(1) The Karnataka General Provident Fund Rules, 1957 are hereby repealed.
Provided that such repeal shall not affect the previous operation of the said rules or anything done or any action taken thereon and the proceedings under said rules pending on the commencement of these rules shall be continued and disposed off, in accordance with the provisions of these rules.
Provided further that subject to the preceding provision anything done or any action taken under said rules shall be deemed to have been done or taken under the corresponding provisions of these rules and shall continue to be in force accordingly unless and until superseded by anything done or any action taken under the Act or these rules as the case may be.
By Order and in the name of the Governor of Karnataka G. SHASHIDHAR Under Secretary to Government Finance Department (Admn and Advance)
SCHEDULE (See Rule-16 & 17) Authorities competent to grant temporary advances and partial final withdrawals under the Karnataka General Provident Fund Rules, 2016.
I. Temporary Advances: Under Rule-16 and Rule-17 of the Karnataka General Provident Fund Rules subject to the limit fixed in Government Order No. FD 48 Ma Ka Mu 1994, dated:21.10.1994 for calculating the 'Take Home Salary' and subject to taking into account the period of available service of the subscriber authorities to grant temporary advances.
Sl.No Level Power delegated
1. Heads of Departments Subject to a maximum of 80% of the balance as on the date of sanction both for ordinary and special reasons in each case.
2 Joint Director/Controlling Officers Subject to a maximum of 75% of the balance as on the date of sanction both for ordinary and special reasons in each case, for three times in the entire service.
3 District level other officers Subject to a maximum of 70% of the balance as on the date of sanction both for ordinary and special reasons in each case, for three times in the entire service.
II. Partial final withdrawals: Under Rule-27 of the Karnataka General Provident Fund Rules, 2016.
Sl.
No. Level Power Delegated 1 Heads of Departments Subject to a maximum of 90% of the balance as on the date of sanction in each case.
2 Joint Director/Controlling Officers Subject to a maximum of 80% of the balance as on the date of sanction in each case.
3 District level other officers Subject to a maximum of 70% of the balance as on the date of sanction in each case.
Form No. 1 (see sub-rule (1) of rule 6) Application for admission to the Karnataka General Providen Fund (To be submitted in duplicate and only for the first time)
1. Name of the Applicant (including surname) (in Block Letters)
2.
Marital Status
3.
Father’s / Husband’s name
4. Designation and Office to which attached
5. Parent Department
6. State service/cadre to which the applicant belongs
7. Basic pay per month and the Scale of pay
8.
Rate of subscription per mensum in whole rupees (Not less than minimum monthly subscription vide Rule 5 of the Karnataka General Provident Fund Rules)
9.
If subscriber to any other Fund, name of such fund (GPF/AISPF) etc.
10.
Whether compulsory or optional subscriber (vide Rule 5 of the Karnataka General Provident Fund Rules) 11 Date of Birth 12 Date of Commencement of service 13 Head of Account to which the pay and allowances are debited.
14 Remarks I agree to abide by all rules of the Fund and any alteration that may be made in them from time to time.
Certified that I am sending the application for the first time and no account number has been allotted to me at any time before.
A form of nomination in the prescribed form duly filed in is enclosed.
Station:
Date:
Signature of the Applicant Office and Designation.
Instructions
1. Admission application may be sent at any time of the year.
2. Only one Account number is allotted to each subscriber.
3. The application should invariable be accompanied by the appropriate form of Nomination duly filled in.
4. Subscription to General Provident Fund is compulsory in the case of permanent officers of Group-D employees who, under the conditions of their service are required to insure their lives in the official branch of the Karnataka Government Insurance Department, but are unable to do so owing to over-age or certified ill health.
5. Subscription to General Provident Fund is to be commenced only after an account number is allotted by the Accountant General.
6. Admission application is to be forwarded by the Head of the Department/Head of the Office.
For use in the office of the Accountant General (A&E) in Karnataka, Bangalore No. PF Returned, Account No.______________ is allotted to Sri/Smt _______________.
Kindly quote this number along with the prefix in all the correspondence connected.
Section Officer/PF To ----------------- ----------------- ----------------- Form No.1 substituted vide Notification No.FD 48 Mubani 2001, dated 8.3.2002 wef 1.6.2002.
FORM No. 2 (see sub-rule (2) of rule 6) KARNATAKA GENERAL PROVIDENT FUND Monthly statement of subscription, etc., realized by deduction in the pay bill of the office of the . . . . . . . . . . . . . . . . . . for the month of . . . . . . . . . . . 20. . . encashed at . . .
. . . . . . . . . .. . . . . . District/Taluk Treasury during the month of . . . . . . . . . . . . . . . .20.
N. B:- If more names are required to be entered, the reverse of this Form may be used, with columns 1 to 10.
Station:
Date:
Signature and Designation of Drawing Officer FOR USE IN THE AUDIT OFFICE Voucher No. . . . . . . . . . .
Date of Encashment . . . . . . . . .
(1) Certified that the names, amount of individual deduction and the total deduction have been checked by reference to the bill.
(2) For schedule attached with March Bill certified that the rates of pay as shown in column No. 4 have been verified with the amounts actually drawn in the bill.
Initials of the Auditor, DAD/GAD/FAD Date . . . . . . . . . . . . . .
(Section . . . . . . . . . ) Sl.
No Name of the Subscri ber G. P. F.
Account No.(in full) Pay Amount deducted No. of present installment of the Refund Remarks Subscription proper Refund of withdrawal Interest Total No. of total installment sanctioned 1 2 3 4 5 6 7 8 9 10 Rs. Rs. Rs. Rs. Rs.
Total Instructions to Drawing Officers
1. Great care should be taken in nothing the Account Numbers correctly, as otherwise the amounts deducted (recovered) are likely to be posted wrong accounts.
2. Account Numbers should be written in “Serial Order” (Under Col. 3) irrespective of the order in which the names of the subscribers occur in respective pay bill.
3. The amounts (in figures) under Columns 5, 6 and 7 should always be in “whole rupees” only transactions involving in Naye Paise being particularly avoided.
4. No entries without an Account Number should be made.
5. The account number in the previous month’s statements should be repeated and the reasons for the non-recovery of subscription and refunds of temporary Advance (withdrawals), such as “Proceeded on Leave” from . . . . . . . . . . . “Transferred to . . . . . . . . . . . Office . . . . . . . . . . . . .
District”, “Quitted Service”, Died on . . . . . . . . . . . . . . . .”, “Subscription discontinued”, etc., should invariably be furnished in the “Remarks” column (No.
10), or overleaf.
6. When new names are entered in the statement other than those found in the previous month’s statement, the reason therefore (such as, “New Subscriber”, “Returned from Leave”, “Transferred from . . . .
. . . . . .. . . . . Office . . . . . . . . . . .
District”, “Resumed subscription”, etc., should invariably be noted in the remarks column overleaf).
7. With regard to supplemental claims, the month(s) to which the original claim (s) relates should be furnished clearly and correctly in line 2 above, i.e., at the top of the Form (or in the body of the Form if more space is required).
