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Form 425 C

uttar pradesh power sector trust form c

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rajpoot.rohit865
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19 views

Form 425 C

uttar pradesh power sector trust form c

Uploaded by

rajpoot.rohit865
Copyright
© © All Rights Reserved
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 - 425 (C)

FORM OF APPLICATION FOR FINAL PAYMENT OF BALANCES IN THE PROVIDENT FUND


ACCOUNT OF A SUBSCRIBER TO BE USED BY THE NOMINEE OR ANY OTHER
CLAIMANTS WHERE NO NOMINATION SUBSISTS.
To,
The Deputy General Manager,
U. P. POWER CORPORATION Ltd.,
SHAKTI BHAWAN,14-ASHOK MARG,
Lucknow.
Sir,
It is requested that arrangements may kindly be made for the payment of the accumulation in
the EB/ Provident Fund Account of Late
Sri……………………………………The necessary particulars required in this section are
given below.
(1) Name of the Servant -
(2) Date of Birth -
(3) Post held by the Servant -
(4) Proof of death in the form of a death certificate by the Municipal Authorities etc., if available
Enclosed.
(5) Date of Death
(6) Provident fund Account No. EB\ allotted to the subscriber.
(7) Amount of Provident Fund money standing to the credit of the subscriber at the
time of his death, if known.
(8) Details of the nominees alive on the date of death of the subscriber, if a nomination subsists.

Name of the nominee & Relationship with the subscriber, share of the nominee :-
1.
2.
3.
(9) In case the nomination is in favour of a person other than a member of the family, the details
of the family if the subscirber subsequently acquired a family.

Name – Relationship with the subscriber age on the date of death.


1.
2.
3.

(10) In case of nomination subsists, the details of the surviving members of the family on the date
of death of the subscriber. In case of a daughter of a deceased son of the subscriber, married
before the death of the subscriber, it should be stated against her name whether her husband
was alive on the date of death of the subscriber.

Name – Relationship with the subscriber as on the date of death; -


1.
2.
3.

(11) In the case of amount due to a minor child whose mother (widow of the subscriber) is not
Hindu, the claim should be supported by Indemnity bond or Guardianship certificate as the
case may be.
-2-

(12) If the subscriber has left no family and no nomination subsists, the names of persons to whom
the Provident Funds money is payable (to be supported by letters of probate or succession
certificate etc.,)

Name – Relationship with subscriber Address.


1.
2.
3.

(13) Religion of the claimants


(14) The payment is desired through the office of the (through the
Treasury/sub-treasury. In this connection the
following documents (duly attested by a Gazetted Officer in the service/ Magistrate etc.) are
attached.

(i) Personal mark of identification.


(ii) Left / Right hand thumb and finger impressions (in case of illiterate claimants).
(iii) Specimen signatures in duplicate. (in the case literate claimants).

Station :-
Date:
Yours’ faithfully,

(Signature of claimant)
Full name and address.

This applies only when payment is not desired through the Head of Office.
( FOR USE OF HEAD OF OFFICE \ DEPARTMENT)
Forwarded to the Deputy General Manager, U. P. Power Corporation Ltd., Shakti Bhawan,
Lucknow for necessary action
The particulars furnished above have been duly verified.
(2) The provident fund account No EB\ of Late as
verified from the annual statement furnished to him \ her.
(3) He/she died on a death certificate issued by the Municipal authorities has been
produced is not required in this case asz thered is no doubt about his / her death.
(4) The last deduction was made from his / her pay for the month of drawn in this
office bill No. date for Rs. (Rupees
)Cash Voucher No. dated UPSEB the amount of deduction being Rs.
And recovery on account of refund of advance Rs. (5) Certified that he \
she was neiether sanctioned any temporary advance nor any final withwrawal from his \ her Provident fund
account during the 12 months immediately preceeding the date of his \ her death.
Or
Certified that the following temprary advance \ final withdrawal were sanctioned to him \ her
and drawn from his \ her Provident Fund Account during the last 5 years immediately preceeding the date
of his \ her death.
Amount of Advance\ Date and place of Encashment Voucher No.
withdrawal
1.
2.
-3-

6. Certified that no amount was withdrawn \ the following amounts were withdrawn from his \ her
Provident Fund Account during the last 5 years immediately preceding the date on his \ her new
policy.
Policy No. And Name of Company Amount Date
1.
2.
3.
(7) He \ She had not opted for the continued retention of his \ her Provident fund money in terms
of Vitta Vibhag Office Memorandum No. G-2-2445/X-511-1958 dated January 16, 1960.
or
He \ She had opted for the continued retention of his \ her Provident fund money in
terms of Vitta Vibhag Office Memorandum No. G-2-2445/X-511-1958 dated January 16, 1960.and
his \ her option was forwarded vide this office letter No. Dated is attached.
The other particulars required in this connection are given as under:-
i) Date of retirement from Board’s \ Corporations services.
ii) Amount at the credit of the subscriber on the date of retirement.
iii) Account finally withdrawn after retirement, if any
(8) (I) Certified that the application was received in my office on which was with in
six month from the date when the amount become actually payable but the delay in
submission of the application was beyond the control of the applicant.
Or

(II) Certified that the application was received in my office on which was after
six month from the date, when the amount become actually payable but the delay in submission of
the application was beyond the control of the applicant.

Signatures of the head of the office\


Department
Seal of the office

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