APPENDIX – O
Form of application for part – final withdrawal of money from the Provident Fund for House Building, purchase or redemption of houses and house – sites, higher – education purposes or marriage or medical expenses.
1. / Name of the subscriber / :2. / Designation / :
3. / Pay / :
4. / Name of the provident fund
Account No. / :
5. / (a) Balance at the credit of the subscriber on the date of application.
Note: In the case of a part – final withdrawal for house building and marriage purposes, as well as purchase of house/house-site, the total balance at the credit of all the provident funds should be taken in account, if the subscriber subscribes to more one Provident Fund.
(b) It is a second part-final withdrawal for the purpose of carrying out additions and alterations to or reconstructions of a house acquired with the help of withdrawal already made or which may be made in future from the Provident Fund,
(i)Amount of part – final withdrawal taken;
(ii)Balance at credit at the time of making the first part – final withdrawal. / :
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6. / Amount required, in the case of construction of a house or for the purchase of a house – site, the number of installments in which it is required should be stated.
7. / The purpose for which the amount is required.
(A)If it is house building or for the purpose of purchasing a house-site or for the express purpose of repayment of any loan taken under:
i. For purchasing a house
ii.For constructing, reconstructing a
house
iii.For redemption of a housing
iv.For making additions or alterations
to a house
- For purchase of a house- sites
taken for the purchase of a house-
site; and
vii.For repayment of any loan taken
Under.
B. If it is for higher education
i. Relationship with the person (who is
actually dependant on the subscriber ) for
whom the withdrawal is required;
ii.The specific course taken by the person
and the name and place of the Institution;
iii.Whether the course is for more than three
years and beyond the High School stage;
iv.Whether this is the first or the second
withdrawal for the current year
v.The date of previous withdrawal or
advance, if any, taken for this purpose;
(PTO)
C. If it is for marriage or betrothal ceremony expenses;
i. Whether for the marriage or betrothal
ceremony of the subscriber’s daughter /son
or for any other female relation dependent
on the subscriber, who has no daughter ;
ii.Whether any advance under ordinary rules
has been drawn in respect of the betrothal
ceremony of marriage for which the
present withdrawal is sought for;
iii. actual date fixed for celebration of the
Betrothal ceremony or marriage. / :
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8. / i. Total service including broken period if any
ii. period of service required on the date of
application for attaining the age of
superannuation; and
iii. The date of Superannuation / :
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9. / (a) i.Actual cost of acquiring the house site
ii. Anticipated cost of house proposed to
be built/rebuilt
iii. Anticipated cost of additions
alternation to be made to the house
iv.Actual amount required for redemption
of the house or house site.
v. Total amount & date of loan taken for the
purchase of house site and the amount
outstanding against that on date.
b. particulars of expenses required to be
incurred on the higher education and
c. Amount required for meeting marriage
expenses indicating the number of
marriage to be celebrated. / :
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10. / Amount of installment or installment last taken, if any, for house building or and purchase of house-site (site particulars of amount dates on which taken) / :
11. / Amount, if any received already from Government for purchase of house – site or house building purpose other than from the provident. / :
RECOMMENDED/
No. SIGNATURE OF THE APPLICANT
DESIGNATION:
Date:
Proce.No.Rc/ENC/G5/ / dt: - - 2012
Sanction is here by accorded to drawn the part-final withdrawal of Rs: …………………(Rupees ………………………………………………….) from the GPF A/C.
Signature of the Head of
Office / Drawing officer
P R O F O R M A
Application for Temporary Advance form the G.P.F. (Proforma)
1. / Name of the Subscriber / : / Gundi Raghavendra2. / Account No. / : / 62753-PW
3. / Designation / : / Senior Stenographer
4. / Pay / : / Rs.18030/-
5. / Balance at credit of the subscriber on the date of Application / : / Rs.2,14,116/-
6. / Amount of advance outstanding
If any, and the purpose for
Which advance was taken / : / Rs.97,500/-
7.. / Amount of advance required / : / Rs.1,47,500/-
8. / Purpose for which the advance is required rule (I) / : / To meet the medical expenses, as it became hard to meet from my salary.