8. Ordinarily only one line should be used for each subscriber, entries between lines being, however, strictly avoided.
9. The blanks against Total Deductions, Signature and Designation of Drawing Officer, Station and Date, etc., should invariably be filled in only in the respective spaces allotted thereof and not in the middle of the Form.
10. The Account Numbers should be furnished in full, i.e., with the guide notation or letters, such as GA (for General Administration), EDN (for Education), PW (for Public Works), etc., as intimated by the Accountant General.
FORM-3 FORMS OF NOMINATION (see sub-rule (3) of rule 9) I. When the subscriber has a family and wishes to nominate one member thereof.
I hereby nominate the person mentioned below who is a member of my family as defined in Rule 2 of the Karnataka General Provident Fund Rules, 2016, 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 has not been paid:- Name and address of nominee Relationship with subscriber Age Contingencies on the happening of which nomination shall become invalid Name, address and relationship of the person or persons, if any, to whom the right of the nominee shall pass in the event of his predeceasing the subscriber, or on the happening of the contingency or contingencies specified in the previous column.
Dated this. . . . . . . . . . . . . . . day of . . . . . .20... ,. .. . . .
at . . . . . . . . . . . . . .. . . . . . .. .
Signature of subscriber.
Two witnesses to signature-
1.
2.
II. When the subscriber has a family and wishes to nominate more than one member thereof.
I hereby nominate the persons mentioned below, who are members of my family as defined in Rule 2 of the Karnataka General Provident Fund Rules, 2016, 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, and direct that the said amount shall be distributed among the said persons in the manner shown against their names:- Name and address of nominee Relationship with subscriber Age *Amount or share of accumulation s to be paid to each Contingencies on the happening of which the nominations shall be come invalid Name, address and relationship of the person, if any, to whom the right of the nominee shall pass in the event of his predeceasing the subscriber.
Dated this. . . . . . . . . . . . . . . day of . . . . . .20.. , at…………………… Signature of subscriber.
Two witnesses to signature-
1. . . . . . . . . . . . . . .
2. . . . . . . . . . . . . . .
*Note:- This column should be filled in so as to cover the whole amount that may stand to the credit of the subscriber in the Fund at any time.
III. When the subscriber has no family and wishes to nominate one person.
I, having no family as defined in Rule 2 of the Karnataka General Provident Fund Rules, 2016, hereby nominate the person mentioned below 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 of nominee Relationship with subscriber Age Contingencies of the happening of which nomination shall become invalid Name, address and relationship of the person, if any, to whom the right of the nominee shall pass in the event of his predeceasing the subscriber.
Dated this ……………………….day of ……………………………………20 …at…………………… Signature of subscriber Two witnesses to signature-
1.
2.
* Note:- Where a subscriber who has no family makes a nomination, he shall specify in this column that the nomination shall become invalid in the event of his subsequently acquiring a family.
IV. When the subscriber has no family and wishes to nominate more than one person.
I, having no family as defined in Rule 2 of the Karnataka General Provident Fund Rules, 2016, hereby nominate the persons mentioned below 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, and direct that the said amount shall be distributed amount the said persons in the manner shown below against their names:- Name and address of nominee Relationship with subscriber Age *Amount of share of accumulations to be paid to each Contingencies on the happening of which the nominations shall be come invalid Name, address and relationship of the person, if any, to whom the right of the nominee shall pass in the event of his predeceasing the subscriber.
Dated this …………..day of………………………….20………,at………….
Signature of subscriber Two witnesses to signature- 1………………………..
2……………………………… * Note:- This column should be filled in so as to cover the whole amount that may stand to the credit of the subscriber in the Fund at any time.
#Note:- Where a subscriber who has no family makes a nomination, he shall specify in this column that the nomination shall become invalid in the event of his subsequently acquiring a family.
FORM No. 4 (see sub-rule(2) of rule 14) THE KARNATAKA GENERAL PROVIDENT FUND Subject:- General Provident Fund Advance application of Sri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Designation . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
holder of GPF/A/c No. . . . . . . . . . . . . . . . .
-------- Letter No. . . . . . . . . . . . . . . dated . . . . . . . . forwarding the G. P. F Advance application of Sri . . . . . . . . . . . . . . . . . . . . . . .
GPF A/c No. . . . . . . . . . . . . . . required in connection with . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . .
ORDER I have satisfied myself that the conditions laid down in Rule 15 of K. G. P. F. rules are fulfilled and accordingly sanction under the authority vested by Rule 15 . . . . . . . . . .of rules, an advance of Rs . . . . . . . . . . . . . . (Rupees . . . . . . . . . . . . . . . . . . . . .) to Sri/Smt .
. . . . . . . . . . . . . . . . . . . from the balance standing at his/her credit in the G. P. F. A/c No.
. . . . . . . to meet the expenses in connection with the .. . . . . . . . . . . . . . . . . The advance should be recovered in .. . . . . . . . . . . . . . . .equal monthly installments of Rs.. . . . . . . . . . .
. . . .each.
Copy to: Head of the Office.
The Accountant General, Karnataka Bangalore Head of the Department.
FORM No. 5 (see sub-rule (2) of rule 14)
1. Subscriber name
2. Subscriber designation
3. Subscriber pay
4. Subscriber G. P. Fund Account No.
5. Amount of advance
6. Object of advance
7.
Rule or rules under which the advance is sanctioned
8.
Balance at credit of the subscriber on the date (as verified from the account last rendered by the Accountant General and subsequent deposits and withdrawals).
9.
Balance of previous advances, if any, outstanding, against the subscriber (principal and interest shown separately).
Principal Rs.
10.
Date of repayment of previous advances, if any
11.
Special reasons for granting the advance (when a previous advance is outstanding or when 12 months have not elapsed after the complete repayment of the previous advance).
12.
Number of installments in which the advance is to be recovered
13. Amount of each installment Signature of the foreign employer FORM No. 6 (see rule 16) Voucher No.
Dated Bill for drawing P. F Advances/Withdrawals of the Establishment of the . . . . . . . . .
. . . . . . . . . . . . . . . . . . . for the month of . .
. . . . . . . . . . . . . . . . . . . . . . . .
Sl No Name of subscriber, pay and No. and date of sanction P. F. Account No.
Advances /withdrawals Rs.
Acquittance Total Net amount required for payment Rs. . . . . . . (Rupees . . . . . . )............
Space for classification Signature Designation of the Drawing Officer.
Pay Rs. . . . . . . . . . . . . . (Rupees . . . . . . . . . . . . . . . . . . . . . . . . . . .)
Station:
Dated:
Treasury Officer . . . . . . . . . . . . . . . . . . . . . . . .
Examined and entered Treasury Accountant . . . . . . . .
CERTIFICATE
1. Received Contents.
2. Certified that I have satisfied myself that all sums included in bills drawn 1 months/ 2 month/ 3 months previous to this date with exception of those detailed below (of which the total has been refunded by deduction from this bill) have been disbursed to the proper persons, and that their acquittances have been taken and filed in my office with receipt stamp duly cancelled for every payment in excess of Rs. 20.
