FORM – I

Application for allotment of Account number in favour of an eligible subscriber.

To
…………………………………….
…………………………………….
…………………………………….
…………………………………….

Sir,

I have become eligible to subscribe to the General Provident Fund with effect from
……………………………………. as my appointment has been approved by
……………………………………. …………………………………….with effect
from ……………………………………. …………………………………….
……………………………………. (Name of competent authority).

I wish to subscribe to the General Provident Fund at the rate of Rs. ……………
(Rupees ……………………………………. ) per month for the present.

Nomination in the prescribed form duly filled in duplicate is submitted herewith.

Place: Yours faithfully,

Date:

Designation
 FORM OF NOMINATION-II

Account No. …………………… I ………………………………………………. hereby nominate the person(s) mentioned below who is/are member(s)/Non-member(s)
of my family [as defined in para 4(f) of the W. B. Recognised Non-Government Educational Institution Employees’ Management of General Provident Fund Accounts)
Scheme, 1995] 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.

Name & Full address of the Relationship Age of Share payable to Contingencies on Name, address & relationship If the nominee is not a
nominee(s) with the the each nominee(s) the happening of of the persons, if any, to member of the family as
subscriber nominees which the whom the right of nominee provided in Para 4(f)
nomination will shall pass in the event of indicate the reasons
become invalid his/her predeceasing the
subscriber
(1) (2) (3) (4) (5) (6) (7)

Dated this ............. day of....................................... 19 ............ at ………………………………..

Two witnesses to signature:
Name & Address Signature
(1)………………………………………… Signature of the Subscriber: ....................................................
…….………………………………………
Name in Block Letters: .............................................................
(2) ….……………………………………..
…………………………………………… Designation: .............................................................................

Space for use by the Head of Office

Nomination by Sri/Smt/Kumari, ....................................................... Designation ……………..……….. Signature of Head of Institution: ……………………..

Date of receipt of nomination:…………….. Designation: ……………………………………………

Instruction for the subscribers:

(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 para 4(f) of the Scheme, is reproduced below:

Family means:

(i) In the case of a male subscriber, the wife or wives and children of a subscriber and the widow or widows, children of a deceased son of the subscriber. Provided
that, if a subscriber proves that his wife has been judicially separate from him or has ceased under the customary law of the community to which she belongs to be
entitled to maintenance, she shall thenceforth be deemed to be no longer a member of the subscriber’s family in matters to which this scheme relates, unless the
subscriber subsequently indicates by express notification in writing to the Accounts Officer that she shall continue to be so regarded;

(ii) In the case of a female subscriber, the husband and children of a subscriber, and the widow or widows and children of a deceased son of a subscriber : Provided
that if a subscriber by notification in writing to the Accounts Officer expresses her desire to exclude her husband from her family, the husband shall thenceforth be
deemed to be no longer a member of the subscriber’s family in matters to which this scheme relates, unless the subscriber subsequently cancels formally in writing her
notification excluding him.

Note: 1. — “Children means legitimate children”.

2. — An adopted child shall be considered to be child when the Head of the Institution, of if any doubt arises in the mind of the Head of the Institution, the
Government is satisfied that under the personal law of the subscriber, adoption is legally recognised as conferring the status of a natural child, but in this case only.

(d) Col. 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) Col. 5— Death of nominee(s) should not be mentioned as contingency in this column may be filled in with the words in the event of divorce or insanity.

(f) Col. 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.

Note: A nomination shall become invalid in case a subscriber, who had no family at the time of nomination, subsequently acquires a family.
 FORM – III

INDEX REGISTER

Name of the subscriber Name of father / Date of birth Date of Account number Month and year Ledger Details of Details of
husband of the appointment allotted for which Folio No. nomination reasons for
subscriber deduction closure of
towards GPF account
started
(1) (2) (3) (4) (5) (6) (7) (8) (9)
 FORM-IV
Acknowledgement

To
……………………………………
……………………………………
……………………………………
……………………………………

Sir,

With reference to your application dated …………………………… for admission

as subscriber to the General Provident Fund, you are hereby informed that Provident
Fund Account Number …………………………………………………. has been allotted in
your favour.

The nomination furnished by you has been accepted and recorded in the Index
Register maintained by this Institution/Office and one copy has been kept in the safe
custody. The second copy of the duly accepted nomination is hereby returned.

OR

The nomination furnished by you cannot be accepted as you, having a family,

nominated a person who is not a member of your family; as such the same is returned
with the request to submit a fresh nomination.