9. / Amount of consolidated advance (Item 6 & 7 )and number and Amount of monthly installments
In which the consolidated advance to proposed the
temporary withdrawal / : / Rs.2,45,000/-
@ Rs.7000/- in 35 EMIs.
10. / Full particulars of the pecuniary
Circumstances of the subscriber, justifying the application for the temporary withdrawal. / : / My Mother is suffering with cardiac problem (consequences emerged due to implantation of pace maker) and it requires regular & frequent checkups and treatment.
Signature of the applicant
APPENDIX-I
STATEMENT IF FIXATION OF PAY UNDER ANDHRA PRADESH REVISED SCALES OF PAY RULES, 2010.
( Circular Memo No. 33327-A/549/A1/PC-1/2009 dated: 13.03.2010)
Note : 1. Separate statement be prepared for fixation of pay in respect of substantive
and officiating post.
2. In respect of employees holding Special Grade / Special Promotion post /
Special Adhoc Post, fixation shall be in the corresponding relevant Revised
Scales assigned.
1. / Name of the Employee / :2. / Designation of the post in which pay is to be fixed ( the actual nomenclature of the post i.e Ordinary Special Grade / SPP/ SAPP held by the employee is to be only mentioned) / :
3. / Whether substantive or officiating / :
4. / a) Whether the employee has opted
to Revised Pay a Scales of 2005
b) Date on which option was exercised
c) Date from which option to come
over to the Revised Pay Scales,
2005 from 1.7.2003 or the date
of next increment. / :
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5. / a) Existing Scale of Pay of the post on the date
of entry into the Revised Pay Scales, 2010.
b) Pay in the existing Scale (i.e., RPS, 2005) / :
6. / c) Special Pay, if any in the existing Scale
(i.e., RPS, 2005)
a) Whether this case attracts first Proviso to Rule 6(b) of the Andhra Pradesh Revised Scales
of Pay Rules, 2010
b) If so, the stepped up pay (attach CHECK LIST) / :
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7. / Existing Emoluments on the date of entry into Revised Pay Scales,2010.
a)‘Basic Pay’ i.e. pay as defined in
Fundamental Rule 9 (21)(a) (i)
including stagnation increments
b) Personal Pay under Rule 9 (23)
(a) of the Fundamental Rules or
Rule 7 (40) (a) of the Hyderabad
Civil Service Regulations
c) Personal Pay sanctioned under
A.P Revised Scales of pay Rules 1999.
d) Dearness Allowance admissible at the rate
(without being rounded off) which existing
on 1st July,2003 appropriate to ‘Basic Pay’
referred to at sub –item (a) above / :
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Total 7 (a to d) / :
8 / Fitment benefit 39% of Basic Pay referred to in
item 7 (a ) / :
9 / Total of items 7 and 8 / :
10 / The Revised Scale of Pay, 2005 for the post in which the pay is fixed now. / :
11 / Revised Pay as fixed in the Revised Scale at the stage next above the amount referred to in item 9 above irrespective whether, the amount is a stage or not, in the Revised Scale / :
12 / Increase in Emoluments
i) Basic Pay
ii) Special Pay *
iii) Personal Pay *
(under FR/AP.RSPR,2005)
iv) Family Planning Increment *
v) Advance Increments *
vi) Dearness Allowance
vii) House Rent Allowance 20% Maximum 4000/-
viii) City Compensatory Allowance
ix) Other Compensatory
Allowances
x) Interim Relief
Total
Net Increase Y – X / :
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(a) / The amount of pay fixed in the Revised Pay Scales, 2010 in the lower/substantive post / :
(b) / amount of pay fixed in Revised Pay Scale 2010 (vide item 11 above) / :
(c) / pay fixed in the Revised Pay Scales, 2010 in officiating post as per Rule 6 (g) (i) of the
Andhra Pradesh Revised Scales of Pay Rules, 2010 in case where the pay in Item 14 is equal or less than pay in Item 13 above (i.e. next stage to the amount of the substantive pay as per item 13 above) / :
14 / Date of next increment / :
15 / Any other relevant information / :
Station: Hyderabad.
Date:
Signature of the Head of the Office/
Drawing and Disbursing Officer.
Shall not be reckoned as pay for purpose of calculation of Dearness
Allowance, House Rent Allowance and City Compensatory Allwance.