3. Certified that the balance at the credit of the subscriber on the date of withdrawal covers the sum drawn in the bill. The Policy No.*.
. . . . .. . .with . . . . . . . . . . . Company has already been assigned in favour of the Governor and submitted to the Account Officer.
* Give details here if more than one policy has to be cited.
Signature Designation FORM No. 7 (see rule 16 ) APPLICATION FOR KARNATAKA GENERAL PROVIDENT FUND ADVANCES To . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . .
Sir, I request an advance of Rs. . . . . . . . . . . . . . .(Rupees . . . . . . . . . . .. . . . . . . .
.only) from my General Provident Fund Account No. . . . . . . . . . . . . . . . . . ..
(1) It is required for the purpose of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . .
(2) I shall bind myself to pay it regularly in . . . . monthly installments of Rs. . . . . . . .
. . each. [The maximum number of installments is 40 and the amount of each installment should be equal and in whole rupees throughout. The gross amount of the advance has to be fully repaid before actual retirement of the subscriber].
(3) My pay is Rs. . . . . . . . . . . . . . . . . . . . per month
(4) Rs. . . . . . . . . . is the balance unpaid of the previous advance of Rs.. . . . . . . .
. . . . taken in the month of . . . . . . . . . . . . . . .20. .,
(5) The gross amount of this temporary advance will be fully refunded by me, as indicated above, before my retirement from service, the date of my birth being . . .
Signature and Designation of Subscriber.
Date. . . . . . . . . . . . . . . . . . . .
Station . . . . . . . . . . . . . . . . . .
Memo No. Date . . . . . . . . . . . . . . . 20.
Forwarded to . . . . . . . . . . . . . . . . . .
The advance asked for may be sanctioned. It is also within the permissible limit.
Recoveries towards G. P. F. Subscription and Refunds of temporary Advance have been made during the month of application and during the month previous there to from the pay of the applicant as detailed hereunder:- Pay for month of Encased on Subscription Refunds Total Signature and Designation of the Head of the Office.
FORM-8 (For Gazetted Officer) (see sub-rule (1) of rule 19) FORM OF APPLICATION FOR FINAL PAYMENT OF BALANCES IN THE GENERAL PROVIDENT FUND ACCOUNT To THE ACCOUNTANT GENERAL, KARNATAKA, BAN GALORE.
Through . . . . . . . . . . . . . . . . . . (The Head of Office/Department) Sir, I am due to retire/have retired/have proceeded on leave preparatory to retirement for . . . . . . . . . . . . . . . . . . . . .months/have been discharged/dismissed/have resigned finally from Government Service and my resignation has been accepted with effect from. .
. . . . . . . . . . . . . . . . . . . . . . . ., forenoon/afternoon.
2. I have not opted for the continued retention of my provident fund money in the Fund in terms of the (O.M. No. FD. 25 S.P.F. 58, dated 15th December 1958) as extended from time to time. I, therefore, request that the entire amount at my credit with interest due under the rules may be paid to me through . . . .. . . . . . . . . . . . . . . . . . . . . . . .
treasury/Sub-Treasury. My Provident Fund Account No. is . . . . . . . . . . .
OR I have opted for the continued retention of my provident fund money in the Fund in terms of the (Official Memorandum No. FD 25 S PF 58, dated 15th December 1958) and my option has been forwarded vide letter No. . . . . . . dated . . . . . . . . . . . . is attached. I request that a sum of Rs. . . . . . . . may be paid to me in terms of para 2 of that letter through . . . .. . . . . .Treasury/Sub-Treasury. My Provident Fund Account No.
is . . . . . . . . . . . . . .
3. A sum of Rs. . . . . . . . . . (Rupees . . . . . . . . . . . . . . . . . . ) was last deducted as Provident Fund subscription and recovery on account of refund of advance from my pay bill for the months of . . . . . . . . . . . . . for Rs. . . . . . . . . encashed on . . . . . . . . . . . . . . .
., at . . . . . . . . . . . . . Treasury/Sub-Treasury.
*4. My specimen signature, in duplicate, duly attested by another Gazetted Officer of Government, is enclosed.
5. I certify that I have neither drawn any temporary advance nor made any final withdrawal from my Provident Fund Account during the 12 months immediately preceding the date of my quitting service/proceeding on leave preparatory to retirement or thereafter.
OR Details of the temporary advances drawn by me/final withdrawal made by me from my Provident Fund Account during the 12 months preceding the date of my quitting service/proceeding on leave preparatory to retirement or thereafter are given below:- Amount of Advance Date 1 2
7. I hereby certify that no amount was withdrawn/the following amounts were withdrawn by me from my provident fund account during the 12 months immediately preceding the date of my quitting service/proceeding on leave preparatory to retirement or thereafter for payment of Insurance premia or for the purchase of a new policy.
Amount Date 1 2
7.The particulars of the Life Insurance Policies financed by me from the Provident Fund which are to be released by you are given below:- Policy Name of the Co. Sum assured
1.
2.
Yours faithfully, (Signature).
Name and Address.
Station:
Date:
*Para 4 applies only when payment is desired at a treasury other than the one at the District Headquarters where the subscriber last served otherwise it may be struck out.
CERTIFICATE BY THE HEAD OF OFFICE/DEPARTMENT
1. It is certified after due verification with reference to the records in my office, that no temporary advance/final withdrawal was sanctioned to the applicant 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.
2. It is certified after due verification with reference to the records in my office, that the following temporary advance/final withdrawals were sanctioned to and drawn by the applicant from his/her Provident Fund Account during the 12 months immediately preceding the date of his/her quitting service/proceeding leave preparatory to retirement or thereafter.
Amount of Advance/withdrawal Date Voucher No.
1.
2.
*3. It is certified that no demands/following demands of Government are due for recovery.
(Signature of the Head Officer/Department).
* Certificate No. 3 to be furnished in the case of Contributory Provident Funds only.
FORM 9 (For Non-Gezetted Officers) (see sub-rule (2) of rule 19 ) FORM OF APPLICATION FOR FINAL PAYMENT OF BALANCES IN THE GENERAL PROVIDENT FUND ACCOUNT.
To.
THE ACCOUNTANT GENERAL, KARNATAKA BANGALORE.
(Through the Head Office) Sir, I am due to retire/have retired/have proceeded on leave preparatory to retirement for . . . . . . . . . . . . . . months/have been discharged/dismissed/ have resigned finally from Government Service and my resignation has been accepted with effect from . . . . . .
. . . . . . . . . . forenoon/afternoon.
2. I have not opted for the continued retention of my Provident Fund money in the Fund in terms of the (Official Memorandum No. FD 25 SPF 58, dated 15th December 1958). I therefore, request that arrangements may kindly be made to pay the entire amount at my credit with interest due under the rules.
