CS-45a
form of application for final payment balances in the...... provident fund account
To
The Assistant Commissioner
Kendriya Vidyalaya Sangathan,
(Through the Head of Office)
Sir,
I am due to retire/have retired/have proceeded on leave Prepratory to retirement for...... months/have been discharged/dismissed/have been permanently transferred to...... have resigned finally from Sangathan service/have resigned service under Sangathan resignation has been accepted with effect from...... F.N./A.N. I joined service with...... on F.N./A.N.
2.I request that the entire amount at my credit with interest due under the rules may be paid to me/transferred to......
3.My Provident Fund Account No. is......
4.I desire to receive payment direct/through my office/Principal, Kendriya Vidyalaya......
5.My specimen signature in duplicate, duly attested by the Principal, Kendriya Vidyalaya...... Head of my office is enclosed.
Your faithfully,
(SIGNATURE OF THE EMPLOYEE)
Station...... Name and address......
Date......
(For Use by head of office)
Forwarded to the Assitant Commissioner, Kendriya Vidyalaya Sangathan, ...... for necessary action.
2.The Provident Fund (Account No...... ) of Shri./Smt./Kumari (as verified from the statements furnished to him/her from year to year) is......
3.He/She has finally retired/will retire/has proceeded on leave preparatory to retirement for...... months/has been discharged/dismissed/has been permanently transferred to...... / has resigned finally from Sangathan service has resigned service under Sangathan to take up appointment with...... and his resignation has been accounted w.e.f...... F.N./A.N. He/She joined service with ...... on...... F.N./A.N.
4.The last fund deduction was made from/his/her pay in this office Bill No...... dated...... for Rs...... (Rs...... and stands included in Demand Draft No...... dt...... The amount of deduction being...... (own share plus Management Share...... ) on recovery or refund of advances......
5.Certified that he/she was neither sanctioned any temporary advance nor any final withdrawal from his/her Provident Fund account during the 12 months immediately preceding the date of his/her proceeding on leave preparatory to retirement or thereafter.
Or
Certified that the following temporary advance/final withdrawals were sanctioned to him/her and drawn from his/her Provident Fund account during the 12 months immediately preceding the date of his/her quitting service under Sangathan/proceeding on leave preparatory to retirement or thereafter.
Amount of advance withdrawlDateBill No.
1.
2.
3.
6.It is certified that no demand/following demands of Sangathan are due for recovery.
7.Certified that he/she has not resigned from Sangathan Service with prior permission of the Sangathan to take up an appointment in another department of the Central Government of under a State government or under a body corporate owned or controlled by the State.
......
(Signature of Head of Office)
Certified No.6 to be furnished in the case of CPF only please score out if not necessary.