Application for Final Payment / Transfer to Corporate Bodies

APPENDIX – D

APPLICATION FOR FINAL PAYMENT / TRANSFER TO CORPORATE BODIES / OTHER GOVERNMENT OF BALANCE IN THE GENERAL PROVIDENT FUND ACCOUNT .

To The Accountant General Tripura, Agartala ( Through the Head of Office ) Sir, I am to retire / have retire / have proceeded on leave preparatory to retirement for______months/ have been discharged/dismissed/ have been permanently transferred to ______/ have resigned finally from Government service voluntary / have resigned service under ______Government to take up appointment with ______and my resignation has been accepted with effect from 31st January/2012 forenoon / afternoon. I have joined service with ______on ______forenoon / afternoon.

My provident Fund Account No is T/CW/2558 and I desire to receive payment through my office /through Treasury/Sub Treasury. Particulars of my personal marks of identification, left hand thumb and other finger impressions (in the case of illiterate subscriber) in duplicate, dully attested by a Gazetted officer of the Government are enclosed.

PART – I

(To be filled when the application for Final Payment is submitted up to one year prior to retirement.)

I request that the amount of Rs.2,20,051/- ( Rupees. Two lakhs twenty thousand and fifty-one) only standing to the credit in my Provident Fund Account as identified in the Accounts Statement issued to me for the Year 2010-11 (Enclosed) / as appearing in my ledger account being maintained by you ______Through TREASURY-II /Sub Treasury/ HEAD OF OFFICE, may please be arranged to be paid to me as first installment of final payment.

After payment of First installment of my Provident Fund balance, I will apply for the payment of a subsequent installment in part – II of the Form immediately on retirement.

Station :Agartala Yours faithfully

Date : ______SIGNATURE :______SRI SUDHANYA SINHA. MATHCHOWMUHANI, A.A.ROAD BACK SIDE OF BANK OF BORODA, JAIL ASHRAM BRANCH, PO: AGARTALA : 799001, TRIPURA (WEST). This applies only when payment is not desired through the Head of Office.

( FOR USE BY THE HEADS OF OFFICES )

Forwarded to the Accountant General, Tripura for necessary action .

The Provident Fund Account No of Sri Sudhanya Sinha Assistant Engineer ( as certified from the Statement furnished to him /her from year to year.)

is GPF A/C No T/CW/2558 He / She is due to retire from Government Service on 31st January/2012 (afternoon).

Certified that, He/She has taken the following Advances in respect of which ______Installments of Rs .NIL are yet to be recovered and credited to the Fund Account. The details of the withdrawals granted to him/her are also indicated below.

TEMPORARY ADVANCES WITHDRAWALS 0 NIL 01 Rs.7,00,000.00 1 0 NIL NIL 02 2

SIGNATURE OF THE HEAD OF OFFICE

PART –II

To be submitted by the subscriber immediately after his/her retirement. This part is also applicable in the case of Subscribers who apply for Final payment for the Ist time after the date of superannuation / discharge / resignation etc. In continuation of my earlier application, dated: NIL for the Final payment of General Provident balance, I request that the entire balance at my credit with interest due under the rules may be paid to me OR I request that the entire amount at my credit with interest due under the rules may be paid to me / transferred to ______.

SIGNATURE :______] SRI SUDHANYA SINHA. MATHCHOWMUHANI, A.A.ROAD BACK SIDE OF BANK OF BORODA, JAIL ASHRAM BRANCH, PO: AGARTALA : 799001, TRIPURA (WEST). ( FOR USE BY THE HEADS OF OFFICES )

Forwarded to the Accountant General, Tripura for necessary action / in continuation of the endorsement ______dated :______.

He/She has finally retired with effect from 31st January/2012( afternoon).

The last fund deduction was made from his /her pay in the office Bill No : 348 dated 19.01.2012 for Rs.15,000/- ( Rupees Fifteen thousand )only Cash Voucher No ______of Treasury. The amount of deduction being Rs.15,000/- ( Rupees Fifteen thousand )only and recovery on account of refund of advance Rs.NIL .

Certified that, He/She was neither sanctioned any temporary advance or any Final withdrawal from his /her Provident fund account during the 12 (twelve) Months immediately proceeding the date of his /her quitting service under ______Government / proceeding on leave preparatory to retirement or thereafter. OR Certified that, Following advances / Final withdrawal were sanction to him/her and drawn from his /her Provident Fund Account during the 12 (twelve) Months immediately proceeding the date of his /her quitting service under Government of Tripura / proceeding on leave preparatory to retirement or thereafter.

Sl.N Amount of Advance /Withdrawal Date Voucher No. o 01 Rs.7,00,000.00 30.07.2011 Bill No:136 dated.30.07.201 1 ------It is to certify that, No demands /following demands of Government are due for recovery.

Certify that, He/She has not resigned from Government service with prior permission of the Central Government to take up another Department to the Central Government or under a State Government or under a Body Corporate or Controlled by the State. SIGNATURE OF THE HEAD OF OFFICE/DEPARTMENT GOVERNMENT OF TRIPURA OFFICE OF THE SUPERINTENDING ENGINEER PLANNING CIRCLE, PWD(R&B), TRIPURA.

No.F.______Date:______

OFFICE ORDER NO:______

In pursuance of communication No.P.F.4/598/FP/CW/2558/105 Dated.16.04.12 of the Office of the Senior Deputy Accountant General (A&E), Tripura, Agartala sanction is hereby accorded for an amount of Rs.2,38,086/- (Rupees two lakhs thirty-eight thousand and eighty-six)only in favour of Sri Sudhanya Sinha, Retired Assistant Engineer of this Circle for final payment from his General Provident Fund vide his GPF Account NO:T/CW/2558 . The copy of the authorization letter as received from the Office of the Senior Deputy Accountant General (A&E), Tripura, Agartala is appended herein as ready reference.

(Er Surjya Mohan Sarkar) T.A to Superintending Engineer Planning Circle, PWD(R&B), Tripura

Copy to :: 1. The Senior Deputy Accountant General (A&E), Tripura, Agartala. 2. The Superintending Engineer Planning Circle,PWD(R&B), Tripura . 3. The Treasury Officer, Agartala Treasury NO:II, Agartala The copy of the authorization letter as received from the Office of the Senior Deputy Accountant General (A&E), Tripura, Agartala is appended herein as ready reference. 4. Bill Copy. 5. The Cashier of this office for information and necessary action please. 6. Sri Sudhanya Sinha, Retired Assistant Engineer, Mathchowmuhani, A. A Road, Back side of Bank of Boroda, Jail Asharm Branch, PO:Agartala, Tripura(West). 7. Office Order Book.

T.A to Superintending Engineer Planning Circle, PWD(R&B), Tripura