Forms - Benefit under the Welfare Scheme
CLAIMING BENEFIT UNDER THE WELFARE SCHEME UNDER GPF
Application for claiming benefit under the Welfare Scheme Under GPF
1. Name of the Applicant _____________________________________________________________
2. Father's name of the applicant ______________________________________________________
3. Address of the applicant ___________________________________________________________
4 Age of the applicant _______________________________________________________________
5. Relation with employee ____________________________________________________________
6. Name of employee ________________________________________________________________
7. Designation of employee___________________________________________________________
8. Father's name of the employee ______________________________________________________
9. Date of appointment of employee _____________________________________________________
10. Scale of present post of employee ____________________________________________________
11. Basic pay of employee______________________________________________________________
12. Date of death of employee ___________________________________________________________
13. Present place of posting of employee at the time of death __________________________________
14. Death certificate issued by competent authority __________________________________________
15. Name of nominee for General Provident Fund Account (as per records). ________________________
Signature of the claimant (Claiming payment on behalf of subscriber)
Declaration from Drawing and Disbursing Officer. Certified that the above particulars are correct as per records and to the best of my knowledge.
Signature of Drawing and Disbursing Officer