AP GPF Application Form for Final payment of GPF Balance-GO.214

New TS GPF Application Form, GO.214 Revised AP GPF Application Form for Final payment of GPF, How to fill AP GPF Details for final payment of GPF Balance. GOVERNMENT OF ANDHRA PRADESH-GPF-Revision of ‘’Form of Application for the Final Payment of General Provident Fund (GPF) Balance”- Orders -issued. Finance(HR.5-Pensions& GPF)Department. G.O.MS.No. 214 Dated: 04-11-2016.

Read the following
1. G.O.Ms.No.261, Finance & Planning (FW.Pen.II)Department, Dated 28.08.1999.
2. Letter.No.FM/GL.II/9-3/2016-17/797 dated 28.07.2016 of the Accountant
General (A&E), Andhra Pradesh and Telangana, Hyderabad.

In the G.O. 1st read above Government issued orders revising Form of Application for Final Payment of General Provident Fund balances.

2. In the reference 2nd read above the Accountant General proposed certain changes in the form of application for final payment of General Provident Fund Balances.

3. Government after careful examination of the proposal have decided to revise the form of application for final payment of General Provident Fund as suggested by the Accountant General (A&E), Andhra Pradesh and Telangana. The revised form is annexed to this G.O.

4. All Drawing and Disbursing Officers/Head of the Departments shall hereafter send to the Accountant General (A&E) two sets of applications in the revised format instead of 3 sets of form of application for processing of final payment from the General Provident Fund.

Form of Application for Final Payment of General Provident Fund Balance
(Retirement/Resignation/Removal/Transfer of Balance or Death Case)
TO BE FILLED IN BY THE APPLICANT
The Principal Accountant General (A&E) Andhra Pradesh & Telangana HYDERABAD.

(Through the Head of office in case of Non-Gazetted and Through Head of the department in case of Gazetted officers)

1. 1. (i)Name of the Subscriber(in capital letters) : Emp I(7 digit) :
   (ii) Personal Mobile No :
   (iii) Mail id :
   (iv) Aadhar Card No. :

1. 2. Date of Birth :
2. 3. Designation and office to which attached :
3. 4. G.P.F. Account No. With Departmental Suffix :
4. 5. Details of Nomination filed : ( As per Rule 7 ) :
5. 6. Residential address of the claimant :
6.  Present Address: 
7. Permanent Address:
8. 7. Copy of the latest Account slip is enclosed: YES/NO
9. 8. i) Date of Retirement : or ii) Date of resignation :or
10. iii) Date of voluntary Retirement :or
11. iv) Date of dismissal/removal/Compulsory retirement/invalidation
12. 9. Particulars of offices worked during the Last 3 years 
13. Name of Office & Address Working during the period Designation From To
14. 10. Office/Treasury at which payment is desired:

10 (A) If payment is desired out side the place of last duty enclose the following documents:

1. a) Personal marks of identification :
2. b) Two specimen signatures :
3. c) Left/Right hand thumb impression (in case of illiterate claimants) 

CERTIFICATES:

1. i) I have not resigned from Government Service to take up appointment in another department of State Government/ Central Government or under a Body Corporate owned or controlled by the state or Central Government.

Note: This certificate is to be furnished only by a subscriber who resigned from Government service. If resigned to take up appointment elsewhere, the information regarding transfer of balance may be given in the form prescribed in the Annexure.

iii) I hereby undertake that no appeal shall be preferred by me against my dismissal/removal/compulsory retirement/invalidation)

1. iv) I hereby undertake to refund any excess payment arising out of clerical error in the settlement of G.P.F. Clai
2. 12. In case of death the following particulars may be furnishe a) Date of death : (Copy of death certificate to be enclosed)

1. b) Religion of Deceased Government :
2. c) Details of the surviving members of the family on the date of death of the subscriber are furnished below (copy of Family Members Certificate issued by Revenue Department)

SI.No Name Relationship Date of birth Marital Status as on the with Date of death of the subscriber subscriber

Place Signature of the
Date Subscriber/ Claimant

FOR THE USE OF HEAD OF THE OFFICE/HEAD OF THE DEPARTMENT
The final withdrawal application is forwarded to the Accountant General, Andhra Pradesh, Hyderabad, for authorizing the balance.

1. 13. Certified that all the particulars furnished above have been verified with reference to office records and are found correct.
2. 14. The last fund deduction was made from his/her pay for the month of …………….Vide this Office Bill No……………………….Dt………………………………for Rs…………………………..(Rupees……………………………………………………………….)cash voucher No……………………………………………..of Treasury, the amount of deduction towards G.P.F

subscription being Rs…………………….and recovery on amount of refund of advance

Rs…………………………….

1. 15. Details of G.P.F. Deduction made from the subscriber’s salary during the last 12 months immediately preceding the date of retirement (in the proforma appended to G.O. No. 216. Dated 4-6-1986.
2. 16. Certified that he/she was neither sanctioned any temporary advances nor any part – final withdrawal from his/her provident fund account during the 12 months immediately preceding the date of his/her quitting service/proceeding on leave preparatory to retirement or thereaft OR

1. 17. Certified that the following temporary advance part-final withdrawals were sanctioned to him / her and drawn from his / her provident fund account during the 12 months immediately preceding the date of his / her quitting service/proceeding on leave preparatory to retirement or thereaft

Amount of Advance/ Date Voucher No. Part-final withdrawal

1.

2.

Yours faithfully,

Station: SIGNATURE

With date and Designation

Date : Official Mobile /Phone No.

DDO ID:
TRANSFER OF BALANCE:
ANNEXURE
In case of absorption in other Departments other state Government/Public/sector under takings Furnish the following information.

1. Date of absorption : 
2. II. Is absorption on permanent basis? :
3.  III. Is absorption without breaks in service? :
4. IV. In case of break in service whether it is limited to joining time allowed on transfer? :
5. V. Is the absorption with the approval of State : Government? If yes, Copy of the order may be enclosed
6. VI. Accounts Officer to whom the balance has to  be transferred and the new G.P.F. Account No. allotted by him

AP GPF Application Form for Final payment of GPF Balance