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P'
Revision of Forms under the General
Provident Fund (Gentral services)
Rules,
1960 and Gontributiory provident
Fund Rures (rndia), 1962 -regarding.
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i.1
I 8-INSTITUTIONAL AREA,
SHAHEED JEET SINGH MARG,
SUl,;irl_r.r_..
.,i*,i,,,-;,
_ _ . ! 1 . : ri , : r ,
dr"t.Aqftwerq
T$ ffi
sfqery
F.rr0r2512014/Revised
formsof GpF/KVS
(He)/(pF)
/xnwDELHI- 1100 16
Dated:
.20t4
Dy.Commissioner/Di
rector
"rtnu
Kendirya
Vidyalaya
Sangadhan
All RegionalOffice/ZIETS
Sub: - Revisionof Forms under the General provident Fund (Central
Services) Rules, 1960 and Contributiory provident Fund
Rules
(India), 1962-regarding.
SirTMadam,
With referenceto the captir
O.M. No20l4l1014-p&pw(F)dater
pensions
Pernsonal"P.G"&
developmer
Delhi,revisingof Formsunderthe Gr
provider
Rules,1960and Contributiory
It is requestedthdt the revisedforms may be circulatedamong
the
Kendriya Vidyalayas
underyourregionandalsosuo-moto
adopted.
Hindiversionis beingissuedseparately.
Yoursfaithfuliy'
-*l
-/"
( S . M u t h u s i v a\ lm
l ^) o It'Iy
-' l vt'L"
Asstt.Commissioner
irin;
the requestto uploadthe circular
ir'j.i.' i ,. : l:
rt;
; S , . .
No. ?{Li4l?0
I 4-I'tt I}\l'(lt)
iloverriruent
of lrrclil
p.G. & pensions
l\,'Liiristrv
of liersonncl,
Ilepurirnr:nt
r:l Pensior& Fcnsiolers'lVciiarc
Lok Nayal<
l.ilrlivun,
lilian llnrliet, Nclv I)clhi
, I u n c1 ! 1 ,2 t i 1 . l
0ftlr:c iVlemoranclum
Sub:
Re','isir:in
of Ftlrnis ilndtr ll,e GenerulProvidenrIurrci (Cenrrrl Servicri:;)l?'Lrlcs.
l9t'j{)
a n c ic o n t r i h u t o r vP r o r i i d e n[t; u n d{ L u i e s( l n d i a 1 ,I g 6 2 - r c g a r d i n g ,
Thc Ltndc:rsigned
is dircc,ledtc statc thar flre Dcpartnrcnloi.Perrsior-r
&.p\\r has Lrcgrin
tire 1:rclcess
of'rcvietvitteI'clrmsli:r I:)c:n-sion:uy,lrctirerlent
I:crictltsancll',lcnrinlijr,rns
underthe
vrrrious]l"ules adrrrinistcred
hy this l)r:par.hlentior sornetirne.
"l'l,cliorms under
2.
thc CICS("fcrrsion)J{ul,:s,CCS (CorniriLrtation
o1-pcn-sirrn)
ItLrleslnil
Pny'11t.,'tt
uf ,4,trearsof Pettsion(F{orriination)llLrleshav'ebeerrrnnrerrclecl
lLnJpoLillcdjp thcr
Ciazelie <lf Inclia (E.xtraorilitrarl').ivlrich irrrl availeble oli riris dL'pxr.rntcuL'ij
rvclrsir,;
.LIuc
!I.
'I'he
3,
lrr":rmstrnclertltc (-ir:rteral
ProvidentFund Rulcs lncl ClonlribnLorr,r
Pfovi(lcnt.Prritd
{{uJesl"lnveb,eenlooketJiirto ancltfie revisedForrnsruecnc[oseclhcreLo,
i[,
[t is re-errrphasized
that theto is no provision rurderthe rulcs litl an upprJication
b_ylhc
e m p k : ; ' c c f t r t ' p a y n r c n to i ' l r n a l ] ? a V n r e n t / t r a n s o
l b{ l b a l a n c , so r r r o t i r e r r c n to r d i s c h a r g cr i r
dismiss:rlor pgfmanenltrans{i..rrrrrlsiil*iltf (it:vt. 'l'hrr F{ilailol'Ol'ltcc shall tal<cncces:j3rv
Itci:lottiti 1:'ornt.l in suc,lii::trsi:s
ir,iiJ;rluiasking the Go','cr-nrr"leiil
:icr!.:lnltrr rppii iirr lhe slrne.
