APPLICATION FOR GPF ADVANCE

OFFICE OF THE GENERAL MANAGER TELECOM DISTRICT

DIMAPUR- 797112 (NAGALAND)
1. Name of the applicant

2. Account Number

3. Date of appointment

4. Designation

5. Scale of pay

6. Balanced at credit of the subscriber on the date of application below :(a)

(b)
(c)
(d)
(e)
(f)
(g)

Closing balanced as per statement for the year--------------------------------------------Credit from----------------------------to-----------------------subscription-----------------Refund of advanced/ Advance outstanding -----------------------------------------------Withdrawal during the period from--------------------------------------------------------Net balance at credit from--------------------------------------------------------------------Amount of the advance/ Advance outstanding--------------------------------------------Amount of the advance taken Rs.-----------------------balanced outstanding
as--------------------------------on date of sanction -----------------------------on
date---------------

7. Amount of advance required --------------------------------------------------------------------(a) Purpose for which advance required--------------------------------------------------------(b) Rules under which the request in recovered-----------------------------------------------(c) If advance is sought for house building etc. following information may be
given------------------------------------------------------------------------------------------------------8. Location and the measurement of the plot -----------------------------------------------------(a) Whether the plot is free hold or on lease---------------------------------------------------(b) Plan for construction--------------------------------------------------------------------------(c) If the flat or plot being purchased is from (A) House building society, the name of
the society, the location and the measurement etc.
(d) Cost of construction--------------------------------------------------------------------------(e) If the purchase or flat is from DDA or any housing board etc. the location
diminution etc. maybe given-----------------------------------------------------------------(f) If advance is sought for education of children, following details may be
given--------------------------------------------------------------------------------------------------------(g) Name of the Son/Daughter -------------------------------------------------------------------

(h) Class & institution/college where studying------------------------------------------------(i) Whether a day scholar or hostellers----------------------------------------------------------

9. The name of the patient and relationship-------------------------------------------------------(a) Name of the Hospital/ Dispensary/ Doctor Where the patient is under going
treatment----------------------------------------------------------------------------------------(b) Whether outdoor/indoor patient-------------------------------------------------------------(c) Whether reimbursement available or not---------------------------------------------------NOTE:- In case of advance under B (C) to E(E) not certified----------------------------------Of documentary evidence would be required------------------------------------------------------

10. Amount of the consolidated advance (item 6&7) and number of the monthly
installments----------------------------------advance is proposed to be repaid in
--------------------------------------installments---------------------------------------------------------------------11. Full particulars of the circumstances of the subscribers justice the application for the
temporary withdrawal.
12. -----------------------------------------------------------------------------------------------------I certify that the particulars given above are correct and comply to the best of my
knowledge and belief and that nothing has been cancelled by me.

Date:
Place:

Signature of the applicant

with designation