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Place: Vazhakulam
Date : 12/14/2011 Ajayakumar.R
Head Clerk
10. Enquiry Certificate:-
1. Certified that the subscriber has no other means to raise the amount from any other sources
2. Certified that I have made enquiries about the purpose for which the loan is applied and I have satisfied
myself with genuiness of the fact stated in the application
3. Certified that the subscriber will continue in service till the complete repayment of the advance
4. Certified that the subscriber has opted the GPF(K) Rules with in the prescribed time
5. Certified that six months have elapsed from the date of drawl of the previouse advance
6. Certified that no application for advance from this subscriber is pending
Place Vazhakulam
Date: 12/14/2011 Mathai A J
Block Development Officer
Vazhakulam
Verification Report
14. Any other fact requiring consideration : Special Case No other source to raise the fund
1 2 3 4 5 6 7 8 9
Mar-11 1000 0 0 1000 12/9/2011 493703 363052 ST,
Apr-11 1000 0 0 1000 12/10/2011 492968 364878 Aluva
May-11 1000 0 0 1000 12/11/2011 492387 356494 ''
Jun-11 1000 0 0 1000 12/12/2011 51715 29753 ST
Jul-11 1000 0 0 1000 12/13/2011 34407 29753 Angamali
Aug-11 1000 0 0 1000 12/14/2011 36660 29753 ''
Sep-11 1000 0 0 1000 12/15/2011 33252 28498 ''
Oct-11 1000 0 0 1000 12/16/2011 33252 28498 ''
Dec-99 0 0 0 0 12/30/1899 0 0 0
Dec-99 0 0 0 0 12/30/1899 0 0 0
Dec-99 0 0 0 0 12/30/1899 0 0 0
Dec-99 0 0 0 0 12/30/1899 0 0 0
Dec-99 0 0 0 0 12/30/1899 0 0 0
Dec-99 0 0 0 0 12/30/1899 0 0 0
Dec-99 0 0 0 0 12/30/1899 0 0 0
Dec-99 0 0 0 0 12/30/1899 0 0
Dec-99 0 0 0 0 12/30/1899 0 0 0
Dec-99 0 0 0 0 12/30/1899 0 0 0
Dec-99 0 0 0 0 12/30/1899 0 0 0
Dec-99 0 0 0 0 12/30/1899 0 0 0
Dec-99 0 0 0 0 12/30/1899 0 0 0
Dec-99 0 0 0 0 12/30/1899 0 0 0
Dec-99 0 0 0 0 12/30/1899 0 0 0
Dec-99 0 0 0 0 12/30/1899 0 0 0
Total 8000 0 0 8000 0 0 0 0
Certified that the particulars furnished above have been verified with reference to pay abstract
acquittance roll PF.Pass Book and other connected records and found correct
Vazhakulam Mathai A J
12/14/2011 Block Development Officer
Vazhakulam
Mathai A J
Block Development Officer
Vazhakulam
A temporary advance from the General Provident Fund(Kerala) as particularised below is sanctioned
by the under signed under the rules regulating that fund.
7 Rule or rules under which the advance is sanctioned 16(1) (d).GPF (K) Rules
8 Balance at credit of the subscriber on this date (As
verified from account last render by the Head of Office Rs. 84637
9 Balance of previous advance, If any outstanding
against the subscriber (Principal and interest Rs. 4320
shown separately)
10 Date of repayment of previous advance if any Being repaid
11 Special reason for granting the advance Special Case No other source to raise the fund
12 Amount of consolidated advance Item 5 and 9 and Rs. 67680 4320 63360 )
the No. of installments in which the consolidated to be recoverd in
advance to be recovered. 36 Installments @ Rs. 1880
13 Amount of each Installment Rs. 1880 /PM
14 Date of Birth 4/6/1966
15 Date of retirement 3/31/2022
Mathai A J
Block Development Officer
Vazhakulam
Copy to
1 The Accountant General (Kerala)
PF Head of Account
Sl No Name of subscriber & Monthly pay GPF Account No Number & Date of sanction Order
1 Ajayakumar.R No. A.283/11 Dt 12/14/2011
Head Clerk CP 1405122 of Block Development Officer
Grand Total
Received Rs. 63360 (Rs. Sixty Three Thousand Three Hundred and Sixty Only
Mathai A J
Signature of messenger Block Development Officer Signature of messe
POC No……………………………………………...…………..Date………………/…………./……………….
Accountant
CERTIFICATE
1. Certified I have satisfied myself that all sums included in bills in Form D drawn 1, 3 months previous to this date in
favour of Messers……………………………………………………Account Nos……………………………………………..
