Form 31

eksckby [email protected] Mobile Number
dsoy dk;kZy; esa iz;ksx ds fy;[email protected] For Office use only
nkok la[;[email protected] I.D ……………………………
deZpkjh Hkfo’; fuf/k ;kstuk] 1952
EMPLOYEES’ PROVIDENT FUND SCHEME, 1952
QkeZ la[;k&31/FORM NO-31
fuf/k ls vfxze gsrq izkFkZuk i= /Application for Advance From the Fund
(d`i;k vuqns”k ns[ks)a (Refer: INSTRUCTIONS)
vfxze ysus dk iz;kstu++ Purpose for which
visf{kr vfxze /ku jkf”k Amount of Advance
advance is required
required ₹………....................................
………………………………………
“kCnksa esa In words …………………………
………………………...…………………
12-
3-
456-
lnL; dk uke ¼Li’V v{kjksa esa½
Name of the member (in block letters)
[email protected] dk uke ¼fookfgr efgykvksa ds ekeys
esa½
Father’s/ husband’s Name in the case
of married women
QSDVª[email protected] dk uke o irk ftlesa lnL;
कार्यरत है @Name and Address of the
Factory /Establishment in which the
member is employed.
Hkfo’; fuf/k [kkrk [email protected] Fund
Account No.
ekfld ewy osru rFkk eagxkbZ HkÙkk
ewy
+eagxkbZ HkÙkk
= ;ksx
Monthly Basic Wages & D.A
Basic
+ D.A.
= Total
i= O;ogkj dk iwjk irk
[email protected]@[email protected]/Smt./Kumari.......................
Full postal address (in block letters)
................................................................................
[email protected]@[email protected]/o/W/o/D/o...............................
................................................................................
................................................................................
.............................. fiu dksM /Pin No. …………….
lnL; ds gLrk{[email protected] of applicant
Form 31 (www.epfindia.gov.in)
fu;ksDrk ds gLrk{[email protected] of Employer
Page 1 of 4
7- Hkqxrku dh fof/[email protected] Mode of Remittance
¼d½ ,tsUlh ds ek/;e ds [email protected]@[email protected] [kjhnus @fuekZ.k gsrq ;k edku _.k okfil djus ds fy,
(a) In case of Advance for purpose of Site/House/Flat or Construction through an
“Agency” ‘or’ Repayment of housing loan, indicate
¼1½ crkb, psd fdl i{k esa gksuk pfg, in whose favour the cheque is to be drawn, and
…………………………………………………………………………………
¼2½ iwjk irk Full Address
...............................................................................................................................................
nwljs ekeyksa esa fuEufyf[kr esa ls fdlh ,d ij dks’Vd esa fVd yxkdj
In other Cases put a tick  against any one of the following:¼[k ½ eq>s lwfpr djrs gq, esjs cpr [kkrk la-¼vuqlwfpr [email protected]?kj½ esa js[kfdar [email protected] bysDVªkWfud ek/;e
ls vknkrk [kkrk lh/ks Hkstk tk,@ (b) By account payees cheque/ electronic mode sent
Directly for credit to my S.B. A/C (Scheduled Bank /P.O.) Under intimation to me
cpr cSad [kkrk [email protected] S.B Account no…………………………………
CkSad dk [email protected] Name of the Bank ……………………………………
“kk[[email protected] Branch ………………………………………………………
vkbZ-,Q-,l- dksM @ IFS Code………………………………………..
“kk[kk dk iwjk [email protected] Full Address of the Branch………………………
(vius cSad [kkrs ds [[email protected]Ì pSd dh ,d izfr layXu djsa Please attach a copy of cancelled/blank
Cheque)
¼x½ esjs [kpZ ij euhvkMZj }kjk enn l[;k&6 esa fn, x, irs ij
(c)*By money order at my cost (To the Address given Sl.6)
;fn jkf”k nks gtkj :Ik;s ls de gks
If the amount is less than Rs 2000/-
eSa ?kksf’kr djrk gwa fd vfxze eq>s LO;a ds [email protected][email protected]@cgu dh “kknh ds fy, visf{kr gSaA I declare that
advance is required to meet the expenses in Connection with my marriage/marriage of
my Son/Daughter/Brother/Sister.#
¼uke) [email protected] (Name) Sh. / Kumari …………………………………………………....
mez Aged ……………… “kknh dh frfFk marriage on (date)……………………….. ………
irk at address ……………………………………...................………............................
………………. . …............……………………………………………………………..)