OR I have opted for the continued retention of my Provident Fund money in the Fund in terms of the (Official Memorandum No. FD 25 SPF 58, dated 15th December 1958) and my option has been forwarded vide letter No. . . dated . . . . . . . . . . . . is attached. I request that arrangements may kindly be made to pay me a sum of Rs. . . . . . . . . . . . . .
3. My Provident Fund Account No. is. . . . .. . . . . . . . . . . I desire to receive payment through my office/through the . . . . . . .. . Treasury/Sub-Treasury. *Particulars of my personal marks of identification, left hand thumb and finger impressions (in the case of illiterate subscriber) and specimen signature (in the case of literate subscriber), in duplicate, duly attested by a Gazetted Officer of the Government are enclosed.
4. The under mentioned Life Insurance Policy financed by me from my provident fund account may kindly be released.
Policy No Name of the Company Sum assured
1.
2.
3.
4.
Yours faithfully, Station (Signature).
Date:
Name . . . . . . . . . . . . . . . . . . . . . . .
Address . . . . .. . . . . . . . . . . . . . . .
Note:- *This applies only when payment is not desired through the Head Office.
(FOR USE BY HEADS OF OFFICES)
(1) Forwarded to the Accountant General, Karnataka, Bangalore for necessary action.
(2) The Provident Fund Account Number of Shri/Smt. /Kumari (as verified from the statements furnished to him/her by you from year to year) is . . . . . . . .. . . . . . . . .
(3) He/She has finally retired/will retire/has proceeded on leave preparatory to retirement for . . . . . . . . . . . months/has been discharged/dismissed/has resigned finally from Government Service and his/her resignation has been accepted with effect from . . . . . . . . . . . . . forenoon/afternoon.
Foot Note- This applied only when payment is not desired through the Head Office.
(4) The last fund deduction was made from his/her pay in this office Bill No. . . . . . ., dated. . . . . . . . . . . . . for Rs. . . . . . . . . . .(Rupees. . . . .. . . . . . . . . . . . . . . . . . ), cash voucher No. . . . .. . . . of . . .. . . . . . . . . Treasury, the amount of deduction being Rs. .
. . . . . . . .
(5) Certified that he/she was neither sanctioned any temporary advance for any 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.
OR Certified that the following temporary advances final withdrawal 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.
(6) Certified that no amount was withdrawn/the following amounts were withdrawn 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 for payment of Insurance premia or for the purchase of a new policy.
Amount of Advance/withdrawal Date Voucher No.
1.
2.
(7) He/She has not opted for the continued retention of his/her provident fund money in the Fund in terms of the Official Memorandum No. FD 25 SPF 58, dated 15th December 1958.
OR He/She has opted for the continued retention of his/her provident fund money in terms of the Official Memorandum No. FD. 25 SPF 58, dated 15th December 1958 and his/her option has been forwarded vide this office letter No . . . . . . . . . .dated . . . . . . . . . . . . . is attached.
(8) *It is certified that no demands/following demands of Government are due for recovery.
(Signature of the Head of Office/Department) * Note:- Certificate No. 8 to be furnished in the case of contributory funds only.
Amount of Advance/withdrawal Date Voucher No.
1.
2.
FORM 10 (see sub-rule (1) of rule 20) FORM OF APPLICATION FOR FINAL PAYMENT OF BALANCES IN THE PROVIDENT FUND ACCOUNT OF A SUBSCRIBER TO BE USED BY THE NOMINEES OR ANY OTHER CLAIMANTS WHERE NO NOMINATION SUBSISTS.
To.
THE ACCOUNTANT GENERAL, KARNATAKA BANGALORE.
(Through the Head Office) Sir, It is requested that arrangements may kindly be made for the payment of the accumulations in the Karnataka General Provident Fund Account of Shri/Smt . . . . . . . .
. The necessary particulars required in the connection are given below:- 1 Name of the Government servant 2 Date of birth 3 Post held by the Government servant 4 Date of death 5 Proof of death in the form of a death certificate issued by the municipal authorities, etc., if available.
6 Provident Fund Account No. allotted to the subscriber 7 Amount of Provident Fund money standing to the credit of the subscriber at the time of his death, if known
8. Details of the nominees alive on the date of death of the subscriber if a nomination subsists.
Name of the nominee Relationship with the subscriber Share of the nominee
1.
2.
3.
4.
9. In case the nomination is in favour of a person other than a member of the family, the details of the family if the subscriber subsequent acquired a family.
Name Relationship with the subscriber Age as on the date of death
1.
2.
3.
10. n case no nomination subsists, the details of the surviving members of the family on the date of death of the subscriber. In the case of a daughter or of a daughter of a deceased son of the subscriber, married before the death of the subscriber, it should be stated against her name whether her husband was alive on the date of death of the subscriber.
Name Relationship with Share of the the subscriber nominee
1.
2.
3.
11. In the case of amount due to a minor Child whose mother (widow of subscriber) is not a Hindu, the claim should be supported by Indemnity Bond or (Guardianship Certificate), as the case may be.
12. If the subscriber has left no family and no nomination subsists, the names of persons to whom the Provident Fund money is payable (to be supported by letters of probate or succession certificate, etc).
Name Relationship with the subscriber Address
1.
2.
3.
13. Religion of the claimant (s).
14. *The payment is desired through the office of . . . . . . . . . . . . . . . .through the . . . . . .
. . . . . . . . . . . . . . Treasury/Sub-Treasury. In this connection the following documents duly attested by a Gazetted Officer in service/Magistrate are attached.
(i) Personal marks of identification.
(ii) Left/Right hand thumb and finger impression (in the case of illiterate claimants).
(iii) Specimen signatures in duplicate (in the case of literate claimants).
Station: Yours faithfully, Dated:
Signature of claimant (Full name and address) * This applies only when payment is not desired through the Head Office.
FORM-11 (see rule 21) Form of Bond of Indemnity for drawal of Provident Fund money due to the minor child/children of deceased subscriber by a person other than its/their natural guardian (to the extent of Rs.
5,000).
KNOW ALL MEN by these present I/We (a) . . . . . . . . . .
son/daughter/wife of . . .. . . . . . . . . . . .(hereinafter called ‘obligor’) resident of . . . . . . . . . . . . . . . and (b) (I) . . . . . . . . . . . .
. . . . . . . .son/daughter/wife of . . . . . . . . . . . . . . . . . . . . . . .
and resident of . . . . . . . . . . . . . . . . . . . (hereinafter called ‘Sureties’). Sureties on her/his their behalf are held firmly bound to GOVERNOR OF KARNATAKA (hereinafter called ‘Government’ in the sum of Rupees (in words) . . . . . . . . . . . . . . (in figures) . . .
. . . . . . . . . . . . . to be paid to the Government or his successors or assigns for which payment to be well and truly made, each of us severely binds himself and his heirs, executors, administrators and assigns and every two and all of us jointly bind ourselves and our respective heirs, executors, administrators and assigns firmly by these presents.
Signed this day of . . . . . . . . . . . . . . Two Thousand . . . . . .