[strike out whichever is not applicable]

Signature of the Head of the Institution

 FORM-V

Schedule of recovery towards General Provident Fund of …………………………………………………………………… (Name of Institution)

Salary for the month of …………………………………………….

Sl. Account No. Name Designation Pay Subscription Refund of Number of Total Remarks
No. withdrawals/ instalments
advance of advance

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

Total ……………….
In words …………………………………….
No.1. Account number shall be arranged serially and not according to the position of the subscriber.

2. Column 8 shall be filled in such way that the entry shall reveal the total number of instalments in which the temporary advance shall be recovered and the number
of instalment in the present schedule e.g. if an advance is recoverable in 20 instalments and the present one is 6th instalment the entry shall be 6/20.
 FORM –VI
FORM OF APPLICATION FOR ADVANCE FROM GENERAL PROVIDENT FUND

1. Name of the Subscriber :

2. Account No :

3. Designation :

4. Pay :

5. Balance at credit of the subscriber on the :

last day of previous accounting year.

6. Amount of advance outstanding, if any and :

the purpose for which the advance was
taken.

7. Amount of advance required. :

8. Purpose for which the advance is required. :

9. Whether refundable, if so, amount of the :

consolidated advance (Item 6&7) and
number of (and amount of) monthly
instalments in which the consolidated
advance is proposed to be paid.

10. Full particulars of pecuniary circumstances :

of the subscriber justifying the application
for the temporary advance/withdrawal.

11. Date of entry into service. :

12. Date of retirement. :

__________________________________ ___________________________________
Signature of HOI/Secretary Signature of the applicant with date
 Form-IXA
To

Sir,

I am to inform you that:-

1. I am due to retire/have been retired from service with effect from AN/FN.
2. I have resigned finally from service in (Name of the
Institution) with effect from and my resignation has been accepted
with effect from .
3. I have been dismissed from service with effect from .
Necessary steps for final payment of Balance standing at my credit in my G.P.F. Account may
be made at the earliest convenience.
OR

I have been appointed as , in the

(Name and address of the Institution) with effect from
which comes under the jurisdiction of
(Name of authorised officer under the Act).
Necessary steps may please be taken for transfer of the balance including interest standing at
the credit of my General Provident Fund Account Number to
my G.P.F. Account Number allotted in my present
employment in (Name of the Institution).

(Signature)

Name in Block letters:

Address:
 Form IXB
To
___________________________
___________________________
___________________________

Sir,

I/We do hereby inform you that Shri ________________________________ (Name of the

employee), employed as ______________________________ (designation) in your institution,
expired on _______________________ (date of expiry).

I/We being nominee(s)/ Natural heir/ Legal heir to receive the balance standing at the credit of his
General Provident Fund Account request you to kindly make necessary arrangements for payment
of the amount in accordance with the provisions of the scheme.

I/We hereby submit herewith death certificate issued by

* Registrar of births and deaths of the area/ Municipality/ Municipal Corporation/ Panchayat.

** I/We hereby submit succession certificate as a proof of Legal heirship.

*** I/We hereby submit documentary evidence as my/our natural heirship. I/We also hereby declare
that there is no other member of his family who is eligible to claim as natural heir.

Yours faithfully,

______________________________
(Signature)
* Strike out which ever is not applicable.

** Shall be required where no valid nomination subsists and the subscriber had no family at the
time of his death.

*** Shall be required where no valid nomination subsists and the subscriber had a family at the
time of his death.
 FORM - X
Name of Institution/Office ………………………………………………………….………
Address ……………………………………………………………………………………....

Annual Statement of General Provident Fund Account

Year: 20……… 20 ………… Rate of Interest ……………. allowed under Finance Deptt. Memo No. ………. Dated: ………………..

Deposits/ Interest
Withdrawal
Opening Recoveries allowed Total Balance
Name of the Subscriber Account No. during the Remarks
Balance during the during the (3+4+5) (6-7)
year
year year
(1) (2) (3) (4) (5) (6) (7) (8) (9)
 DECLRATION REGARDING OVERDRAWAN

I Sri/Smt. ____________________________________________________________
H.M/T.I.C/A.T/Clerk/Peon of _________________________________________________
__________________________, P.O. ___________________________________________,
P.S. _____________________________, Dist. _________________________________, do
hereby declare that the amount (G.P.F/C.P.F) which is to be sanctioned by the appropriate
authority if afterwards be found to be in excess over which I am actually entitled to, I will be
bound to refund the same (excess money) forthwith on demand.

___________________________ _____________________
Countersigned by HOI/Secretary Signature of Applicant

Name: _____________________________
Date: ____/____/_____ Address: _____________________________
_____________________________
_____________________________
_____________________________