APPLICATION FOR A N O N - R E F U N D A B L E PART FINAL W I T H D R A W A L FROM T H E

G E N E R A L P R O V I D E N T FUND.

1. Subscriber's Name : AMAL K U M A R M A J U M D A R

2. Subscriber's designation and HINDI T E A C H E R

office to which a t t a c h e d .

3. a) S u b s c r i b e r ' s date o f b i r t h 22.05.1964

b) S u b s c r i b e r ' s date of entry 16.01.1991
into s e r v i c e
4. Subscriber's probable date of 3 1.05.2024
retirement

5. S u b s c r i b e r ' s Pay RS. 5 8 6 0 0 / -

6. Account Number MSD029060

7. B a l a n c e at C r e d i t of t h e
s u b s c r i b e r ' s on the date of
Sanctioning the withdrawal.
i) B a l a n c e as p e r G P F A / c . slip Rs. 1,1 7 , 0 3 0 6 / -
for t h e y e a r / A s o n 1 4 . 1 0 . 2 0 1 9 :

ii) A d d . : D e p o s i t s f r o m to Rs. 1 , 1 7 , 0 0 0 / -

Less: W i t h d r a w a l s Rs. 0
Balance Rs. 2 , 3 4 , 0 3 6 / -

8. O b j e c t of w i t h d r a w a l :

9. Amount ofwithdrawal required : Rs. 1 , 1 7 , 0 0 0 / -

(in w o r d s a s well a s i n f i g u r e s ) (Rupees One lakh s e v e n t e e n t h o u s a n d ) only

10. O f f i c e in w h i c h p a y m e n t is :
required (drawing officer may
be indicated)
11. In t h e c a s e o f w i t h d r a w a l for :
House building p u r p o s e state
w h e t h e r you have been
sanctioned house building
a d v a n c e p r e v i o u s l y if so.
i) O r d e r No.In w h i c h s a n c t i o n :
ii) A m o u n t of L o a n s a n c t i o n :
iii)Amount drawn from GPF : Rs. 8 0 , 0 0 0 / - ( Non r e f u n d a b l e a d v a n c e )
(either a s t e m p o r a r y a d v a n c e
or part final withdrawal)

Signature of the Applicant

Place: M u d u l i p a d a Name: Amal K u m a r M a j u m d a r
Date: 1 4 . 1 0 . 2 0 1 9 Designation: Hindi T e a c h e r
O / o H e a d m a s t e r , Govt. SSD High School,
Office to w h i c h A t t a c h e d :

" R e c o m m e n d e d for s a n c t i o n "

 GPF RECOVERY STATEMENT

Name

GPF A c c o u n t No.

Designation

Amount received
Total a m o u n t in
Month towards subscription
(Rs.)
in (Rs.)
GPF slip for t h e v e a r

Less: Withdrawals

Total :

( Rupess: only)

Certified that, above credits and debits are

v e r i f i e d w i t h r e f e r e n c e FCR a n d f o u n d c o r r e c t .
 UTILISATION CERTIFICATE

C e r t i f i e d t h a t I h a v e fully utilized the G.P.F. Part Final

W i t h d r a w a l f r o m m y GPF A / c . No. and an a m o u n t

of Rs. ( Rupees only)

sanctioned vide Memo.No. ,

Dt. for the p u r p o s e .

( )
 APPENDIX- M

( F o r m o f u n d e r t a k i n g t o b e f u r n i s h e d b y t h e B o a r d / A P N P D C L s e r v a n t a p p l y i n g for
the House Building Advance)

T h e S e n i o r A c c o u n t s O f f i c e r (GPF)
APNPDCL/Warangal.

In c o n s i d e r a t i o n of the APTRANSCO/APNPDCL Employee (hereinafter referred to

a s t h e E m p l o y e e ) h a v i n g a g r e e d a t m y r e q u e s t t o p e r m i t for t h e p u r p o s e o f b u i l d i n g o r
a c q u i r i n g s u i t a b l e h o u s e i n c l u d i n g t h e c o s t o f t h e site t h e r e o f o r a l t e r i n g o r m a k i n g
a d d i t i o n s t o t h e h o u s e a l r e a d y o w n e d b y m e w i t h d r a w a l o f t h e s u m o f Rs.
(Rupees only) f r o m t h e a m o u n t s t a n d i n g t o m y
credit in the General Provident F u n d . I hereby u n d e r t a k e to observe and
p e r f o r m the t e r m s and c o n d i t i o n s c o n t a i n e d there in so far they are applicable to me
and in p a r t i c u l a r to comply with the following t e r m s and c o n d i t i o n s n a m e l y

1) T h a t t h e a m o u n t for w h i c h t h e w i t h d r a w a l i s a p p l i e d for s h a l l b e a c t u a l l y
u t i l i z e d for t h e p u r p o s e o f b u i l d i n g o f a c q u i r i n g s u i t a b l e h o u s e i n c l u d i n g t h e
site t h e r e o f a l t e r i n g o r e n l a r g i n g h o u s e a l r e a d y o w n e d b y m e .

