APPENDIX-1

FORM(1)
(See Rule 14)
Application for Sanction of Temporary Advances From
General Provident Fund
1.Name of the Subscriber

2.Account No.

3.Designation

4.Pay

5.Balance at credit of the subscriber

On the date of application

6.Amount of advances outstanding if

Any,and the purpose for which

Advane was taken then
7.Amount of advance required

8.Purpose for which the advance is

Required
9.Amount of the consolidated advance

(item 6&7)and No.(and amount)

Of monthly instalments in which the
Consolidated advance is proposed
To be repaid
10.Full particulars of the peculiarly

Circumstances of the subscriber

Justifying the application for the
Temporary with drawal

SIGNATURE OF THE APPLICANT

FORM-40A
(See instruction 41(i) to (111) under treasury rule 17)
BILL FOR WITHDRAWAL FROM GENERAL AND OTHER PROVIDENT FUNDS
ANNEXURE
DISTRICT:----------------------SUB-ACCOUNT NO-------------------------------------------------VOUCHER NO
-----------------------------------PF------------------------------20
STATE PROVIDENT FUND------------------------------------PROVIDENT FUND
-----------------------------------OF
BRANCH
Bill
for
withdrawing
-----------------------------------------------------------------------------------------------------------Withdrawals from the zilla praja parishad provident fund. ------------------------of------------------------------For the month of ---------------------------------------------------in the office of----------------------------------------------------------------------------------------------------------------------

1.Name and designation of the subscriber

2.Z.P.P.F.No.

3.Pay

4.No.&Date of sanction of Letter of

Authority
5.Nature withdrawn

1.Advance
2.Partfinal
3.Final
6.Acquittance

1.certified that I have satisfy my self sums included in bills (form 40-A)drawn one month/two three
month previous to this datein faviour of member accounts No-------------with theexception of these detailed (of
which the total have been refunded by deduction in this form) have been disbursed to thr proper persons and that
acquittance have taken and filed in my office with receipt stamps duly cancelled for every payment.
2.certified that the balance in the funds at the credite of the date of withdrawn covers the sum in this bill.
3.certified that the amount asked form the bill as required to meet the yearly premium due on in respect of policy
No----------------------------with the company limited-------------------in policy/policies in questions has been assigned to
the Government of A.P and in the custody of the ZPP for the details,of the policy/policies proposed to be taken has
been communicated to and accepted by the zilla parishad.in his letter No--------------------,Date----------------------4.certified that in respect of withdrawals made in bills(form-10A)onemonth/twomonth/three months/ dates towards
a payment of insurance premium the original premium receipt have been within onemonth of the date of
withdrawals forwarded to the ZPP,--------------------------------with the exception of those----------for the scrutiny and
the necessary and endorsements have been made on the receipt to that effect that the abetment of incometax is
admissiable.
5.certified that the member of policies from the GPF Dues not exceed fours the number of policies financed from the
GPF exceeded four as these were accepted prior to 16-081998------------------------------------------------------------------------------------------------------------------------------------------------------------------Station:
Date:
Signature of the D.D.O with seal

7.Remarks
Particulars of Amount Refunded:S.No.
Name of the
subscriber&Designation

ZPPF Account
No.

Date of
Drawal

Particulars of
amount
Drawn

Amount Now
Refund Rs.

Dy.Chief Executive Officer,

Zillz praja parishad,------------------------Passed
for
Rs.-------------------------------------------------(in words
rupees-------------------------------------------------------------------------------------------- only) and
pay
the
same
to
------------------------------------------------------------------------------------------------------------------------------------------------------------By way of cheque/D.D./On-line adjustment to the
individuals saving Bank Account No.----------------------------------------------------------- at State Bank of
India,------------------------------------------Branch.
//ACCOUNT VERIFIED//

Accounts officer,
Officer,
Zilla Praja Parishad,---------------------------------.
---------------------------------------------------.
FOR USE IN AUDIT OFFICE

Dy.Chief Executive
Zilla Praja Parishad,

FORM-40A
(See instruction 41(i) to (111) under treasury rule 17)
BILL FOR WITHDRAWAL FROM GENERAL AND OTHER PROVIDENT FUNDS
ANNEXURE
DISTRICT:----------------------SUB-ACCOUNT NO-------------------------------------------------VOUCHER NO
-----------------------------------PF------------------------------20
STATE PROVIDENT FUND------------------------------------PROVIDENT FUND
-----------------------------------OF
BRANCH
Bill
for
withdrawing
-----------------------------------------------------------------------------------------------------------Withdrawals from the zilla praja parishad provident fund. ------------------------of------------------------------For the month of ---------------------------------------------------in the office of----------------------------------------------------------------------------------------------------------------------

1.Name and designation of the subscriber

2.Z.P.P.F.No.

3.Pay

4.No.&Date of sanction of Letter of

Authority
5.Nature withdrawn

1.Advance
2.Partfinal
3.Final
6.Acquittance

1.certified that I have satisfy my self sums included in bills (form 40-A)drawn one month/two three
month previous to this datein faviour of member accounts No-------------with theexception of these
detailed (of which the total have been refunded by deduction in this form) have been disbursed to thr
proper persons and that acquittance have taken and filed in my office with receipt stamps duly
cancelled for every payment.
2.certified that the balance in the funds at the credite of the date of withdrawn covers the sum in this
bill.
3.certified that the amount asked form the bill as required to meet the yearly premium due on in
respect of policy No----------------------------with the company limited-------------------in policy/policies
in questions has been assigned to the Government of A.P and in the custody of the ZPP for the
details,of the policy/policies proposed to be taken has been communicated to and accepted by the zilla
parishad.in his letter No--------------------,Date----------------------4.certified that in respect of withdrawals made in bills(form-10A)onemonth/twomonth/three months/
dates towards a payment of insurance premium the original premium receipt have been within
onemonth of the date of withdrawals forwarded to the ZPP,--------------------------------with the
exception of those----------for the scrutiny and the necessary and endorsements have been made on the
receipt to that effect that the abetment of incometax is admissioble.
5.certified that the member of policies from the GPF Dues not exceed fours the number of policies
financed from the GPF exceeded four as these were accepted prior to
1998--------------------------------------------------------------------------------------------------------------------------------------------------------------

Station:
Date:
signature of the D.D.O with seal

7.Remarks
Particulars of Amount Refunded:S.No.
Name of the
subscriber&Designation

ZPPF Account
No.

Date of
Drawal

Particulars of
amount
Drawn

Amount Now
Refund Rs.

Dy.Chief Executive Officer,

Zillz praja parishad,------------------------Passed

for

Rs.-------------------------------------------------(in words

rupees-------------------------------------------------------------------------------------------- only) and

the

same

pay

to

------------------------------------------------------------------------------------------------------------------------------------------------------------By way of cheque/D.D./On-line adjustment to the individuals saving Bank Account

No.----------------------------------------------------------- at State Bank of India,------------------------------------------Branch.
//ACCOUNT VERIFIED//
Accounts officer,
Officer,
Zilla Praja Parishad,---------------------------------.
---------------------------------------------------.
FOR USE IN AUDIT OFFICE

Dy.Chief Executive
Zilla Praja Parishad,