APPENDIX-12 Government of West Bengal Office of the ........................................ Order No. ................

ORDER In terms of the provisions of Rule 15A &15B of the General Provident Fund Rules (West Bengal) sanction is hereby accorded for a non-refundable withdrawal of Rs. ...................... (Rupees ...................................................................................................................... .....) only to Sri/Smt. .............................................................. out of credit in his/her General Provident fund Account No. ......................................... for meeting the expenses for ........................................ subject to the following conditions:a) That the subscriber shall furnish a declaration to the effect that the money has been utilised for the purpose for which it has been withdrawn within 3 (three) months from the drawal of the same; That his failure to do so, the whole of the sum so withdrawn or so much thereof as has not been applied for the purpose for which it was withdrawn, shall forthwith be repaid in one lump sum together with interest thereon at the rate specified under Rule 11 of the said Rules by the subscriber to the fund; Further that in default of payment, referred to above, the undersigned shall recover from the emoluments of the subscriber in a lump sum or alternatively in such number of monthly instalments, as may be determined by the appropriate authority. Certified that the subscriber has completed more than 20 years service under the State Govt. he has only 10 years of service left and will not retire from Govt. Service on superannuation within the period of six months. Certified that amount sanctioned hereby does not exceed 3/4ths of the balance at his/her credit in the fund which stood at Rs. ......................... an on; Sri.Smt. ............................................................................. was last sanctioned a part final withdrawal for an amount of Rs. ................................... vide this Office memo. No. ............................... dated ................................ was not granted any non-refundable withdrawal previously for which he/she has furnished utilisation certificate. The Accountant General, West Bengal (A&E), West Bengal is being requested to note sanction of the aforesaid withdrawal in the ledger Account of the subscriber and to intimate the action taken to this Directorate in due course. The charge is debitable to the head 8009-State Provident Fund-01-Civil-101-G.P.F. (Designation of D.D.O.) to draw & disburse the amount to Sri/Smt. .............................. ..................... .

Dated.

b)

c)

2.

3. 4.

5.

6. 7.

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8. The Pay & Accounts Officer Calcutta/The Treasury Officer, .......................................... & the Accountant General, West Bengal are being informed accordingly. (Designation of Sanctioning Authority)

Memo. Copy forwarded for information and necessary action to: 1. 2. 3. 4. 5. 6. The Accountant General (A&E), West Bengal, G.I. Press Buildings, 8, No. Kiron Sankar Roy Road, Kolkata-1 The Pr. Accountant General(Audit), W.B. Treasury Buildings, Kolkata-1 The Accountant General, (RW &LBA)), WB. 3rd MSO Buildings, 5th floor, A Wing, DF Block, Salt Lake, Kolkata-700064 The Pay & Accounts Officer, Pay & Accounts Office, Kolkata-1 Treasury Officer ............................................ Treasury Shri/Smt. .........................................................................

(Designation of Sanctioning Authority)