For Evaluation Only. Copyright (c) by VeryPDF.com Inc Edited by VeryPDF PDF Editor Version 2.3 APPENDIX-I (NEW ONLINE ADJUSTMENT) APPLICATION FOR SANCTION OF TEMPORARY ADVANCE (REFUNDABLE LOAN) FROM PROVIND FUND ACCOUNT F O R O F F IC E U S E O N LY File Number & Date No. Date: Amount Amount in Words Amount Sanctioned Clerk Superintendent Accounts Officer (ZPP) For Evaluation Only. Copyright (c) by VeryPDF.com Inc Edited by VeryPDF PDF Editor Version 2.3 P # 2 ANNEXURE - I Instructions 4 (7) under Treasury Rule 17 bills for withdrawal from Provident Fund Annexure District Voucher No. Sub-Account No. Of State Provident Fund Provident Fund Provident of For the month of in the office of the Bills for from the Withdrawing Advance Other Irregularities Name & Pay ZPPF No. of date of Nature of withdrawal REMARKS Designation of (Rs.) Account sanction of Refundable Loan Subscriber Number letter authority FOR SUBSCRIBER'S USE ONLY RECEIVED CONTENTS THROUGH MY BANK ACCOUNT NUMBER OF (BankName)______________________________________ . Rs.1/- Revenue Stamp For Evaluation Only. Copyright (c) by VeryPDF.com Inc Edited by VeryPDF PDF Editor Version 2.3 P # 3 PARTICULARS OF THE AMOUNT REFUNDED Sl.No Name and Designation of the subscriber Accou nt No. Particulars of amount drawn Amount now refunded Rs. Net amount required For payment Rs. Signature of the Drawing Officer & Designation Station : Please Pay Rs.____________________________________________________ Date : CONTENTS RECEIVED 1. Certified that 1 have satisfied myself all some including (Form 40-A) drawn one month/ two months/three months provision to this date in favour of member Account No. with the expected of those detailed of which the Total has been refunded by deduction in this Form have been disbursed to the proper places and that acquittance have been taken and filed in my office with receipts stamps duly cancelled for every payments in cast of Rs.20/ 2. CERTIFIED that the balance asked from the bill is required to meet yearly premium due on the respect of Policy No. with the company limited in Policy No. detailed below and that he policy/policies in position has been assigned to the Government of Andhra Pradesh and in the custody of the Z.P. for the policy/ policies proposed to be taken has been communicated to the accepted by the Zilla Parsishad.