In alI othet casesol'wilhdrilv:ii ,fi'rrnr
therCencr:rl/ContriLrLrt<;i-y
FroviclentI;,.urd,
thr sLLbscribcr
: s h a ial p p l y i t t l j r . r n t . t rl.{ c a d o 1 ' 0 l l l c e r v i l l a l s os n s u f et h i } is u i h p i r y n l e n t , i t r l r r s l tbrcs i r a C co r r
'l
l i r r t e , h e r c .s h L r u l cLl r e n o r d d i l i o r r n l l i a b i i i t v o n t l r e G { i y c r n m c r . lot r l i r L - c o n noti ' i n t e r c s r
Pit1t11*nt5"
T h c F * i t t t s h u v e b c c n r c - d c s i r l r c csi o t h r t t h c D r n r v i n sa n i i l ] i s l i L r r s i n O
g f l i c i : r .t l r c
H e a i l o f ' O i t l c e a t t c ia n t ' o t h s l ' a u t i r o r i t vc c r n c c r n e icrlr r e r n r so f t l i c r u l e s r r a y i : c c \ ) i rlil l u i r
rentnrlison rhc l:ortns aul'ILroscpiuirlsnoting irr t]rc noic shc--ct
is rcquiled, uxcepii;r speciai
L'itsils
warrantiugfin exrminati0uof the ftictsof lhc ca:icctc.
{;.
A l I N , l i n i s f r i c s / D e F l r i n r c nr rt rsi r c q u e s t e ct ol g i v c r - r , i c lpcu b l i c i r t ' t o i h e s cl . ' , r r r nisr n r i
ilstrr.rctthe aLilhcrriticsrli]ltflL?rnid
tr.rrr:;etheset'ormshcrrccfirrih,
;i f r. L,"
q-l'ripL
l -i. G h o s h )
L)irector
'['o
i
2.
A l l i r . ' l i n i s t r i c s l D e p r r i m i lonl t' tsh * C o v t . o I I n d i r
Cr-rntrollcr
Lisnsriilof Accaunts.7'LFlc,",r.[-ok *\ar':ri.:
lJhirr'-'ln.
Nerr'l-tcliri.
FORM 1
in the
of balances
Form to be usedby Head of Officefor Final Payment/transfer
ProvidentFund Accountto AutonomousBodies/OtherGovernments
GeneraVContributory
The General Provident Fund/ContributorvProvident Fund Account Number of
flirnishecl
to him/her
Shri/Smt.tKm
..........7as certifiedfrom the statements
fromyearto year,is .....
to
?.,
He/Sheis due to retire from Govefnmentservice/hasproceededon leavepreparatory
retirementfor ..,
beenpermanently
.., months/has
beendischarged/dismissed/has
transferred to
/has resigned finally fi'om Government senrice
on.....
3.
Cerlifiedthat he/shehad takenthe tbllowing advancesin respectof which
installments
eerch
areoutstandins.
of Rs.
Amountof Temporaryadvances
1......
2......
3......
4......
Amount outstanding
4.
Details of the withdrarvalsgrantedto him/her in the current iinancial year are also
indicatedbelowAmount of Final withdrawal
1......
Date of withdrarval
2......
3.....,
4,.....
5.
After adjustingthe abovewithdrar,vals
and advances,
ar1amountof Rs
standingto thecreditin hisiherProvidentFundAccountis appearingin theledgeraccount.
6.
The final paymentbe madeafterverifyingthe records.
Signature
Headof Office
Fonvardedto the PayandAccomts Office
for necessary
action.
Form 2
Form of applicationfor final paymentof balancein the ProvidentFund Account
on deathof a Subscriber
Prrt - I
To
The Head of Office,
5rI.
'....' it is
!rii.ii, dated.
