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www.sahayam.in
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DECLARATION
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An advance payment of provident fund balance (in my General Provident Fund Account No. .................................................... having been agreed to be authorized in my favour, I ........................................................................................................................................................ (Name & Designation) hereby declare that I clearly understand that the payment is strictly provisional and is subject to revision after the exact amount of balance of my G. P. F. Account has been decided upon and I undertake that if, upon such revision, any payment of the General Provident Fund balance made to me has been in excess or the amount eventually decided upon, I shall repay all such excess payments by deduction from the D. C. R. G and / or my Family Pension. The particulars of my P. P. Order are given below.
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P. P. O. No.:
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Date of Issue:
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Treasury:
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Amount of Pension:
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Place:
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Date :Signature
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Name and Designation
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Address and Occupation of the Witnesses:
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Signature :
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Signature :
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(Note : - the witnesses should be Govt. Employees in Service)
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