WHEREAS (c) . . . . . . . . . . . . . . . . . . . . . was at the time of his death a subscriber to the General Provident Fund and Whereas the said (c) . . . . . . . . . . . died on the day of . . . . . . . . . . . . . Two thousand, . . . . . . . . . and a sum of Rupees (in figures) . . . . . . . .
(in words) . . . . . . . . . . . . .. payable by Government on account of his General Provident Fund accumulations AND WHEREAS the above bounden Obligor claims. . . . . . . . . . . . . . @ the said sum on behalf of the minor child/children of the said (c) . . . . . . .
. . . . . . . .but has/have not obtained a guardianship certificate.
AND WHEREAS the Obligor has/have satisfied the (d) . . . . . . . . .
. (officer concerned) that he/she/they/is/are entitled to the aforesaid sum and that it would cause undue delay and hardship if the Obligor were required to produce a guardianship certificate and WHEREAS GOVERNMENT desire to pay the said to the Obligor but under Government rules and orders it is necessary that the Obligor should first execute a bond with two sureties to indemnify Government against all claims to the amount so due as aforesaid to the said (c) . . . . . . . . . . . (deceased) before the said sum can be paid to the Obligor, which the Obligor and at hid/her request the sureties have agreed to do………..
(a) Full name of claimant (s) with places (a) of residence
(b) Name and address of the sureties.
(c) Name of the deceased.
(d) Name and designation of the officer NOW THE CONDITION of this bond is such that if after payment has been made to the Obligor the Obligor or Sureties shall in the event of a claim being made by any other person against Government with respect of the aforesaid sum of Rs. . . . . . . . . .
. . . . refund to Government, the sum of Rupees . . . . . . . . and shall otherwise indemnify and keep the Government harmless and indemnified from all liabilities in respect of the aforesaid sum and all costs incurred in consequence of any claim thereto.
THEN the above written bond or obligation shall be void but otherwise the same shall remain in full force, effect and virtue.
The Government have agreed to bear the stamp duty if any chargeable on these presents.
IN WITNESS WHEREOF the Obligor and the Sureties hereto have set and subscribed their respective hand here unto on the day, month and year above written.
Signed by the above named ‘Obligor’
1.
2.
in the presence of Name and Designation of the Witness Signed by the above named ‘Sureties’
1.
2.
in the presence of (Name and Designation of Witness) Accept for and on behalf of the Government of Karnataka.
[Name and Designation of the Officer directed or authorized in pursuance of the Article 299 (1) of the Constitution to accept the bond for and on behalf of the Governor] FORM-12 (see clause (i) of sub-rule (1) of rule 27) APPLICATION FOR PROVIDENT FUND WITHDRAWALS FOR BUILDING, RECONSTRUCTION, ACQUISITION, REDEMPTION, ETC., OF HOUSE (To be submitted in quadruplicate) 1 Name and Date of birth 2 Official designation 3 Monthly substantive pay of the applicant 4 The length of service (No withdrawal is permissible in the case of an officer who has not completed 20 years of service or having a service of not less than ten years before attaining the age of superanuation ).
5 Amount of advance applied for:-
(i) House building
(ii) House purchase
(iii) For redemption of a subsisting loan in respect of the property to be redeemed
(iv) Additions or alterations to and reconstruction
(v) Purchase of house site N. B:- Maximum amount permissible is one year’s pay or half the amount at the credit of the subscriber, whichever is less.
6 Estimated cost of -
(i) Building proposed to be constructed
(ii) Building proposed to be purchased
(iii) Property proposed to be redeemed
(iv) Additions or alterations to and reconstruction
(v) The house site proposed to be purchased 7 To what extent it will be financed from the applicant’s own funds and to what extent from other borrowings (details to be given) 8 Locality (with the municipal number or site number in the case of an authorized lay-out) where the house is to be –
(i) Built;
(ii) Purchased; or
(iii) Redeemed.
9 Whether :-
(i) The site intended to be built upon
(ii) The house proposed to be purchased
(iii) The house proposed to be redeemed or repaired if encumbered is situated at the place of his duty or his intended place of residence after retirement
(iv) The house site proposed to be purchased 10 Whether the applicant already owns a house or a house site at the places referred to in column 9 or at any other place.
11 Whether-
(1) The site intended to be built upon (present market value to be stated) is encumbered and if so how and to what extent. If not whether he possesses an unencumbered title deed to the site.
(2) The house and the site on which it stands and proposed to be purchased or repaired are encumbered, and if so, how and to what extent.
Is he willing to secure an undisputed title to the house and the land on which the house is built before the purchase price is authorized for payment?
Details of property to be redeemed (such as locality, municipal number, present value of the property, amount of subsisting loan, extent up to which the redemption will be lessened by this withdrawal, title deed, etc).
N. B—A certificate of having possessed an approved plan for the construction of the house to be produced.
12 Advance already drawn if any, for –
(i) House building, or
(ii) House purchase, or
(iii) House repair
(iv) the purchase of a house site, either by Government or under Low Income Group Housing Scheme or by any approved Bank or Society; if so, what the amount and the terms of repayment of the same are.
I hereby bind myself too use the money for the purpose I have applied for and in accordance with the Karnataka General Provident Fund Rule, 2016, regarding premature partial withdrawal of G. P. F. amount for building, acquisition or redemption of one house only/purchase of a house site and orders of Government and further engage myself to refund forthwith any surplus that may remain unutilized for the said purpose, together with interest at 5 percent per annum.
Signature of the applicant.
Official Superior’s Certificate I certify that I have examined the documents regarding the site on which the building is proposed to be constructed or the house proposed to be purchased or proposed to redeem the loan already raised for the house building or purchase or the house site proposed to be purchased and consider that the premature partial withdrawal of amount from the G. P. F. Account No. . . . . . . . . . . . . . . of the subscriber applied for is necessary and may be sanctioned. Connected documents are also forwarded herewith for reference and return.
Signature of Officer Memo No. . . . . . . . . . . . . . . . Dated. . . . . . . . . . . . . . . .
Forwarded to the . . . . . . . . . . . . . . . . . . . . . . . . . . . . or the Secretary to Government, Finance Department (if sanction of Government is necessary) for obtaining necessary sanction.
Head of the Department.
Memo No. . . . . . . . . . . . . . . . Dated. . . . . . . . . . . . . . . .
The substantive pay of the subscriber is Rs. . . . . . . . . . . . . . . . . . . . . . . a sum of Rs. . . . . . . . . . . . . . . . . . . . . . . . is at the credit of the subscriber as on . . . . . . . . . . . . .
. . a sum of Rs. . . . .. . . . . . . . . . due by the subscriber from out of the previous advance of Rs. . . . . . . . . taken on . . . . . . . . . . . . . . . . . . . . . the premature partial withdrawal now applied for by the subscriber is admissible/inadmissible.
Accounts Officer.
Report of inspection by, and opinion of, the Deputy Commissioner/Collector of the District when the application is for a second installment of the premature partial withdrawal already sanctioned for the same building.