With the exception of those detailed below ( of which the total has been refunded by deduction from this bill) has been
disbursded to the proper persons and that their acquitances have been taken and filed in my office with receipt stamp
duly cancelled for every payment as per stamp act.
2. Certified that I have satisfied myself that the amount withdrawn previously on the same account has been utilized
by the subscriber on the date of the withdrwal covers the sum in the relevant premium receipt/receipts has/have duly
enfaced by me.
Note: Separate bill should be prepaed for each index prefix of GPF Accounts.
FOR THE OFFICE USE ONLY
Admitted Rs……………………………………………..
Objected Rs……………………………………………..
Provident Fund Type Decode Head of Account Provident Fund Tyep Decode H/Ac.
8009-01-
KPEC & PPSPF 119 8009-01-101-90 Panchayath Emp. PF 124 101-93
8009-60-
KASEPF 120 8009-01-101-98 Contri.Prov.Pension Fund 126 102-00
8009-01-
KPCSPF 121 8009-01-101-97 KASRSEPF 127 101-92
8009-01-
KPCNSPF 122 8009-01-101-96 Continency Emp.PF 128 101-98
8009-01-
123 8009-01-101-95 GPF 701 101-99
INSTRUCTIONS
P F ACCOUNT
2233222
12/14/2011
1207630731
………………………………………….
Voted(V)/Charged(C)
63360
Only )
.........................................
Signature of messenger
Treasury Officer
ccounts.
H/Ac.
8009-01-
101-93
8009-60-
102-00
8009-01-
101-92
8009-01-
101-98
8009-01-
101-99
ce of the sanction-
ase where the san-
signation should be
Date 12/14/2011
Payment/Advance
Bill for with drawing Final/Temporary Advance /Other from the KASEPF/
General Provident Fund (Kerala) of Smt/Sri. Ajayakumar.R Head Clerk
of the Block Development Office,Vazhakulam for the month 12/2011
No and date
Final Payment/
Name of Subscriber and PF Account of sanction/
No Advance/other Acquittance
monthly pay No Letter of
withdrawls
authority
1 2 3 4 5 6
1 Ajayakumar.R A.283/11 63360
Head Clerk CP 1405122 12/14/2011
Rs.18,740
Block
Development
Officer
Vazhakulam
Total 63360
Net amount required for payment
In words Rs. Sixty Three Thousand Three Hundred and Sixty Only
Pay Rs.
Treasury Officer
Mathai A J
Examined and entered Block Development Officer
Vazhakulam
Treasury Accountant
1.Certified that I have satisfied myself that all sums included in bills in form drawn 1 month/
2months/3months previous to this date in favour of Massers…………………………………………….
Account Nos……………………….with the exception of these detailed below(of which the total has
been refunded by deduction from this bill) have been disbursed to the proper persons and their
acquittance have been take and filed in my Office with receipt stamp duly cancelled for every
payment in excess of Rs.20/-
II.Certified that the balance at my credit/at the credit of the subscriber or the purpose for which
it was intended and that the bill certified also that amount asked for in this bill is required to
meet the early premium due on……………………………………………………………………
respect of Policy No…………………with the LIC and that the Policy in quistion has been assigned
to the Governor and is the custody of the accounts officer………………………………………
or the details of the policy proposed to be taken have been communicated to and accepted by the
account Officer in his letter No……………….Date…………………..
Certified also that the number of policies financed from the KASEPF/GPF(Kerala)does exceeds
four as these were accepted prior to the Commancement of KASEPF/GPF(Kerala)Rules
Certified further that I have satisfied myself that the amount withdrawn previosly on the same
account has been utilised by the subscriber on the data of the withdrawl covers tha sum drawn
in the relevent premium receipts have been duly enfaced me
Mathai A J
Block Development Officer
Vazhakulam
Given details if more than one policy has to be cited
Admitted………………………………………………………………..
Sd
Place: Vazhakulam Ajayakumar.R
Date : 12/14/2011 Head Clerk
Block Development Office,Vazhakulam
Mathai A J
Block Development Officer
Block Development Office,Vazhakulam
DECLARATION
Ajayakumar.R
Head Clerk
Block Development Office,Vazhakulam
Vazhakulam
Mathai A J
Block Development Officer
Block Development Office,Vazhakulam
CERTIFICATE
1. It is certified that I have verified the particulars furnished by the Subscriber against columns 2, 3, 4,
5, 6 and 11 with reference to the relevant records in my office and that they are found to be correct.
2. It is also certified that I have caused enquiries to be made about the statement contained in the
application regarding the object of the proposed withdrawal and that I am satisfied that it is bona fide.
Mathai A J
Block Development Officer
Block Development Office,Vazhakulam