FORM-3 APPLICATION FOR ADMISSION INTO THE ZILLA PARISHAD PROVIDENT FUND (UNMARRIED PERSONS) 01 Name of the Applicant 02 Official Designation & Address of working place 03 Office to which attached. If on deputation, state the parent Department 04 Service to which the applicant belongs 05 Whether applicant's service is pensionable or not 06 Whether the applicant's service is permanent, temporary or re-employed, if temporary, give the date of commencement of service. 07 Basic Pay Drawing Per Month 08 Rate Of Subscription To Be Recovered Per Month 09 Whether the individuals is a compulsory or optional subscriber 10 If subscriber is subscribing to any other fund, the name of such fund. 11 Whether the applicant has a family or not (Yes/ No) 12 Account Number to be allotted by the Accounts Officer (For Office Use) 13 REMARKS (For Office Use) STATION : Dated : Signature & Address Of the Applicant Signature of the Head of Office & Designation Office Of the Zilla Parishad, Chittoor Dated ______________ RETURNED with Account Number allotted. The Account Number allotted is ________________. This number should be quoted in all correspondence connected to provident fund. Signature Of The Accounts Officer, Zilla Parishad-Chittoor. (PTO FOR NOMINATION) P#2 FORM OF NOMINATION I .WHEN THE SUBSCRIBER HAS NO FAMILY AND WISHES TO NOMINATE ONE PERSON. I having no family as define in rule 2 of the General Provident Fund (Andhra Pradesh) Rules hereby nominate the person mentioned below, to receive the amount that may stand to my credit in the fund, in the event of my death before that amount has become payable or having become payable has not been paid . Name and Address Of the Nominee Relationship with the Subscriber Age Contingencies on the happening of which the nomination shall become invalid (#) Name, address & relationship of the person to whom the rights of the nomination shall pass in the event of predeceasing of the subscriber Signed on (dated) ______________________ at (Place) ______________________________ Witnesses With Full Address (2 Members) (*) (1) Signature and address of the Subscriber (2) (*) Witnesses without their full addresses will not be entertained (#) Specify in this column that the nomination shall become invalid in the event of his/her subsequently acquiring a family.