W i t h r e f e r e n c et o y o u r l e t t e r n o . . .
recluested that arrangements may lcindly be made for the payment of the accumulations in the
Fund/Contributory
General
Provident
.. ........
Shri/Smt,/Km
this connectionaregivenbelow
I
l.
of
Fund
Account
Provident
pariiculars
requiredin
.. The necessary
Nameof the subscriber
Postheld by the subscriber.
I
f
Dateof deathof thesubscriber
4.
5.
ProvidentFund Account numberallottedto the subscriber
Informationin 5 A or 5 B below, as applicable:-
5 A. Detailsof membersof farnilyand the nomineesalive on the dateof deathof the
subscriber:
Relationshipof the i Whetherhe/she
Nameandaddress
of the
I Dateof I Marital
norninee/member
i isanominee
of family r birth of I statusof
nominee/member
i
,
l
: '1^rrrrlao
+tla
all
'
the
deceased
r
r
v
r
r
r
r
r
r
v
v
v
with
,
rlru
i
i thedateof
subscriber i
inominee/
:member i
deathof
i
iof familyi subscriber
(-1J
{
i
tt - - - - - ' - - - -
,
1
i
l
.
I
Or
5 B. If the subscriberhas lefl no famiiy and no nominationsubsists,the nameU I
^.c
personsto rvhom the providentflind money is payable(to be supportedby letter()l
etc).
probateor succession
certificate,
with the snbscriber
Nameandaddress Relationship
(i)
(1U
(iii)
Dateof birth
6.
In casethe recipient(s)is/areminor,detailsof the guardiani-"--:---_
iDateof ;Relationship
with
i bkth i
t l r e mrnor
mrnrrr
the
------=r
i
I
r
i
tr-----'-------i
i
I
l
i
,
,
l
i
l
l
I
l
. l
I
l
t
I
i
l
l
is not a Hindu,the claimant
Note: In caseof a minor child whosemother(widow of subscriber)
shall submitan IndemnitvBond. or Guardianshipcertificate,asthe casemay be.
7.
duly attested:
The claimants,shallenclosethe followingdocuments,
(a)
(b)
Photograph
Specimensignaturesin duplicate (in case of literate claimants)/Thumbor finger
impression(in caseof illiterateclaimants)
8.
to be enclosed:
Otherdocuments
(a)
Deathcertificate
heir certificate,etc.(where
(b)
certificate/legal
A copy of letterof probate/succession
applicable).
(c)
Any otherdouumentregardingeligibility of the claimant,asper rules
Yours faithftilly
Station
Date
(Sign
e of claimant,includinggurdian)
(Full nameandaddress)
PART II
(FORTTTEUSE OF I{E
OF OFFICE)
Forwardedto the Pay andAccountsOfficer
particularsfirnished abovehavebeenduly verified.
2.
The General Provident Fund/ContributorvProvident Fund Account No. of
is.....
Shri/Smt./Kumari.
m his/herpay for the month of ....
3.
The last fund deductionwas made
.... (Rupees
... for Rs ...
dated.
drawnin this office Bill No.
and
recovery,
on account
Rs.
being
. . . , . . . ..), the amountof deduction
of reftind of advancebeinsRs
4.
Certifredthat he/shewas neither sanctionedany temporaryadvancenor any final
withdrawalfrom his/herProvidentFundAccountduringthe 12 monthsimmediatelypreceding
thedateof hisi her death:or
to
withdrawalswere sanctioned
Certifiedthat the following temporaryadvances/final
precedinghis/ her death.
Amountanddateof advances/withdrawals
Date
(i)
(ii)
at thetime of
5.
Amountof ProvidentFundMoneystandingto the creditof the subscriber
h i s / h edr e a t hi s R s . . . ,
(Signatureof theHeadof Office)
Form 3
from
GeneralProvidentFund/ContributoryProvident
Form for Applicationfor Advance
Fund
l.
Name of the subscriber
2.
Account Number (with Departmentalsuftrx)
l
(i)
Designation
(ii)
Section/Branch
4.
BasicPayl (Payin the PayBand*GradePay)
5.
