FORM 31





APPLICATION FOR ADVANCE FROM THE FUND



Refer: Instructions

For office use only

Date ………

Official seal and Registration No……

Purpose for which advance Amount of advance required (in words)……. is required………………….

1. Name in full (in block letters)………….

2. Father’s/Husband’s name………………..

3. Name of the factory/establishment in which employed and address………………

4. Provident Fund Account No……………

5. Monthly basic wages, DA: Basic + DA…………….Total……….

6. Full postal address of the member to which payment/intimation to be sent.

7.Mode of remittance

(a) In case of advance for purchase of site/house/flat or construction through an ‘agency’ or repayment of housing loan, indicate (i) in whose favour the cheque is to be &awn and (ii) full address…………

In other cases put the tick against any of the following:

(b) By account payee cheque, through the employer (to the address given against SI. No. 3)

(c) By deposit in Bank A/c No………….. located at……..(Full postal address) (d) By money order at my cost to the address given against SI. No. 6.

*I declare that the advance is required to meet the expenses in connection with my marriage/marriage of my son/daughter/brother/sister, Shri/Kumari…….(name) aged…… to be celebrated on……………..(Date) at……………(Address).

I declare that the above particulars are true to the best of my knowledge and I will abide by the conditions governing the grant of advance under the Scheme. Certificate(s)/document(s) in support of my application is/are furnished/enclosed.

Station ……… Signature/left or right hand thumb-

Date ……….. impression of the member

*Delete if the advance applied for is not for marriage.

ADVANCE STAMPED RECEIPT



[To be furnished with reference to 7 (a) or (b) or (c) above only)

Received a sum of Rs……………(Rupees………) from the Regional Provident Fund Commissioner/Officer-in-charge of Sub-regional Office, Employees’ Provident Fund towards the grant of advance from my Employees’ Provident Fund Account maintained by him.

Affix one

Rupees

Revenue

Stamp

Signature of member

*To be filled by the Employees’ Provident Fund Office

TO BE FURNISHED BY THE EMPLOYER



(During the closure/lock-out of the factory/establishment by any Gazetted Officer or the Chief Executive/Head of a local authority or MP or MLA or a Member of CBT/Regional Committee, EPF.)

Certified that the application has been signed by the member in my presence after he/she had read the contents/the contents had been explained to him/her by me and that the information given in the application is correct. Required certificates) is/are closed.

Date……………………

Designation of the signing official with stamp of the factory/establishment.

Encls:…………

Signature of employer or an authorised official of the factory/establishment.

FOR USE IN PROVIDENT FUND COMMISSIONER’S OFFICE



Section………………. Account No………………………

AUTHORITY FOR PAYMENT OF ADVANCE UNDER PARA. 68



Passed for payment for Rs…………….(Rupees………………only)

Mode of remittance: Refer SI. No. 70

M.O. Commission, if any………..

Net amount to be paid by M.0………….

Clerk’

Head

Clerk Accounts Officer

P.I. No……………….

Vide payment scroll P.C. to A.0.

FOR USE IN CASH SECTION



Paid by inclusion in Cheque No………………dated…………..Vide Cash Book (Bank) Account No. 3 debit item No………………

Clerk

Head Clerk

Assistant Commissioner

REMARKS



Instructions

A member of the Fund may avail the following non-refundable advances:

The documents to be furnished in support of the application are given in brackets:

1. Purchase of a dwelling site-

(From an ‘agency’)-Original allotment order.

(From an individual)-Original title deed non-encumbrance certificate.

(for verification and return agreement with the seller).

2. Purchase of a dwelling-house/flat

(From an ‘agency’)-Original allotment order.

(From an individual) Original title deed (for verification and return agreement with the seller, non-encumbrance certificate from an appropriate authority that the house/flat is a new and unlived one furnishing the number and date of approval of plan, commencement and completion of the house/flat tax bills and receipts.

3. Construction of house:

(Original title deed) (for verification and return), non- encumbrance certificate, estimated cost for construction. Approved plan.

Note: While claiming the second and subsequent installments the declaration/certificate as required by the Commissioner in his letter sanctioning the advance should be submitted along with the application.

