STATEMENT OF DEPOSITS AND WITHDRAWLS FOR THE PERIOD AFTER THE LAST CREDIT CARD TILL THE DATE OF APPLICATION
GPF Account No. Name of Subscriber :
Month & Year
PF A/C No:
Total amount Refund of deducted from the Advance month(3+4)
Date of encashment of the bill
Gross Net amount Name of amount of the bill of the bill Treasury
B. Details of DA Credited to GPF since Last Credit Card which Amount SL. No. & Date of G.O as per which the arrears credited to No D.A Arrears was credited PF relate GPF
encashme Gross nt of the amount of bill the bill
Net amount of Name of the bill Treasury
C. Details of withdrawals made since the Last Credit Card. No. and date of sanction Date of Amount Name of Treasury Drawl
Nature Purpose ofAdvance TA/NRA
Total amount at the credit as per last credit card for the year 2015-16
2 . Toatal amount credited PF account after the last credit card (Total of A & B) 3.
Grand Total (item 1+2) above
Total amount of advance drawn after the issue of last Credit Card (Vide details furnished under C above)
Total amount of D.A arrears & Pay Revision Arrears if any not due for withdrawal as per existing Government Orders.
Grand Total (item 4+5 ) above.
Net Balance at credit of the subscriber(3-6) on the date of application
Certified that the particulars furnished above have been verified with reference to pay abstract acquittance roll, PF Pass Book & other connected records & fund correct.
Signature of Drawing & Disbursing Officer/ Signature of Subscriber in the case of Gazetted Officer
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