwarded to the ZPP,--------------------------------with the exception of those----------for the scrutiny and the necessary and endorsements have been made on the receipt to that effect that the abetment of incometax is admissiable. 5.certified that the member of policies from the GPF Dues not exceed fours the number of policies financed from the GPF exceeded four as these were accepted prior to 16-081998-------------------------------------------------------------------------------------------------------------------------------------------------------------------

Station: Date:
signature of the D.D.O with seal

7.Remarks Particulars of Amount Refunded:S.No. Name of the subscriber&Designation ZPPF Account No. Date of Drawal Particulars of amount Drawn Amount Now Refund Rs.

Dy.Chief Executive Officer, Zillz praja parishad,------------------------Passed same for to Rs.-------------------------------------------------(in words pay the

rupees-------------------------------------------------------------------------------------------- only) and

-------------------------------------------------------------------------------------------------------------------------------------------------------------B y way of cheque/D.D./On-line adjustment to the individuals saving Bank Account No.---------------------------------------------------------- at State Bank of India,------------------------------------------Branch. //ACCOUNT VERIFIED// Accounts officer, Officer, Zilla Praja Parishad,---------------------------------. ---------------------------------------------------. FOR USE IN AUDIT OFFICE Dy.Chief Executive Zilla Praja Parishad,

FORM-40A
(See instruction 41(i) to (111) under treasury rule 17) BILL FOR WITHDRAWAL FROM GENERAL AND OTHER PROVIDENT FUNDS ANNEXURE DISTRICT:----------------------SUB-ACCOUNT NO-------------------------------------------------VOUCHER NO -----------------------------------PF------------------------------20 STATE PROVIDENT FUND------------------------------------PROVIDENT FUND -----------------------------------OF BRANCH Bill for withdrawing provident fund. ------------------------of-------------------------------

-----------------------------------------------------------------------------------------------------------Withdrawals from the zilla praja parishad For the month of ---------------------------------------------------in the office of---------------------------------------------------------------------------------------------------------------------1.Name and designation of the subscriber 2.Z.P.P.F.No. 3.Pay 4.No.&Date of sanction of Letter of Authority 5.Nature withdrawn 1.Advance 2.Partfinal 3.Final 6.Acquittance : : : : :

1.certified that I have satisfy my self sums included in bills (form 40-A)drawn one month/two three month previous to this datein faviour of member accounts No-------------with theexception of these detailed (of which the total have been refunded by deduction in this form) have been disbursed to thr proper persons and that acquittance have taken and filed in my office with receipt stamps duly cancelled for every payment. 2.certified that the balance in the funds at the credite of the date of withdrawn covers the sum in this bill. 3.certified that the amount asked form the bill as required to meet the yearly premium due on in respect of policy No----------------------------with the company limited-------------------in policy/policies in questions has been assigned to the Government of A.P and in the custody of the ZPP for the details,of the policy/policies proposed to be taken has been communicated to and accepted by the zilla parishad.in his letter No--------------------,Date----------------------4.certified that in respect of withdrawals made in bills(form-10A)onemonth/twomonth/three months/ dates towards a payment of insurance premium the original premium receipt have been within onemonth of the date of withdrawals forwarded to the ZPP,--------------------------------with the exception of those----------for the scrutiny and the necessary and endorsements have been made on the receipt to that effect that the abetment of incometax is admissiable. 5.certified that the member of policies from the GPF Dues not exceed fours the number of policies financed from the GPF exceeded four as these were accepted prior to 16-081998-------------------------------------------------------------------------------------------------------------------------------------------------------------------

Station: Date:
signature of the D.D.O with seal

7.Remarks Particulars of Amount Refunded:S.No. Name of the subscriber&Designation ZPPF Account No. Date of Drawal Particulars of amount Drawn Amount Now Refund Rs.

Dy.Chief Executive Officer, Zillz praja parishad,-------------------------

Passed same

for to

Rs.-------------------------------------------------(in words pay the

rupees-------------------------------------------------------------------------------------------- only) and

-------------------------------------------------------------------------------------------------------------------------------------------------------------B y way of cheque/D.D./On-line adjustment to the individuals saving Bank Account No.---------------------------------------------------------- at State Bank of India,------------------------------------------Branch. //ACCOUNT VERIFIED//

Accounts officer, Officer, Zilla Praja Parishad,---------------------------------. ---------------------------------------------------.

Dy.Chief Executive Zilla Praja Parishad,

FOR USE IN AUDIT OFFICE