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Form 31 (www.epfindia.gov.

in) Page 1 of 4

-ii; ., Mobile Number

ii - in l, For Office use only
ii i,Clam I.D

deZpkjh Hkfo; fuf/k ;kstuk] 1952
EMPLOYEES PROVIDENT FUND SCHEME, 1952
i- is/FORM NO-31
lli ln- r n iii /Application for Advance From the Fund
(;k vuqnsk ns[ksa )(Refer: INSTRUCTIONS)
ln- i i Purpose for which visf{kr vfxze /ku jkfk Amount of Advance
advance is required required ....................................
kCnksa es a In words
...

. lnL; dk uke LiV v{kjksa es a
Name of the member (in block letters)


z. lni,ln i i- (lilrn -lrii -i-
- )
Fathers/ husbands Name in the case
of married women

s. -|,-iii i i- ni l- -
,Name and Address of the
Factory /Establishment in which the
member is employed.

.
Hkfo; lli iini .,Provident Fund
Account No.


r.
-il - n nii -rni; i-ii - +- rni; i-ii = in
Monthly Basic Wages & D.A Basic + D.A. = Total
c.


ri i i ni
Full postal address (in block letters)


|,|-ln,-i|,Shri/Smt./Kumari.......................
................................................................................
,-|,|,S/o/W/o/D/o...............................
................................................................................
................................................................................
.............................. l i /Pin No. .






- r-nii,Signature of applicant lini r-nii,Signature of Employer
Form 31 (www.epfindia.gov.in) Page 2 of 4


/. inni | lli, Mode of Remittance
() | -i- -ii,-i,i-, i| ,l-ii rn i -i ~i il l
(a) In case of Advance for purpose of Site/House/Flat or Construction through an
Agency or Repayment of housing loan, indicate
() ni; l i - rii lr in whose favour the cheque is to be drawn, and

(z) i ni Full Address
...............................................................................................................................................

-i-i es a fuEufyf[kr esa ls fdlh ,d ij dksVd es a fVd ni
In other Cases put a tick against any one of the following:-
(i ) -n ln n r - n iini .(ln ,ii) - iln , ; -il -i-
iini iini |i ii i, (b) By account payees cheque/ electronic mode sent
Directly for credit to my S.B. A/C (Scheduled Bank /P.O.) Under intimation to me
n iini ., S.B Account no
i i i-, Name of the Bank
kk[kk@ Branch
i;... i , IFS Code..
kk[kk dk iwjk irk@ Full Address of the Branch
( iin ii|, | ln Please attach a copy of cancelled/blank
Cheque)
(n) - i -|i ,ii - ic - l n n
(c)*By money order at my cost (To the Address given Sl.6)
;fn jkfk nks gtkj :Ik;s ls de gks If the amount is less than Rs 2000/-
- ?kksfkr ni r l ln- - n - ,|,ii;,r | kknh ds fy, visf{kr gSaA I declare that
advance is required to meet the expenses in Connection with my marriage/marriage of
my Son/Daughter/Brother/Sister.#
(i-) |,-i| (Name) Sh. / Kumari ....
- Aged ii| | lnli marriage on (date)..
ni at address ...............................................
. . ..............)
#;fn visf{kr vfxze kknh ds fy, u gks rks dkV nsa Delete if the Advance applied if not for marriage.


lnL; ds gLrk{kj vFkok nk;sa @ckaa ; gkFk ds vaxw Bs dk fukku
Signature/Left/Right thumb impression of the member





- r-nii,Signature of applicant lini r-nii,Signature of Employer
Form 31 (www.epfindia.gov.in) Page 3 of 4


ln- iln | ADVANCE STAMPED RECEIPT
in / () i (i) dh nkk es a With reference to 7(a) or (b) only]

vius Hkfo; fuf/k [kkrs ds vfxze ij {ks=h; fuf/k vk;qDr @izHkkjh mi{ks=h; dk;kZy;
:i;s kCnkas esa
.. in r|
#Received a sum of . ( .) from Regional
Provident Fund Commissioner/ Officer in-charge of Sub Regional Office. Employees
Provident Fund Account maintained by him.

{ks=h; Hkfo; fuf/i in,ii|
i| ii ,ii i
l si i i
The space should be left
blank which shall be filled
in by Regional Provident
Fund Commissioner,
Office-incharge of Sub-
Regional Office.

- r-nii k ck,a@nk,a gkFk ds vaxw Bs dk fukku
Signature or Left/Right hand thumb impression of the member
(lini ,ii i l)
(TO BE FURNISHED BY THE EMPLOYER)

-|,-iii ,nii| ii l| iln lii| i - ii|,-ii| ilii|
i i - lii ii -,| i| -,i| lfefr ds lnL; dEkZpkjh Hkfo;
lli| (During Closure/Lock out of the factory/establishment by any Gazetted Officer or
the Chief Executive/Head of Local authority of M.P. or M.L.A. or member of
C.B.T/Regional Committee E.P.F.)
-ilin li ini r l - - | l-iln - - ,ii -ni in iii r-nii
l r i iii - l~lin ii| r| r lin -ii r|
Certified that the application has been signed by the member in my presence after He/She
had read the Contents/the contents have been explained to him/her by me and that the
information given in the application is correct. Required Certificate (s) is/are enclosed.

li, Date
-|,-iiilii| i i-
-ir lrn
Designation of the Signing Official with
stamp of the Factory/Establishment

-| -iii lini i ilin lii| r-nii
Signature of the Employer or an Authorised Official of the Factory/Establishment

,Encls ...



i- l--
1 Revenue
Stamp
Form 31 (www.epfindia.gov.in) Page 4 of 4

Hkfo; fuf/k vk;qDr dk;kZY; ds iz;ksx ds fy,
FOR USE IN PROVIDENT FUND COMMISSIONERS OFFICE

iin Section................................... iini i Account No..................................

i cs i| ilin ln- | in| rn
AUTHORITY FOR PAYMENT OF ADVANCE UNDER PARA-68
i| Under Rs
inni l i li Passed for payment for ..
kCnksa es a In words...........................................

inni | lli Mode of Remittance i - i Refer Sl.No.7 ( )
euhvkMZj dehku ;fn dksbZ gi) M.O. Commission (if any): .
Hkqxrku dh tkus okyh fuoy jkfk Net amount to be paid by M.O. .



i... . ii lii|
SSA SS Accounts Officer

inni - i P.I.No. -i . Scroll No.

(i iin in l)
(FOR USE IN CASH SECTION)

i Cheque no.. li Date........................

i r| iini is - i- i ,ii li ni
Vide Cash book (Bank) Account No-3 Debit item
No..............................................................



i... . .i.,i.i
SSA SS A.C./R.C.

lilni,REMARKS