Balanceat creditof the subscriberon the dateof
application
...... (if known)
6.
if so,the
is outstanding,
Whetheranyadvance
purposefor lvhichadvancewastaken:
7.
required. . .
Amountof advance
8.
(a)
(b)
(c)
Purposefor which the advanceis required
is soughtfor HouseBuilding,etc,.
If advance
followinginformationmay be givcn:(i)
of theplot
Locationandmeasurement
(ii)
Whetherplot is freeholdor oirlease
(iii) Planfor construction
(iu) If the flat or plot beingpurchased
is from
a GroupHousilg Sociefy,thenameof the Society,
thelocationandmeasuremenl,
etc.
(v)
Costof construction
("i)
of flat is from DDA or any
If the purchase
authorityor
otherState/cityDevelopment
anyHousingBoardor anyother
Governmentagency,the location,
Dimensionetc.,maybe given
Ifadvanceis requiredfor education
ofchildren,
followingdetailsmaybe given:(i)
Nameof the son/daughter
(ii)
where
ClassandInstitutiori/College
studying
(iii) Whethera day-scholar
or a hostler
(d)
If advanceis requiredfor treatmentof ailing
member(s)of family, followingdetailsmay be
given:(i)
Nameof the patientandrelationship...
(i0
r'
Doctor where the patient is undergoing
Treatment
(iii)
(iv)
Whetheroutdoor/indoorpatient
Whether reimbrusement available or not
Note:- In case of advance under 8 (c) to 8 (e), no certificate or documentary evidence is
required.
Number of monthly instalmentsin which theconsolidatedadvance(total of items 6 and7)
instalments
is proposedto be repaid
9.
r0. (i)
(ii)
for theadvanceif it is in excessof the limit laid downin rule l2
Specialreasons
(1) or if there is an advancgoulstandingason thedateof application
if the advanceis appliedfor the reasonsotherthanthose
Special.circumstances
mentioned
in rule 12(l)
I certify that particulars given above are correct aud complete to the best of my
knowledgeand belief and that nothing has been concealedby me.
Signatureof Applicant
Dated:
Part II
(To be filled in by the Drawing & DisbursingOfficer)
l.
on the dateof applicationis givenbelow:Balanceat creditof the subscriber
for
(r)
Closingbalanceasper staternent
. . . .. ..t
theyear.
......,on
(ii) Creditfrom.. .,.....to
accountof monthlysubscription
(iii)
Retunds
. ... ...{
(iv) A unt of advanceoutstandiug. .
(v)
Withdrawalsduringthe periodfrom..
(vi)
Z.
tu.....
,..'....\
Netbalanceatcredit
........t
talcenearlier.
Purposefor which advancer,vas
(Signature)
NameandStampof DrawingandDisbursingOfficer
PartIII
(To be filled by theAdministrativeOffice)
on theapplicationfor advancefrom ProvidentFund
Comments/recommenclations/orders
(Signature)
Forrn 3 A
Pro forma for sanctionof advancefrom ProvidentFunds
No
M i n i s t r yo f . . . . .
To
Accounts Officer
Sir,
...,....of
I am directedto conveysanctionofthe Competent
AuthorityunderrRule
ProvidentFund Rules
the GeneralProvidentFund (Civil Services)Rules, 1960/Contributory
( I n d i a ) ,1 9 6 2.
. . . . . . . . t o the advanceof a sum of
(nameand designation)
(Rupees
from
only) by Shri ..
him to meettheexpenditure
on ....
hisAccormtNo. ..
.... to enable
2.
The advancewill be recoveredin
fromthesalaryfbrthernonthof ....
commencing
monthly instalmentsof f ...."..",eaeh,
......payablein...
. o n l y )o u to f a d v a n coef < . . .
3.
A s u mo f r . , , . . . . ( R u p e e,s. . . . .
amountas specifled
in . . , .
.... andpaid to him / her in the consolidated
sanctioned
aggregating
to {..."......., will
beiow. This amormttogetherwith the advancenor,vsanctioned
from the salaryfor the
be recovered
in .. .. monthlyinstalments
of r . .., ..... each,comrnencing
m o n t ho f . . . .
. . .p a y a b lien . . . . .
(iii)
(iv)
(v)
. . . . . . .a so n . . . .
