Revised TS GPF Application Form for Final payment of GPF Balance

Revised TS GPF Application Form: New TS GPF Application Form, GO.113 Revised TS GPF Application Form for Final payment of GPF, How to fill TS GPF Details for final payment of GPF Balance. G.O.MS.No. 113, Dated: 09-09-2016. Govt of Telangana,-GPF-Revision of application for the final payment of G.P.F. balance-Amendment-orders issued.

Read the following:
1) G.O.Ms.No.261 Finance & Planning (FW.Pen.II) Dept. dated. 28-8-1989.
2) Letter No.T.S.H2/4860/2015 dated. 24-11-2015 received from the DTA Telangana Hyderabad.
3) Letter No. FM/GL.II/9-3/2016-17/14 dated.28-07-2016 received from the AG (A&E) Telangana and Andhra Pradesh Hyd.

In the G.O. 1st read above Government have issued orders for revision of Form of Application for Final Payment of General Provident Fund balances. In the reference 2nd read above, the DTA Telangana Hyderabad has requested to make mandatory the nominee’s name on final authorization of GPF to avoid inconvenience, hardship and ensure timely payment of final authorization of GPF amount to the families of deceased subscribers, in the event of death of the subscriber before receiving GPF final withdrawal amount.

2. In the reference 3rd read above the AG has proposed the change in the form of application for final payment of General Provident Fund Balances as revised in the reference first read above.

3 Government after careful examination of the proposals have decided to revise the form of application for final payment of General Provident Fund as suggested by the AG. The revised form is annexed to this G.O.

4. The existing practice of sending of 3 sets of Form of application for Final Payment of GPF shall be discontinued and two sets of applications shall be sent to AG for processing of final payment from the GPF.

Form of Application for Final Payment of General Provident Fund Balance
(Retirement/ Compulsory Retirement / Voluntary Retirement / Resignation// Dismissa) /Removal/Invalidation/ Transfer of Balance or Death Case etc., )

The 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)

I. (i) Name of the Subscriber (in capital letters) : Emp ID. (7 digit)
(ii) Personal Mobile No : (iii) Mail id : (iv) Aaadhar Card No. : (v) Bank Account Details :
(a) Account Number
(b) Name of the Bank
(c) Branch
(d) IFSC Code
2 Date of Birth :
3. Designation and office to which attached :
4. G.P.F. Account No. With Departmental Suffix :
5 . Details of Nomination ( As per Rule 7 & appendix – R )


I hereby nominate the person mentioned below, who is a member of my family as defined in Rule 2 of the General Provident Fund (Telangana) Rules to receive the amount that may stand to my credit in the Fund, in the event of my death before that amount has become payable or having become payable, has not been paid:-

Name and address Relationship Age Contingencies on Name, address and
Of nominee with the happening of relationship of the Subscriber which the- person, if any, to nomination shall become whom the right of invalid the nominee shall pass in the event of his predeceasing the subscriber.

Dated this day of 200 at
Two witnesses to signature-
Signature of subscriber.

6. Residential address of the claimant : Present Address:
Permanent Address:
7. Copy of the latest Account slip is enclosed: YES/NO
8 i) Date of Retirement : or
ii) Date of resignation :or
iii) Date of voluntary Retirement :or
iv) Date of dismissal/removal/Compulsory retirement/invalidation

9. Particulars of offices worked during the Last 3 years
Name of Office & Address Working during the period Designation
From To
10. Office/Treasury at which payment is desired:
10 (A) If payment is desired outside the place of last duty enclose the following documents:
a) Personal marks of identification
b) Two specimen signatures
c) Left/Right hand thumb impression (in case of illiterate claimants)

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.

ii) I hereby undertake that no appeal shall be preferred by me against my dismissal/removal/compulsory retirement/invalidation)
I hereby undertake to refund any excess payment arising out of clerical error in the settlement of G.P.F. Claim.

12 In case of death the following particulars may be furnished.
a) Date of death (Copy of death certificate to be enclosed)
b) Religion of Deceased Government servant.
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

The final withdrawal application is forwarded to the Accountant General, Andhra Pradesh, and Telangana Hyderabad, for authorizing the balance.
13.Certified that all the particulars furnished above have been verified with reference to office records and are found correct.

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 ………………………

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. Ms. No. 216. Dated 4-6-1986.

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 thereafter.

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

Yours faithfully, Station: SIGNATURE
With date and Designation
Date: Official Mobile /Phone No.

Revised TS GPF Application Form

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