CCS HAU - GPF Final Payment Application Form

📋 GPF Final Payment: This form is used for final withdrawal of GPF balance on retirement, death, or quitting service. Fill all required details carefully.

👤 Personal Information

Name of Subscriber *

Father's/Husband's Name *

Date of Birth *

Sex

Marital Status

Aadhaar Number *

PAN Number

Mobile Number *

Permanent Address *

Address for Correspondence (After Retirement)

💼 Service Details

Designation *

Department *

Office/College *

Date of Joining Service *

Date of Retirement/Leaving Service *

Reason for Final Payment *

Last Basic Pay Drawn

Pay Scale

💰 GPF Account Details

GPF Account Number *

Date of Opening GPF Account

GPF Balance as on Date (Rs.)

Balance as per Last Annual Statement (Rs.)

Year of Last Annual Statement

📊 GPF Deductions & Advances

Any Outstanding GPF Advance (Rs.)

Insurance Premium Deducted (if any)

Any Other Deduction (Rs.)

Total Deductions (Auto)

Net Amount Payable (Auto)

📝 Previous GPF Withdrawals

Any Previous Part Final Withdrawal?

Amount of Previous Withdrawal (if any)

Date of Previous Withdrawal

Purpose of Previous Withdrawal

👨‍👩‍👧 Nomination Details (Form - Nomination)

Note: Nomination is required for payment of GPF balance in case of death of subscriber. Enter details of all nominees.

👤 Nominee 1 (Primary)

Nominee 1 Name *

Relationship with Subscriber

Date of Birth

Share Percentage (%)

Aadhaar Number

Address

👤 Nominee 2 (Optional)

Nominee 2 Name

Relationship

Date of Birth

Share Percentage (%)

Aadhaar Number

Address

👤 Nominee 3 (Optional)

Nominee 3 Name

Relationship

Date of Birth

Share Percentage (%)

🏦 Bank Account Details for GPF Payment

Bank Name *

Branch Name *

Branch Address

IFSC Code *

Account Number *

Account Type

Account Holder Name

📋 Documents & Declarations

Required Documents:

GPF Pass Book (Original)
Last Pay Certificate
No Dues Certificate
Copy of Retirement Order
Bank Passbook/Cancelled Cheque
Aadhaar Card Copy
PAN Card Copy

✍️ Declaration

Declaration Text

Place

Date of Application

🏢 Office Use Section

Verified By (Name)

Verified By Designation

HOD Name

HOD Designation

Comptroller Name

🏛️ CCS HARYANA AGRICULTURAL UNIVERSITY, HISAR

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