GPF – Revision of application for the final payment of G.P.F. balance

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GPF – Revision of application for the final payment of G.P.F. balance –
Amendment – orders issued.

G.O.Ms.No.113 Dated:09.09.2016

Read the following:-
1) G.O.Ms.No.261 Finance & Planning (FW.Pen.II) Dept.Dated.28-8-1989.
2) Letter No.T.S.H2/4860/2015 dated. 24-11-2015 received
from the DTA Telangana Hyderabad.
3) Letter No. FM/GL.II/9-3/2016-17/14 dated.28-07-2016
received from the AG (A&E) Telangana and Andhra Pradesh Hyderabad.


              In the G.O. 1st read above Government have issued orders for
revision of Form of Application for Final Payment of General Provident
Fund balances. In the reference 2nd read above, the DTA Telangana
Hyderabad has requested to make mandatory the nominee’s name on
final authorization of GPF to avoid inconvenience, hardship and ensure
timely payment of final authorization of GPF amount to the families of
deceased subscribers, in the event of death of the subscriber before
receiving GPF final withdrawal amount.

2. In the reference 3rd read above the AG has proposed the change in
the form of application for final payment of General Provident Fund
Balances as revised in the reference first read above.

3 Government after careful examination of the proposals have decided
to revise the form of application for final payment of General Provident
Fund as suggested by the AG. The revised form is annexed to this G.O.

4. The existing practice of sending of 3 sets of Form of application for
Final Payment of GPF shall be discontinued and two sets of applications
shall be sent to AG for processing of final payment from the GPF.



Form of Application for Final Payment of
General Provident Fund Balance
[Retirement/Compulsory Retirement /Voluntary Retirement /Resignation//Dismissal
/Removal/Invalidation/ Transfer of Balance or Death Case etc.]

                                TO BE FILLED IN BY THE APPLICANT
The Accountant General (A&E),
Andhra Pradesh & Telangana Hyderabad.

(Through the Head of office in case of Non-Gazetted and Through Head of the
department in case of Gazetted officers)

I. (i) Name of the Subscriber (in capital letters) :
        Emp ID. (7 digit)
   (ii) Personal Mobile No :
  (iii) Mail id :
  (iv) Aaadhar Card No. :
  (v) Bank Account Details :
(a) Account Number
(b) Name of the Bank
(c) Branch
  (d) IFSC Code
2 Date of Birth :
3. Designation and office to which attached :
4. G.P.F. Account No. With Departmental Suffix :
5. Details of Nomination (As per Rule 7 & appendix-R)

 I hereby nominate the person mentioned below, who is a member of my family as
defined in Rule 2 of the General Provident Fund (Telangana) Rules to receive the amount that
may stand to my credit in the Fund, in the event of my death before that amount has become
payable or having become payable, has not been paid:-

Name and address    Relationship     Age    Contingencies on         Name, address and
Of nominee      with                the happening of relationship of the
              Subscriber              which the nomination person, if any, to
                              shall become invalid        whom the right of
                                          the nominee shall
                                          pass in the event of
                                          his predeceasing the

Dated this day of 20 at

Signature of subscriber.

Two witnesses to signature-



6. Residential address of the claimant : Present Address:

Permanent Address:

7. Copy of the latest Account slip is enclosed: YES/NO

8. i) Date of Retirement : or
ii) Date of resignation :or
iii) Date of voluntary Retirement :or
iv) Date of dismissal/removal/Compulsory retirement/invalidation

9. Particulars of offices worked during the Last 3 years


Name of Office & Address Working during the period Designation

From To

10. Office/Treasury at which payment is desired:

10 (A). If payment is desired outside the place of last duty enclose the following

a) Personal marks of identification
b)Two specimen signatures
c) Left/Right hand thumbimpression (in case of illiterate claimants)


i) I have not resigned from Government Service to take up appointment in
another department of State Government/ Central Government or under a
Body Corporate owned or controlled by the state or Central Government.

Note: This certificate is to be furnished only by a subscriber who resigned from
Government service. If resigned to take up appointment elsewhere, the
information regarding transfer of balance may be given in the form prescribed in
the Annexure.

ii) I hereby undertake that no appeal shall be preferred by me against my
dismissal/removal/compulsory retirement/invalidation)

I hereby undertake to refund any excess payment arising out of clerical error in
the settlement of G.P.F. Claim.