I beg to report that I have inspected site No. . . . . . . . . . . .. . . . . . and the house thereon . . . . . . . . . belonging to Sri . . .
. . . . . . . . . . . . . . . . .in the extension of . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
City/Town and in my opinion the second installment of the withdrawal of Rs. . . . . . . . . . . . applied for is necessary/unnecessary for the completion of the said house.
Deputy Commissioner/Collector.
…………………..District.
No………..DATED………..
FORM-13 (GPF No. 8) (see clause (i) of sub-rule (1) of rule 27) FORM OF ANNUAL DECLARATION.
To The Governor of Karnataka.
I hereby declare that the house built/acquired by me with the amount withdrawn by me from the amount standing to my credit in the Account No. . . . . . . . . of the General Provident Fund, under the provisions of Rule 28 of the said Karnataka General Provident Fund Rules, 2016, has not been transferred by me or by my spouse by way of transfer, sale, mortgage except for the purpose mentioned in Note 2 to clause (a), exchange or gift or on lease for a term exceeding three years, howsoever and that if called upon to do so, I undertake to produce before Government or the Head of Department or the sanctioning authority as the case may be, tax receipts, title deeds and such other documents as may be specified or required by the said authority, showing that the house remains in my or in my spouse sole and absolute ownership.
Dated this . . . . . . . . . . . . . . . . . day of . . . . . . . . . . . . . . . . . .20.., Signature . . . . . . . . . . . . . . . .
Designation . . . . . . . . . . . . . .
Witnesses to signature (with address):-
1.
2.
(G. P. F. No. 9) FORM-14 (see clause (g) of sub-rule (2) of rule 27) (To be executed on stamp paper of the value laid down in the Stamp Law in force at place of execution of the documents).
To, The Governor of Karnataka.
In consideration of the Governor of Karnataka (hereinafter referred to as “the Government of Karnataka”) having agreed at my request to permit, for the purpose of building or acquiring a suitable house including the cost of the site thereof, withdrawal of the sum of Rs. . . . . . . . . . . . . (Rupees . . . . . . . . . . . . . .) only from the amount standing to my credit in the G. P. F. under the provisions of Rule 28
(i) (b) of the Karnataka General Provident Fund Rule, 2016, I hereby undertake to observe and perform the terms and conditions contained therein in so far as they are applicable to me and, in particular to comply with the following terms and conditions, namely :-
1. that the amount for which the withdrawal is applied for shall be actually utilized for the purpose of building or acquiring a suitable house including the site thereof;
2. that if the amount permitted to be so withdrawn is in excess of the actual expenditure incurred by me for building or acquiring a suitable house including the cost of the site thereof, the excess amount together with interest thereon at the rate provided for in Rule 28 (i) (b) of the aforesaid Rules, shall be refunded to the Government of Karnataka for credit to my Provident Fund forthwith without demur in one lumpsum whether the same shall have been demanded or not;
3. that the house proposed to be built or acquired by me with the amount so withdrawn shall be situated at my place of duty or . . . . . . . . . . . . . . . . . .
where I intend to reside after retirement;
4. that in the event of my building a house, the construction of the house shall be commenced within six months of the withdrawal of the aforesaid amount and shall be completed within a period of one year from the date of commencement of construction or within such further extended period as the Government may in its absolute discretion allow. In the event of a ready-built house being purchased, any loan previously obtained by me for such purpose from private parties shall be repaid within three months of the drawal of such amount or such extended period as maybe permitted by the Government of Karnataka.
5. that in the event of my building a house the right to build on the site on which the house is proposed to be built will be acquired by me forthwith;
6. that approved plans and permits where necessary from the local authorities for the purchase of building materials to the extent required shall be furnished by me;
7. that in the case of a drawal for the purchase of a ready-built house I would secure an undisputed title to the house and the land on which the house is built before the purchase price is paid.
8. that so long as I am in service I shall submit every year a declaration in the form prescribed by the Government on or before the 31st March, that the house so built or acquired continues to be in my sole ownership and possession;
9. that while in service the house so built or acquired shall not be transferred by me be way of sale, mortgage, exchange or gift or on lease for a term exceeding three years or otherwise howsoever without the previous permission of the sanctioning authority in writing.
I hereby declare that my private savings together with the amount permitted to be withdrawn will be sufficient to build or acquire the house of the type proposed and that I do not own any house other than the one which is intended to be built or acquired at the place of my duty or at . . . . . . . . . . . . . . . . . . . . . . . . . . my intended place of residence after retirement. I further declare that if the house is not purchased or built in accordance with the provisions of the said Rules or if I commit any breach of any of the aforesaid terms and conditions; I shall repay to the General Provident Fund for credit to account the whole of the amount permitted to be withdrawn from the Fund in pursuance of the said Rules together with interest thereon at the rate provided for therein.
Dated this . . . . . . . . . . . . . . . day of . . . . . . . . . . . . . . . . . . . . . . . . . . .20. . . , Place . . . . . . . . . . . . . . . . Signature FORM-15 (see sub-rule (2) of rule 29) APPLICATION FOR PARTIAL FINAL WITHDRAWAL FROM THE GENERAL PROVIDENT FUND FOR MEETING COST OF HIGHER EDUCATION.
(To be sent in triplicate)
1. Subscriber’s name
2. Subscriber’s designation
3. Subscriber’s substantive pay and non-substantive pay, if any.
4. Date of birth of the Subscriber. . .
5. Date of entry into Government service.
6.
Total length of service put in by the subscriber including the broken periods of service, if any.
7. Subscriber’s General Provident Fund Account Number
8. Object of withdrawal
9. Rule or Rules under which the withdrawal is claimed.
10.
Whether final withdrawal has been sanctioned in the past for any of the purposes specified in Rule27, 28, 29 or 30 of the General Provident Fund Rules. (Details to be furnished).
11.
Whether any temporary advance under Rule 15 of the General Provident Fund Rules has been sanctioned and drawn and, if so whether the same has been repaid in full (date of final repayment be mentioned.)to
12.
The name of the person to be sent for higher education with his/her relationship to the subscriber.
13.
Whether the education will be outside the State in India beyond the High School stage or outside India.
14.
Specialised courses of education to be taken up and duration of such courses.
15. Amount of withdrawal applied for under Rule 29.
16.
Number of installments in which the withdrawal is required to be withdrawn and the date on which the first installment is required to be drawn [vide Rule 29 (c)].
17. Amount of each such installment.
18.
Balance at the credit of the subscriber on this date (as verified from the account last rendered by the Accountant General and subsequent deposits and withdrawals).
19.
Whether a certificate as per Rule 29 (e) of the General Provident Fund Rules has been appended to the application.
Signature of the Subscriber I, . . . . . . . . . . . . . . . . . . . . . . . . . . hereby bind myself to use the money for the purpose for which the withdrawal is applied for in accordance with rules 29 of the Karnataka General Provident Fund Rule, 2016, as also indicated in my application, and further engage. myself to refund forthwith any surplus that may remain unutilized for the purpose under the said rules together with interest at the prescribed rate.
