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www.sahayam.in
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ANNEXURE - III
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FORM OF DECLARATION
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Final Payment of the accumulation in my General Provident Fund Account No. ......................................... having been agreed to be authorized in my favour, I ............................................................................................. do hereby declare that I clearly understand that the payment is strictly provisional and is subject to revision when any discrepancy in my General Provident Fund Account is detected at a later stage and I further promise that if upon such revision the provisional payment made to me has been in excess of the amount actually found admissible. I agree to repay the excess payment in lump failing which I agree that the amount may be recovered from me under the provisions of the Revenue Recovery Act for the time being in force.
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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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