T h eb a l a n caet t h ec r e d iot f S h r i
Balanceasper accountslip for theyear
Subsequent
andrefundsofadvance
deposits
. ...to.
at theratep.m.from
(ii)
(i)
Totalof Col. and
withdrawalsandadvances
if any
Subsequent
Balance
ason dateof sanction
Col.(iii) - (iv)
5.
This
4.
(i)
(ii)
issues with
the
concllrrence of
...isdetailedbelor,v:{
t
{
{
vide Dy.
Sanctioningauthority
Copy fonvarded to:
I.
Drar,vingand DisbursingOfficer.
... His/her attention is drawn to the provisionsof
2.
Shri/Smt./Ifun
the le 12 of GPF (CS) /CPS (India) Rules and requestedthat a certificate to the effect that the
advancesanctionedabove has been utilized for the purposefor which it has been sanctioned
may, therefore,pleasebe furnished r,vithin threemonths of the disbursementof the money.
3.
SanctionFile.
Pay and Account Offrce
4.
Form 4
Pro forma for applicationfor lvithdrawalfrom GeneralProvidentFundiContributory
ProvidentFund
I.
Name of the subscriber
L.
Account Number (rvith Departmentalsuffix)
a
(a)
(b)
A
.+.
Pay)
BasicPay/(Payin the PayBand+Grade
5.
Dateofjoining service
6.
Dateof sr-rperannuation
1.
on the dateof
Balanceat creditof the subscriber
Application
8
(a)
(b)
(c)
9.
Dated:
Designation
Section/Branch
Amount requiredaswithdrawal
madeundermle 15(1) (C),
Is theapplication
that is, oneyearbeforethe dateof superannuation
is required
If no, purposefor wlrichthe withdrar,val
YesA{o
wastakenfor the same
WhetheranywithCrarval
purposeearlier.If so,indicatetheamountandtheyear
Signatureof Appiicant
Name
Part II
(To be filled in by the Head of Office)
t.
(i)
(ir)
(iii)
(iv)
(v)
is givenbelow:Balanceat creditof the subscriber
on thedateof application
fbr theyear
. . .. , ..{
Closingbalanceasper statement
.......on
C r e d i t f r o m . . . . . . . .1. o
accountof monthly subscription
Refunds
(vi)
Amount of Advance outstanding
Withdrawalsdr,rringthe period from..
to.....
N e t b a l a n c ea t c r e d i t
2.
Purposefor which ad.r'ance
was taken
........t
. . . . . . . .T
lt is certified that the amount of withdrawal exceeds/doesnot exceedsix months pay of
3.
the applicantOr half the amount at his/hercredit / subscriptionin the
of the amount of the credit / subscriptionof the
Fund Account,whichever is less/ three-l'ourths
applicantin the Fund Account.
4.
It is certified that the applicant is r.vithin l0 years of his retirement on sllperarnuation/
h a sc o m p l e t e d
....
. . . . .y e a r so f h i s G o v e r n m e nste r v i c eo n , , . .
5.
It is also certified that the total amount drawn, including the withdrawal from the
ProvidentFnnd, from all Govemmentsonrcesby the applicantfor housebuilding purposesdoes
not exceedthe maximum limit prescribedfrom time to time under rules 2 (a) and 3 (b) of the
Scheme of the Ministry of Works and Housing tbr grant of advances for house bLtilding
pr.ll'poses.
Note: Strike-outwhich is not relevant.
(Signature)
andDisbursing
Officer
NameandStampof Drar.ving
PartIII
(To be filledby theAdministrative
Office)
Commentsirecommendations/orders
on theapplicationfor withdralvalfrom ProvidentFund
(Signatue)
Forrn 5
Pro Foruraof Applicationtor conversionof an advanceinto a final lvithdralal
I.
Nameof the subscriber
2.
andofficeto whichattached
Designation
3.
Payin PayBandwith GradePay
4.
GeneralProvidentFund(GPF)/Contributory
ProvidentFund(CPF)AccormtNttmber
5.
