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Forms - Benefit under the Welfare Scheme


Application for claiming benefit under the Welfare Scheme Under GPF

1. Name of the Applicant _____________________________________________________________

2. Father's name of the applicant ______________________________________________________

3. Address of the applicant ___________________________________________________________

4 Age of the applicant _______________________________________________________________

5. Relation with employee ____________________________________________________________

6. Name of employee ________________________________________________________________

7. Designation of employee___________________________________________________________

8. Father's name of the employee ______________________________________________________

9. Date of appointment of employee _____________________________________________________

10. Scale of present post of employee ____________________________________________________

11. Basic pay of employee______________________________________________________________

12. Date of death of employee ___________________________________________________________

13. Present place of posting of employee at the time of death __________________________________

14. Death certificate issued by competent authority __________________________________________

15. Name of nominee for General Provident Fund Account (as per records). ________________________

Signature of the claimant (Claiming payment on behalf of subscriber)

Declaration from Drawing and Disbursing Officer. Certified that the above particulars are correct as per records and to the best of my knowledge.

Signature of Drawing and Disbursing Officer

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