FORM E-2
(See Rule XXX-43(1)(2) and 44(1))
APPLICATION FOR CLOSURE OF KERALA AIDED SCHOOL EMPLOYEES PROVIDENT FUND ACCOUNT
Important : This form is to be used only in cases where the Subsriber has resigned Aided School Service
A.
DETAILS TO BE FURNISHED BY SUBSCRIBER
1.
(a)
Name in full of the subscriber and account number (as indicated in the latest Annual Account Statment received from the Account Officer(PF))
(b) Designation 2. 3. Aided school in which you worked last Date with effect from which you resigned Aided School Service Have you resigned Aided School Service to take up appointment in Government Service? (a) Have you been sanctioned and paid any non-refundable advances or Temporary Advances during the 12 months preceeding the date of your quitting service. (b) If so, what are the Numbers and dates of sanction and amounts (i) (ii) 6. Temporary Advances Non-refundable Advances
4.
5.
Give particulars of Life Insurance Policies financed by you from the P.F money which are to be released. (a) What is the amount at your credit in the fund as communicated by the Account Officer, (PF) through the latest Annual Account Statement received by you.
7.
(b) Do you accept the balance as correct? (c) If not, give details of the discrepencies
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8.
What is the address in which communication are to be sent If you have resigned to take up appointment in Govt. Service or another Aided School. (a) Have you been admitted to GPF.
9.
(b) If so, what is your GPF Account No. (c) What is the address of the Govt. institution in which you were working at the time of admission to GPF.
Station : Date :
Signature of the Subscriber
B. DETAILS TO BE FURNISHED BY HEAD OF OFFICE AND CONTROLLING OFFICER.
1.
Was the resignation tendered by the Subscriber for joining Govt. Service or another Aided School What is the date with effect from which resignation was accepted. Details of Temporary Advances and Nonrefundable withdrawal paid to the Subscriber during the 12 months proceeding the date of resignation
2.
3.
Amount
Sanction No. & Date
Date of drawal
Treasury of encashment of the bill
(a) Temporary Advance (b) Non-refundable withdrawals
Certified that the information furnished above has been verified by referring to the records in my office Signature of Head of Office (Name of school with postal address) Signature of Controlling Officer (Give full address)
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ANNEXURE III
FORM OF DECLEARATION
Final payment of accumulation to the K.A.S.E.P.F Account No ................................................................. having been agreed to be authorised in my favour, I .................................................................................. ............................................................................................................ hereby declare that I clearly understand the payment is strictly provisional and is subject to revision when any discrepency in my K.A.S.E.P.F account is detected at a later stage and I further promise that if upon such revision the provisional payment made to me has been in excess of the amount eventually found admissible I agree to repay excess payment in lump failing which I agree that the amount may be recovered from me under the provisions of the Revenue Recovery Act for the time being in force.
Signatur of the Subscriber
Name and Address
Witness
1.
2.
Controlling Officer / Head of Institution
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FORM OF OPTION
I, ................................................................................................................................................ do hereby opt to cease the Kerala Aided School Employees Providend Fund Subscription for
.............................................
due to my retirement on .............................................
Station Date
Signature Name & Designation
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