Balanceat crediton tlie dateof application
(amomt acrLrally
by him alongrvith
subscribed
the
case
of GPFsubscriber)
thercon
h
interestdue
6
(a) Puroosefor which advancetaken
-
\ *./
""r ""- - vl
(b) Date of paymentof the advance
(c) Amount of advancesanctionecl
(d) Amount of advancerecovered
(e) Amount of advanceor"itstanding
(f) Interestdue on the amonnt of advancetaken
(g) Amount of advanceto be convertedinto a withdrawal
i .
Par-ticularsof communicationunder which advance
was sanctioned(Copy of sanctionto be enclosed)
8.
Whetherany advanceor final i,vithdrawalhasbeen
drawn previously for the purposemeirtionedabove.
If so, particularsthereof
9.
'. .
. ..
(a) Total service,inclLrdingbrokenperiods,if any, on dateof this application
(b) The date of super-annuation
Signatureof the Applicant
Place:
Date:
PartII
havebeenverifiedto be correct.
Theaboveparticulars
of DDO)
(Signature
anddesignation
PartIII
(To be filled by theAdministrativeOftice)
on theapplicationfor withdralvalfrom ProvidentFurd
Comments/recommendationsiorders
(Signature)
PayandAccountsOffrcer
proformaforsanctiont"-1liilr1"ials
Fr'rncls
fromProviclent
M i n i s t r yo f , , , .
To
Accounts Officer
5lr,
. . . . . .. of
I am directedto convey sanctionof the CompetentAuthority under Rule .
I960 or under ntle ......... of Contributory
the GeneralProvident Funcl(Civil Services)Rr.Lles,
Provident Fr-rnclRules (Inciia), 1962......1othe .,vithdrawalof a sum of < .
(name and
only) by Sh-ri
(Rupees
to enable him to meet the
designation)from his Account No,
on ...
expenditure
It is certifiedthat the conditionsfor withdrawalas specifiedin GeneralProvidentFund
2.
Rules,1960havebeenmet.
(CivilServices)
3.
(i)
(ii;
(iii)
(iv)
(v)
(vi)
is givenbelow:on thedateof application
Balanceat creditof thesubscriber
. ' . . . ..T
tbr theyear
Closingbalanceasper statement
o
n
.
.
.
.
.
.
.
t
o
.......
C r e d it ti o m . .
accountof monthlysubscription
........t
Refunds
.....'..{
.
.
a
n
d
.
A
d
v
a
n
c
e
d
r
a
w
n
b
e
t
'
u
v
e
e
i
r
Amountof
. "." '"t
.. .. and
takenbetweett
Withdrawals
. . ' ' ' '..(
Net balanceat credit
s i t h t h ec o n c u r r e n oc fe . . . .
4.
T h i s i s s u ew
d a t e d.
N o .. . .
. . . . . . . . ' v i dD
ey.
Yoursfaithftilly,
aLrthorily
Sanctioning
Copyforrvardedto:
Ofticer,
andDisbursing
Drar.ving
l.
of
,.. His/herattentionis drawnto theprovisions
Z,
ShriiSmt,
that a certificateto the effectthatthe
the le 16 of GPF (CS)/CPS(india)Rules andrequested
withdrawalsanctionedabovehasbeenutilizeeifor the pruposefor which it hasbeensanctioned
of the rnoney.
may,therefore,pleasebe ftirnishedlvithin threemonthsof the disbtusernent
File.
Sanction
3.
4.
PayandAccountOffice
Form 5-A
ORDER
Dated.
No.
underntle 16 of the
.......is herebyconveyed./accorded
Sanctionof ....
GeneralProvidentFund (CentralServices)Rules/mle17 of the ContlibutoryProvidentFund
Rules (India), 1962 for the conversioninto final withdrawal of an amountof <..
balanceout of theGPF/CPFadvanceof
(
only) beingtheoutstanding
ees
. ' . . . . . .o f
. . . . . . .a n d d r a w ni n B i l l N o . ' .
. . . . s a n c t i o n eodn
{......
to Shri / Shrimathi/ Kumari
for the (purpose)
of the office of the
Signature
Designation
No.
Copyforwardedto:
(i)
(ii)
(iii)
(iv)
PAO
Individual
ServiceBook
Qionrfirrc
Designation
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