A.P.F.C. FORM - 12 (See Chapter - X. Article 23C (a) (i) of A.P.F.C. Vol.I) FORM OF APPLICATION BY A GOVERNMENT SERVANT FOR AN ADVANCE FOR THE PURPOSE OF PURCHASE OF A PERSONAL COMPUTER **** 1. Name of the Applicant (In block letters) : 2. Designation of applicant and Office in which employed : 3. a) Whether permanent and if so the particulars of the post b) If not permanent, whether he is an approved probationer and if so the name of the post and date from which he has been declared as approved probationer : : 4. Date of Birth : 5. Date of Superannuation or retirement : 6. Scale of pay of the present post : 7. Basic pay in the present post as desired under Fundamental Rule 9 (21) (Excluding Special Pay) : 8. Amount of gross pay : 9. a) Whether the advance applied for is the first one b) If not i) Amount of previous advance ii ) Number and date of Order in which such advance was sanctioned. ii i) Date of drawal of such advance iv ) Whether any amount of such advance is outstanding repayment (principal and interest to be shown separately) v) In case it is fully repaid whether Clearance Certificate has been obtained from the Accountant General : : : : : : 10 . a) Whether the Personal Computer to be purchased has been allotted by the Government from the Government priority quota b) If so, whether the letters of intimation of availability of p.c. FROM THE company / Dealer has been received. : : 11. a) If the P.C. is to be purchased in the open market, name of the agency and the place of delivery (if possible) b) Are any negotiations or preliminary enquiries being made to facilitate delivery of P.C. within one month from the date of drawal of the advance. c) A nticipated price of the P.C. : : : 12. i) Wh ether the officer is or was in possession of P.C. and ii) If so, the amount or the anticipated amount of the sale proceeds of the Personal Computer. : : 13. Amount of advance applied for : 14. Number of monthly installments in which the advance may be recovered : I hereby declare that the particulars furnished above are true to the best of my knowledge and belief. I have not taken delivery of the Personal Computer on account of which I apply for the advance, that I shall complete the payment for the taking possession of the Personal Computer before the expiry of one month from the date of drawal of the advance and that I shall insure it immediately. SIGNATURE OF THE APPLICANT STATION: DATE: TO BE FILLED UP BY THE HEAD OF THE OFFICE 1. Whether the applicant is eligible for the advance applied for (persons under suspension are not eligible). If so, the maximum amount of advance which the applicant is eligible. Amount of Advance recommended : Number of installments in which The advance should be recovered : SIGNATURE OF THE HEAD OF OFFICE STATION: DATE:
