APPENDIX
(Reverse of the Form)
Office of the ______________________________________________________ Name of Fund
_________________________________________________________________
STATEMENT OF THE PARTICULARS FOR ALLOTENT OF PROVIDENT Please read carefully the instructions printed
FUND ACCOUNT NUMBERS TO COMPULSORY SUBSCRIBER FOR on the reverse before filling in the form
THE MONTH OF _____________________________________________
Head of account to which pay and allowances are debited: _______________________________________________________________________________
Sr. Name of Name of Date of Date of Designation. Emolum Monthly Month from Mobile E-mail Remarks To be filled in
No. Govt. Servant Subscriber’s Birth of Joining ents rate of which number of ID of by Accountant
(Subscriber) father/ Subscriber Service. subscriptio subscription subscriber subscriber General’s
with HRMS husband n (in whole to for receiving office
commence
employee ID rupee). SMS alerts Account No.
Allotted.
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13)
________________
Signature of the applicant
No. __________________________________________ dated _______________ No. _____________________________________ dated _____________
forwarded in duplicate to the Accountant General for necessary action. The Returned to ________________________________________________
Government servant whose name is included in the statement is required to Account No. allotted may be intimated to the subscriber and also noted
join the ____________Fund under the ___________Rules of Govt. of__________. in the Service Book, nomination and other office records in all
Their names have not been included in the previous statement and they are not correspondence connected with Provident Fund of the subscribers, the
already members of any provident Fund (Nomination of G.O’s is enclosed as account No. should be quoted. Receipt of nomination in respect of G.O’s
mentioned in the remarks column). at Sl. Nos. _____________ hereby acknowledged.
(Head of Office) Accounts Officer,
Office of the Accountant General