Signature of the Applicant.
OFFICIAL SUPERIOR’S CERTIFICATE I certify that I have examined the request of Sri . . . . . . . . . . . . . . . . . . . . . . . . . . . .and consider that the premature partial withdrawal of Rs. . . . .. . . . (Rupees . . . . . . . . . . . . .
.) from the General Provident Fund Account No. . . . . . . .. . . . . of the subscriber applied for under Rule. . . . . . . . . . . . . . . . . . . . . . . of General Provident Fund Rules is necessary and may be sanctioned and allowed to be drawn in . . . . . . . . . . . . . . . . .. . . .
.. . . . installments. Connected documents are also forwarded herewith for reference and return.
Signature and designation of the Officer.
Memo No. Dated . . . . . . . . . . . 20. . , A. Sanctioned Rs. . . . . . . . . . . . . . . . . . . . . . . . . . (Rupees . . . . . . . . . . . .)
B. Forwarded to the Secretary to the Government of Karnataka, Finance Department, for obtaining necessary sanction.
(‘A’ This will have to be used when the Head of the Department is himself competent to sanction the withdrawal in which case ‘B’ will have to be struck off).
Signature and designation of the sanctioning authority other than Government.
FORM-16 (see sub-rule (8) of rule 30) APPLICATION FOR PARTIAL FINAL WITHDRAWAL FROM THE GENERAL PROVIDENT FUND FOR MEETING EXPENDITURE ON MARRIAGE PURPOSE.
(To be sent in triplicate).
1. Subscriber’s name
2. Subscriber’s designation
3. Subscriber’s substantive pay and non-substantive pay, if any.
4. Date of birth of the Subscriber. . .
5. Date of entry into Government service.
6.
Total length of service put in by the subscriber, including the broken periods of service, if any.
7. Subscriber’s General Provident Fund Account Number
8. Object of withdrawal
9.
Whether final withdrawal has been sanctioned in the past for any of the purposes specified in Rule 27, 28, 29 or 30 of the General Provident Fund Rules.
10.
Whether any temporary advance under Rule 15 of the General Provident Fund Rules for the purpose has been sanctioned and drawn and, if so, whether the same has been repaid in full (date of sanction and final repayment to be mentioned.)
11. Probable date of the marriage
12. Relationship of the subscriber to the person to be got married.
13. Rule or rules under which the withdrawal is required now.
14.
Amount of withdrawal applied for under Rule 31 (b) and (c) for the purpose specified in column 8 above.
15.
Balance at the credit of the subscriber on this date (as verified from the account last rendered by the Accountant General and subsequent deposits and withdrawals).
Signature of the Subscriber.
1. I certify that I have not applied for and/or obtained a repayable advance under Rule 15 or partial final withdrawal under Rule 27 for the purpose stated in column 8 of this application.
2. I hereby bind myself to use the money for the purpose for which I have applied for in accordance with Rule 31 of the Karnataka General Provident Fund Rules, 2016, regarding premature partial withdrawal of General Provident Fund amount as also indicated in my application, for meeting expenditure on marriage purposes and further engage myself to refund forthwith any surplus that may remain unutilised for the said purpose under the said rules together with interest at the prescribed rate.
Signature of the Subscriber.
OFFICIAL SUPERIOR’S CERTIFICATE I certify that I have examined the request of Sri . . . . . . . .. . . . . . . . . . . . . . . .and consider that the premature partial withdrawal of Rs. . . .. . . . .[Rupees . . . . . . . . . . . .
(in words)] from the General Provident Fund Account No. . . . . . . . . . . . . of the subscriber applied for under Rule . . . . . . . . . . . . of General Provident Fund Rule is necessary and may be sanctioned. Connected documents are also forwarded herewith for reference and return.
Signature and designation of the Officer.
Memo No. Dated . . . . . . . .. . 20. .
A. Sanctioned Rs……………… (Rupees………………….. [in words]).
B. Forwarded to the Secretary to the Government of Karnataka, Finance Department, for obtaining necessary sanction.
(‘A’ This will have to be used when the Head of the Department is himself competent to sanction the withdrawal in which case ‘B’ will have to be struck off).
Signature and designation of the sanctioning authority other than Government.
FORM-17 (see sub-rule (7) of rule 31) APPLICATION FOR PARTIAL FINAL WITHDRAWAL FROM THE GENERAL PROVIDENT FUND FOR MAKING DEPOSIT FOR BOOKING A MOTOR CAR/ MOTOR CYCLE/SCOOTER/MOPED ETC.
(To be sent in triplicate).
1. Subscriber’s name
2. Subscriber’s designation
3.
Subscriber’s substantive pay and non-substantive pay, if any.
4. Date of birth of the Subscriber
5.
Total length of service put in by the subscriber including the broken periods of service, if any.
6. Date of entry into Government service.
7.
Subscriber’s General Provident Fund Account Number
8. Object of withdrawal
9.
Whether final withdrawal has been sanctioned in the past for any of the purposes specified in Rule 27, 28, 29 or 30 of the General Provident Fund Rules
10.
Whether any temporary advance under Rule 15 of the General Provident Fund Rules for the purchase has been sanctioned and drawn and, if so whether the same has been repaid in full (date of sanction and final repayment to be mentioned.)
11.
Name of the Manufacturer or Dealer in whole favour the Deposit is to be made, of the vehicle, amount of deposit, the probable period by which time the vehicle would be delivered.
12.
Rule or rules under which the withdrawal is required now.
13.
Amount of withdrawal applied for under Rule 32 (purpose specified in column 8 above).
14.
Balance at the credit of the subscriber on this date (as verified from the account last rendered by the Accountant General and subsequent deposits and withdrawals).
Signature of the Subscriber.
I certify that I have not applied for and/or obtained a repayable advance under Rule 15 or partial final withdrawal under Rule 27 for the purpose stated in column 8 of this application.
I hereby bind myself to use the money for the purpose for which I have applied for in accordance with Rule 32 of the Karnataka General Provident Fund Rules, 2016, regarding premature partial withdrawal of General Provident Fund amount also indicated in my application, for meeting expenditure for purchase of a vehicle and further, engage myself to refund forthwith any surplus that may remain unutilised for the said purpose under the said rule together with interest at the prescribed rate.
Signature of the Applicant.
OFFICIAL SUPERIOR’S CERTIFICATE I certify that I have examined the request of Sri . . . . . . . . .. . . . . . . . . . . . . . . . . . .
and consider that the premature partial withdrawal of Rs. . . . . . . . .. . . . . . . . . . [Rupees . . . . . . . . . . . . . . . . . . . . ..(in words)] from the General Provident Fund Account No. . .
. . . . . . . . . . . . . . . . . of the subscriber applied for under Rule . .. . . . . . of General Provident Fund Rules is necessary and may be sanctioned. Connected documents are also forwarded herewith for reference and return.
Signature and designation of the Officer.
