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Form 3A

This document contains a form for claiming provident fund amounts on behalf of minor/lunatic nominees or legal heirs. [SECTION 1] It requests particulars such as name, sex, religion, and relationship to the deceased member. [SECTION 2] It asks for the claimant's full postal address and mode of remittance whether by postal money order or bank account. [SECTION 3] The claimant must certify that the particulars are true, that the minor/lunatic is being supported by the claimant, and the money will be used for the minor/lunatic's benefits.

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29 views

Form 3A

This document contains a form for claiming provident fund amounts on behalf of minor/lunatic nominees or legal heirs. [SECTION 1] It requests particulars such as name, sex, religion, and relationship to the deceased member. [SECTION 2] It asks for the claimant's full postal address and mode of remittance whether by postal money order or bank account. [SECTION 3] The claimant must certify that the particulars are true, that the minor/lunatic is being supported by the claimant, and the money will be used for the minor/lunatic's benefits.

Uploaded by

Hillyarea
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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FORM 3A

3A. PARTICULARS OF THE MINOR/LUNATIC NOMINEE(S) LEGAL HEIR(S) FAMILY MEMBER(S) ON WHOSE BEHALF THE PROVIDENT FUND AMOUNT IS CLAIMED. S.No Name Sex Religion Relationship with the guardian

with the deceased member (1) (2) (3) (4)

Delete, if not applicable Shri/Smt S/o, W/o, H/o,

4 Claimants full postal address : . (in Block Letters) D/o.

. . PIN: 5. MODE OF REMITTANCE a. by postal money order at my cost OR (b) By account payee cheque sent : No direct for credit to my S B Account (Scheduled Bank /P.O) under intimation to me (Advance . Stamped receipt furnished below) : Put a tick in the Box against the one opted: ( ) to the address given in item No4 ( ) S B Account Bank Branch Full Address of of the Bank

CERTIFICATE: To the best of my knowledge no posthumous child will be born to deceased member. I certify that the particualrs given above are true to the best of my knowledge. I certify that the minor(s)/Lunatic Shri/Smt . is living with me and is being supported and looked after by my self and the Provident Fund money claimed on behalf of minor/lunatic will be spent in his/her best interests and benefits. I certify that the minor member has not been employed in any Factory/Establishment to which the Act applies for a continuous period of not less than 2 months immediately preceding the date of this application. Encl: Date Delete, if not applicable Signature or Left/Right hand thumb impression of the claimant

ADVANCE STAMPED RECEIPT (To be furnished in case of 5 (b) above) Received a sum of Rs* ................................................................................. (Rupees............... .................................................................................) from the Regional Provident Fund Commissioner/Officer incharge of Sub-Regional office .............................. by deposit in my savings Bank Account towards the settlement of Provident Funds, account of Shri/Smt ......................................................... *The space should be left blank which shall be filled in by Regional Provident Fund Commissioner/Officer-in-charge of Sub regional Office claimant
Affix Re.1.00 Revenue Stamp

Signature or Left/Right hand Thumb impression of the

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