Proforma For Application For Advance From Provident Funds (Page 2 of 2) in pdf

Proforma For Application For Advance From Provident Funds Page 2

(e) If advance is required for treatment of

ailing family members, following details

may be given :

(i)

Name of the patient and relationship :

(ii)

Name of the Hospital/Dispensary/

Doctor where the patient is under-

Going the treatment

(iii)

Whether outdoor/indoor patient

(iii)

Whether reimbursement available

or not

NOTE :

In case of advance under 8(c) to 8(e), no certificate or documentary evidence would

be required.

Amount of the consolidated advance (item 6 and 7) and

Number of monthly instalments in which the consolidated

Advance is proposed to Rs.___________ in be repaid

____________ instalments.

10.

Full particulars of the pecuniary circumstances of the

Subscriber, justifying the application for the advance

____________________

I certify that particulars given above are correct and complete to the best of my knowledge

and belief and that nothing has been concealed by me.

Signature of Applicant

Dated :

Name………………………………..

Designation …………………………

Section/Branch………………./Office

Proforma For Application For Advance From Provident Funds Page 2