FORM OF APPLICATION FOR FINAL PAYMENT OF BALANCE IN THE GENERAL
(Referred to in note 2 below Rules 13.31 and note Rule 14.29
of C.S.R) To The Chief Administrator H.S.A.M.Board (GPF &
Pension Section) C-6,Sec-6,Panchkula (Through the Head Office)
1. I am due to retire/have retired/resigned finally from
service of the Board on _____________.
2. My Provident Fund Account No. is_____________.
3. I desire to receive payment through my office. Particular
of my personal marks of identification left hand thumb and
finger impression( in the case of illiterate subscriber) and
specimen signature (in the case of literate subscriber) in
duplicate attested by a gazetted officer of the Government
4. I request that the entire balance at my credit with interest
due under the rules may be paid to me. Yours faithfully Signature
Name Office Address Residential Address (For use by HEAD OF
THE OFFICE) Forwarded to the Controller Finance & Accounts,
HSAMBoard , Panchkula for necessary action
1. The Provident Fund Account No. of Sh./Smt/Kumari________
2. He/She is due to retire from Government service on____________
3. Certified that he/she had taken the following advances
in respect of which____________ instalments of Rs.__________
are yet to be recovered and credited to the Fund Account.
The details of the final withdrawal granted to him, her are
also indicated below Temporary Advance Final Withdrawal 4.
The last fund deduction was made from his/her pay vide office
Bill No. ___ dated ______________ Rs _________ (Rupees____________________)
cash voucher No. ___________________ of ______ (Head of the
office with seal)