(‘Agency’ referred to in 1 to 3 above would mean Central/State Government, a Co-operative Society, an institution, a trust, a local body or a housing finance corporation. In case of transactions through an agency the payment will be made only by Account Payee Cheque, direct to the ‘agency’ concerned).

4. Additions, alteration or improvement to the house owned by member or by spouse:

(Approval of the appropriate authority, estimate of the work, original title deed of the house (for verification), non-encumbrance certificate, a certificate from the appropriate authority specifying the date of completion of the house.)

5. Repayment of (Housing) loan to the State Government Housing Board, Municipal Corporation or a body similar to Delhi Development Authority:

A certificate from the lending authority furnishing the details of loan and outstanding amount.

6. Closure/Lock-out of the factory/establishment, for reasons other than strike:

(Furnish the certificate ‘A’ given later.)

7. Non-receipt of wages for 2 months:

(Furnish the certificate ‘B’ given later.)

8. Illness of member/family member

(Furnish the certificate ‘C’ given later.)

9. Marriage of self/son/daughter/sister/brother

10. Post-matriculation education of son/daughter

(Certificate from the Institution regarding the course of study and anticipated expenditure)

11. Damage to the property due to natural calamity (Flood/riot/earthquake):

(Furnish the certificate ‘D’ given later.)

12. Affected by cut in electricity:

(Furnish the certificate ‘E’ given later.)

13. Purchase of equipment for physically handicapped members:

(Furnish the certificate ‘F’ given later.)

Note: (1) Such other document, certificate, etc. as may be required by the sanctioning authority are also required to be furnished through the establishment.

(2) In case no intimation is received within a month please write to RPFC/Officer-in-charge of sub-regional office, through the establishment.

CERTIFICATE-A (REFER INSTRUCTION SL. NO. 6)



Certified that no compensation was paid to the member Sri/Smt for the period of lock-out/closure.

Signature of employer/authorised official with date and seal.

CERTIFICATE-B (REFER INSTRUCTION SL. NO. 7)



Certified

(i) The member Sri/Smt……………….. has/bad been granted leave for a period

of……….from………..to………………

(ii) The ESI facilities/cash benefits are not actually available to the member/the member has ceased to be eligible for cash benefits under ESI-Certificate from ESI enclosed.

Signature of the employer/authorised official with date and seal.

CERTIFICATE-C (REFER INSTRUCTION SL. NO. 8)



Medical certificate to be issued; (i) in case of major surgical operation or where the hospitalisation for one month or more had or has become necessary-By a doctor of the Government/ESI/private hospital. (ii) in case of treatment of TB, leprosy, paralysis or cancer-By a doctor of Government/private hospital/ESI or by a registered medical practitioner. (iii) in case of treatment of heart aliment or mental derangement-By a specialist doctor.

(ii) Certified that Sri/Smt. /Kum s/o/w/o/d/o....

*(i) Is suffering from TB/leprosy/paralysis/cancer/mental derangement/heart ailment.

*(ii) Is suffering from (disease) for which a major surgical operation/and hospitalisation for a period of days from to had or has become necessary.

*(iii) Is suffering from and hospitalisation for a period of days from to had or has become necessary.

*Delete whichever is not applicable.

Signature of the Doctor with date and seal.

CERTIFICATE-D (REFER INSTRUCTIONS SL. NO. 11)



Certified that the movable/immovable property of Sri/Smt……viz……situated at…… has been damaged due to………on (date)…………………………..The estimated loss of

property due to……….calamity is valued at Rs……………….The State Government has

declared that the calamity has affected the general public in the area in which the property of the member is /was located vide Notification/Press release No. and date.

Signature of employer/revenue official Gazetted officer/MLA/MP/Member of CBT/

Regional Committee with seal and date.

CERTIFICATE-E (REFER INSTRUCTIONS SL. NO. 12)



Certified that the fall in wages amounting to 25% more than 25% of the wages in respect of Sri/Smt……….due to power cut.

Signature of the employer/authorised official with date and seal.

CERTIFICATE-F (REFER INSTRUCTIONS SL. NO. 13)



Medical certificate from a competent medical practitioner.

Certified that Sri/Smt/Kum…………..s/o/w/o/d/o………………….is physically hand-

capped, viz……………………….(Nature of handicap) and requires the equipment,

viz………..costing about Rs………to minimize the hardship on account of handicap.

Signature of the doctor with seal and date.