Memo No. Dated . . . . . . . . . . . 20. . , A. sanctioned Rs. . . ….. . . . (Rupees . . . …………….. [in words]).
B. Forwarded to the Secretary to the Government of Karnataka, Finance Department, for obtaining necessary sanction.
(‘A’ This will have to be used when the Head of the Department is himself competent to sanction the withdrawal in which case ‘B’ will have to be struck off).
Signature and designation of the sanctioning authority other than Government FORM-18 (see sub-rule (2) of rule 33) APPLICATION FOR PARTIAL FINAL WITHDRAWAL FROM THE GENERAL PROVIDENT FUND DURING THE LAST YEAR OF SERVICE 1 Subscriber’s Name 2 Designation & Office Address 3 General Provident Fund A/C No. with Departmental prefix.
4 Date of Birth of the Subscriber 5 Date of retirement (on superannuation) 6 Closing balance as per account slip from the Accountant General for the year ______ 7 Subsequent General Provident Fund subscription and refunds/withdrawals From:
Total 8 Less withdrawals during the period indicated in Col.7.
9 Balance arrived at Rs.
10. Less 10% Rs.
11. Amount of partial final withdrawal applied for Rs.
12.
a) Gazetted Officers:- Treasury/sub-treasury at which payment is desired.
b) Non-Gazetted Officers:- Office through which the payment is desired.
Date:
(Signature of Subscribers) I, certify that I have examined the request of Sri/Smt . . . . . . . . . . . . . . . . . . . . .
and consider that the premature partial final withdrawal of Rs. . . . . . . . . . . . . . .from the General Provident Fund Account No. . . . . . . . . . . . . . . . . of the subscriber may be sanctioned and allowed to be drawn connected documents are also forwarded herewith for reference and return.
Dated: Signature and Designation of the Officer Sanctioned Rs. . . . . . . . . . . (Rs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .)
Dated:
Signature and Designation of the Sanctioning Authority FORM-19 (see sub-rule (2) of rule 34) APPLICATION FOR PARTIAL FINAL WITHDRAWAL FROM THE GENERAL PROVIDENT FUND FOR MEETING COST OF CHRONIC ILLNESS.
(To be sent in triplicate)
1. Subscriber’s name
2. Subscriber’s designation
3. Subscriber’s substantive pay and non-substantive pay, if any.
4. Date of birth of the Subscriber. . .
5. Date of entry into Government service.
6.
Total length of service put in by the subscriber including the broken periods of service, if any.
7. Subscriber’s General Provident Fund Account Number
8. Object of withdrawal
9. Rule or Rules under which the withdrawal is claimed.
10.
Whether final withdrawal has been sanctioned in the past for any of the purposes specified in Rule 27, 28, 29, 30 or 31 of the General Provident Fund Rules. (Details to be furnished).
11.
Whether any temporary advance under Rule 15 of the General Provident Fund Rules has been sanctioned and drawn and, if so whether the same has been repaid in full (date of final repayment to be mentioned.)
12.
The name of the person, whose chronic illness is being met and his/her relationship to the subscriber.
13.
Specialised type of medical treatment for which withdrawal is being sought.
14. Amount of withdrawal applied for under Rule 34.
15.
Balance at the credit of the subscriber on this date (as verified from the account last rendered by the Accountant General and subsequent deposits and withdrawals).
Signature of the Subscriber I, . . . . . . . . . . . . . . . . . . . . . . . . . . hereby bind myself to use the money for the purpose for which the withdrawal is applied for in accordance with rules 34 of the Karnataka General Provident Fund Rule, 2016, as also indicated in my application, and further engage. myself to refund forthwith any surplus that may remain unutilized for the purpose under the said rules together with interest at the prescribed rate.
Signature of the Applicant.
R.N.I. No. KARBIL/2001/47147 POSTAL REGN. No. RNP/KA/BGS/2202/2017-19 Licensed to post without prepayment WPP No. 297 PROCEDURE CLAIM AND FEEDBACK FORM OF DECLARATION BY THE SUBSCRIBER Hospital…………….. Name…………………………………………………………………………………… Patient Name: ……..……………………………… KGID No. : ………………………... IP Registration No.: ………….................................................., Ward availed DOA:…................................ DOS:…………………….……DOD:……………….……… Preauth Issue Date:……… ..…………..……, Preauth No:
………………..................... Preauth Amount:………………..………., Claimed Amount:
………………………….. Cost of Implants/Stents etc…………………………….. Package Cost :……………………………………….. Total Cost : ……………………… details…………………………………… Bill No: …….……………................Bill Date:
…………………………………… Bill Amount:…………………......
Signature of the subscriber OFFICIAL SUPERIOR’S CERTIFICATE I certify that I have examined the request of Sri . . . . . . . . . . . . . . . . . . . . . . . . . . .
.and consider that the premature partial withdrawal of Rs. . . . .. . . . (Rupees . . . . . . .
. . . . . . .) from the General Provident Fund Account No. . . . . . . .. . . . . of the subscriber applied for under Rule. . . . . . . . . . . . . . . . . . . . . . . of General Provident Fund Rules is necessary and may be sanctioned and allowed to be drawn in . . . . . . .
. . . . . . . . . .. . . . .. . . . installments. Connected documents are also forwarded herewith for reference and return.
Signature and designation of the Officer.
Memo No. Dated . . . . . . . . . . . 20. . , A. Sanctioned Rs. . . . . . . . . . . . . . . . . . . . . . . . . . (Rupees . . . . . . . . . . . .)
B. Forwarded to the Secretary to the Government of Karnataka, Finance Department, for obtaining necessary sanction.
(‘A’ This will have to be used when the Head of the Department is himself competent to sanction the withdrawal in which case ‘B’ will have to be struck off).
Signature and designation of the sanctioning authority other than Government.
ANNEXURE (See rule 24) Transfer of Central Provident Fund balances to the State General Provident Fund on transfer or resignation of subscriber from the Central Government Service to join the State Government Service:- Subject to the conditions contained in Rule 24:- a) Where a Central Government employee join service under the State Government either by transfer or by resignation from the Central Government Service, his Central Provident Fund accumulations under Central Government shall be transferred to the State General Provident Fund by opening a new General Provident Fund Account in his name.
b) Where a Central Government employee who takes up Service under State Government is eligible for insurance in the Karnataka Government Insurance Department, he may not be required to subscribe new General Provident Fund Accounts opened under the State General Provident Fund as a compulsory subscribed but the Central Provident Fund balance credited to his new General Provident Fund Account may by repaid to him only after his retirement or dismissal or resignation from the State Civil Service.
c) Where a Central Government employee who takes up service under State Government is not eligible for insurance in the Karnataka Government Insurance Department he shall be required to subscribe compulsorily to the State General Provident Fund Account.
d) The Provisions of clauses (a) to (c) shall mutatis mutandis be applicable to a Central Government employee who is appointed as probationer in the State Civil Service.
PR. 833 G.SHASHIDHAR SC.250 Under Secretary to Government Finance Department (Admn and Advances)