2) T h e if t h e a m o u n t p e r m i t t e d to be so w i t h d r a w n is in e x c e s s of t h e a c t u a l
e x p e n d i t u r e i n c u r r e d b y m e for b u i l d i n g o r a c q u i r i n g s u i t a b l e h o u s e i n c l u d i n g
t h e c o s t of t h e site, t h e roof or a l t e r i n g or e n l a r g i n g a h o u s e o w n e d by m e , t h e
e x c e s s a m o u n t shall b e r e f u n d e d t o t h e B o a r d for c r e d i t t o m y P r o v i d e n t F u n d
f o r t h w i t h w i t h o u t d e m u r in our lump s u m w h e t h e r the s a m e shall have been
d e m a n d e d or not.

3) That the hose proposed to be built or acquired by me with the a m o u n t to

w i t h d r a w n s h a l l be s i t u a t e d at my p l a c e of d u t y or where I
intend to reside after retirement.

4) T h a t in t h e e v e n t of my b u i l d i n g h o u s e or a l t e r i n g or m a k i n g a d d i t i o n s to a
h o u s e the construction or altering or enlarging of the h o u s e shall be
c o m m e n c e d w i t h i n six m o n t h s o f t h e w i t h d r a w a l o f t h e a f o r e s a i d a m o u n t a n d
shall be completed with a period or one year f r o m the date of c o m m e n c e m e n t of
c o n s t r u c t i o n of a l t e r n a t i o n of m a k i n g a d d i t i o n s to the h o u s e or within such
f u r t h e r e x t e n d e d p e r i o d a s t h e A P T R A N S C O / A P N P D C L m a y , i n its a b s o l u t e
d i s c r e t i o n , allow.

5) T h a t in t h e e v e n t of my b u i l d i n g a h o u s e , t h e r i g h t to b u i l d on t h e site on w h i c h
t h e h o u s e i s p r o p o s e d t o b e b u i l d will b e r e q u i r e d b y m e f o r t h w i t h .

C o n t d .. 2
 2

6) T h a t a p p r o v e d p l a n a n d p e r m i t s , w h e r e n e c e s s a r y f o r m t h e local a u t h o r i t i e s for
t h e p u r c h a s e o f b u i l d i n g m a t e r i a l s t o t h e e x t e n t r e q u i r e d shall b e f u r n i s h e d b y
me.

7) T h a t in t h e c a s e of d r a w a l for t h e p u r c h a s e of a r e a d y b u i l t h o u s e , I w o u l d
s e c u r e a n u n d i s p u t e d title t o t h e h o u s e a n d l a n d o n w h i c h t h e h o s e i s b u i l t ,
before the p u r c h a s e price is paid.

8) T h a t so long as I am in s e r v i c e , I s h a l l s u b m i t every y e a r a d e c l a r a t i o n in t h e
form prescribed by the APTRANSCO/APNPDCL on or before the 31st December,
that the h o u s e so built or acquired or altered or additions m a d e c o n t i n u e s to be
i n m y sole o w n e r s h i p a n d p o s s e s s i o n .

9) T h a t w h i l e in s e r v i c e t h e h o u s e so b u i l t or a c q u i r e d or a l l o t t e d or a c q u i r e d s h a l l
n o t be t r a n s f e r r e d by me w a y of s a l e , m o r t g a g e or f i g h t or on l e a s e for a t e r m
exceeding the year or otherwise howsoever, without the previous permission of
the sanctioning authority in writing.

10) I h e r e b y d e c l a r e t h a t m y p r i v a t e s a v i n g s t o g e t h e r w i t h t h e a m o u n t p e r m i t t e d t o
t h e w i t h d r a w n will b e s u f f i c i e n t t o b u i l d o f a c q u i r e t h e h o u s e o f t h e t y p e
proposed and that I do not own any h o u s e other t h a n the one which is intended
to be b u i l t or a c q u i r e d at t h e p l a c e of my d u t y or at my
intended place of residence after retirement, I f u r t h e r declare that if the h o u s e
is n o t p u r c h a s e d or b u i l t in a c c o r d a n c e w i t h t h e p r o v i s i o n s of it I c o m m i t a n y
b r e a c h of the a f o r e s a i d t e r m s and conditions, I shall repay to the General
P r o v i d e n t F u n d for c r e d i t t o m y a c c o u n t , t h e w h o l e o f t h e a m o u n t p e r m i t t e d t o
the w i t h d r a w n form the f u n d in p u r s u a n c e of rule APTRANSCO/ APNPDCL
R e g u l a t i o n 19-D.

Place:

( Signature )

N O T E : - C o n d i t i o n s 5 a n d 7 a b o v e are n o t a p p l i c a b l e to t h e c a s e of a l t e r i n g or
making Additions to house already owned.