12. In case of death the following particulars may be furnished.
a) Date of death (Copy of death certificate to be enclosed).
b) Religion of Deceased Government servant.
c) Details of the surviving members of the family on the date of death of
the subscriber are furnished below (copy of Family MembersCertificate issued
by Revenue Department)

SI.No  Name Relationship Date of birth Marital Status as on the
       with                 Date of death of the
       subscriber                  subscriber

Place: Signature of the
           Subscriber/ Claimant


The final withdrawal application is forwarded to the Accountant General, AndhraPradesh,
and Telangana Hyderabad, for authorizing the balance.

13. Certified that all the particulars furnished above have been verified with reference to
office records and are found correct.

14. The last fund deduction was made from his/her pay for the month of
Vide thisOffice……………………………………………………Bill No…….. Dt……………………….
forRs………………………… (Rupees) cash voucherNo…………………………. of Treasury, the
amount of deduction towards G.P.FSubscription being Rs……………………… and recovery on
amount of refund of advanceRs…………………………

15. Details of G.P.F. Deduction made from the subscriber's salary during the last 12
months immediately preceding the date of retirement (in the proforma appended to
G.O.Ms. No. 216. Dated. 04-06-1986.

16. Certified that he/she was neither sanctioned any temporary advances nor
any part-final withdrawal from his/her provident fund account during the 12
months immediately preceding the date of his/her quitting service/proceeding on
leave preparatory to retirement or thereafter.
17. Certified that the following temporary advance part-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/proceeding on leave preparatory to retirement or thereafter.
Amount of Advance/ Date Voucher No.
Part-final withdrawal


Yours faithfully,

With date and Designation
Date: Official Mobile /Phone No.



In case of absorption in other Departments other state Government/Public/sector
under takings Furnish the following information.

I. Date of absorption.

II. Is absorption on permanent basis?

III. Is absorption without breaks in service?

IV. In case of break in service whether it is
limited to joining time allowed on transfer?

V. Is the absorption with the approval of
State Government?

VI. Accounts Officer to whom the balance
has to be transferred and the new
G.P.F. Account No. allotted by him.


For GPF Subscribers (Accounts maintained by A.G.Office): How to fill GPF (final
payment) details.

GPF final withdrawal details can be filled only after furnishing
particulars for pension. (A.G.authorized or State Audit authorized).

Ensure that subscriber particulars (compulsory) are furnished against relevant fields
a) Employee I.D. assigned by Treasury.
b) Name of the subscriber in full as per the service register.
c) Father's name or Husbands name in case of a female employee as per records.
d) Religion of the employee as per records.
e) Date of birth as recorded in service register.
f) Designation & office where the subscriber worked/ working.
g) Date of retirement (superannuation/voluntary retirement/compulsory retirement) or
invalidation or resignation or removal/dismissal from service.
h) Date of death (In case of death of the subscriber) Copy of death certificate to be
enclosed to the F.W. application.
i) Name of the claimant in case of death of the subscriber. (Should be the nominee or
eligible family member as per the definition under Rule.2 of GPF Rules).
j) Personal mobile number of the subscriber/claimant. (If exists).
k) Land line phone number with STD code. (If exists).
l) Personal e-mail I.D. of the subscriber/claimant.
m) Address for communication in full including Door No & street (essential for urban
areas) and PIN code.
n) Address after retirement.

Now fill up GPF details for final payment:

o) Select the correct Suffix (appearing in the GPF account statement) from the list and
enter in the appropriate field provided.
p) Enter GPF Account Number as mentioned in the GPF account statement. (Enclose
copy of latest available statement to the F. W. application).
q) Furnish details of office from which retired/last worked.
r) Furnish last fund deduction details including details of STO/DTO/PAO
s) Furnish (compulsory) particulars of GPF withdrawals (TA/PFW) during last 12
(Certificate or Nil statement counter signed by the GPF loan sanctioning authority is
must in the F.W. application)
t) Furnish particulars of employment during last 3 years of service.
u) Furnish list of Family members along with age as on DOD of the subscriber,
relationship and marital status.

In death cases: This list should contain all family members including predeceased,
along with dates of death of the pre-deceased. However. GPF shares are to be
claimed / recommended only to the eligible family members. Forwarding authorities
should not recommend GPF' shares to ineligible family members like major sons,
married daughters along with other eligible family members and at the same time,
should not eliminate any eligible family member like parents and minor children of
the subscriber. Guardian in respect of minor children where ever natural guardian is
not there should be appointed by the DDO. Date of marriage in case of second or
subsequent marriage should be furnished. Mentioning about first wife (whether not
alive or divorced) is a must in these cases. Guidelines under Rule 2 and 30 of GPF:
Rules should be followed for determining eligibility.

Special attention to be given by DDOs in respect of cases involving judicial
orders and they should be forwarded with specific remarks to avoid needless
correspondence. Attested copies of all relevant documents should be enclosed to
the F.W. application.

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