#;fn visf{kr vfxze “kknh ds fy, u gks rks dkV nsa Delete if the Advance applied if not for marriage.
lnL; ds gLrk{kj vFkok nk;[email protected]
a cka;
a gkFk ds vaxBw s dk fu”kku
Signature/Left/Right thumb impression of the member
lnL; ds gLrk{[email protected] of applicant
Form 31 (www.epfindia.gov.in)
fu;ksDrk ds gLrk{[email protected] of Employer
Page 2 of 4
vfxze izkfIr jlhn ADVANCE STAMPED RECEIPT
dsoy mijksDr 7 ¼d½ ;k ¼[k½ dh n”kk esa With reference to 7(a) or (b) only]
vius Hkfo’; fuf/k [kkrs ds vfxze ij {ks=h; fuf/k vk;qDr @izHkkjh mi{ks=h; dk;kZy;
…………………………ls ₹………………………………………… :i;s “kCnkas esa
…………………………………………………….. izkIr gq,A
#Received a sum of ₹ ……………. ( ……………………………….) from Regional
Provident Fund Commissioner/ Officer in-charge of Sub Regional Office. Employees
Provident Fund Account maintained by him.
{ks=h; Hkfo’; fuf/k vk;[email protected]
mi{ks=h; dk;kZy; }kjk Hkjus ds
fy, NksM+k tk;s
The space should be left
blank which shall be filled
in by Regional Provident
Fund
Commissioner,
Office-incharge of SubRegional Office.
₹ 1 jktLo fVdV
₹ 1 Revenue
Stamp
lnL; ds gLrk{kj ;k ck,[email protected],a gkFk ds vaxBw s dk fu”kku
Signature or Left/Right hand thumb impression of the member
¼fu;ksDrk }kjk Hkjus ds fy,½
(TO BE FURNISHED BY THE EMPLOYER)
[email protected] ds [email protected] ds nkSjku fdlh jktif=r vf/kdkjh ;k eq[; dk;[email protected]; izkf/kdkjh
ds v/;{k ;k laln lnL; fo/kku lHkk lnL;@dsUnzh; U;klh [email protected]{ks=h; lfefr ds lnL; dEkZpkjh Hkfo’;
fuf/kA (During Closure/Lock out of the factory/establishment by any Gazetted Officer or
the Chief Executive/Head of Local authority of M.P. or M.L.A. or member of
C.B.T/Regional Committee E.P.F.)
izekf.kr fd;k tkrk gS fd lnL; us esjh mifLFkfr esa i<+us esjs }kjk le>kus ds mijkUr izkFkZuki= ij gLrk{kj
fd, gSa vkSj izkFkZuki= esas mfYyf[kr tkudkjh lgh gS visf{kr izek.ki= layXu gSaA
Certified that the application has been signed by the member in my presence after He/She
had read the Contents/the contents have been explained to him/her by me and that the
information given in the application is correct. Required Certificate (s) is/are enclosed.
[email protected] Date
[email protected]/kdkjh dk inuke
eksgj lfgr
Designation of the Signing Official with
stamp of the Factory/Establishment
QSDVjh LFkkiuk ds fu;ksDrk ;k izkf/kd`r vf/kdkjh ds gLrk{kj
Signature of the Employer or an Authorised Official of the Factory/Establishment
[email protected] ...……………
Form 31 (www.epfindia.gov.in)
Page 3 of 4
Hkfo’; fuf/k vk;qDr dk;kZY; ds iz;ksx ds fy,
FOR USE IN PROVIDENT FUND COMMISSIONER’S OFFICE
vuqHkkx Section................................... [kkrk la[;k Account No…..................................
iSjk 68 ds v/khu izkf/kd`r vfxze dh vnk;xh gsrq
AUTHORITY FOR PAYMENT OF ADVANCE UNDER PARA-68
:i;s ds v/khu Under Rs………………………………………………
:i;s ds Hkqxrku ds fy, ikl fd;k Passed for payment for ₹………………………..
“kCnksa esa In words………………………………………...........................................
Hkqxrku dh fof/k Mode of Remittance lanHkZ dze la[;k& Refer Sl.No.7 ( )
euhvkMZj deh”ku ¼;fn dksbZ gks½ M.O. Commission (if any): ₹…………………….
Hkqxrku dh tkus okyh fuoy jkf”k Net amount to be paid by M.O. ₹……………….
lk-lq-lSSA
vuq- i;Z
SS
Hkqxrku en la[;k P.I.No.
ys[kk vf/kdkjh
Accounts Officer
Ldzksy ua- Scroll No.
¼jksdM+ vuqHkkx ds iz;ksx ds fy,½
(FOR USE IN CASH SECTION)
pSd la[;k
Cheque no………………………….. fnukad Date……........................
jksdM+ cgh cSad [kkrk la[;k&3 en uke la[;k }kjk fn;k x;k
Vide Cash book (Bank) Account No-3 Debit item
No…………..............................................................…………………
lk-lq-lSSA
vuq- i;Z
SS
[email protected]{ks-vk
A.C./R.C.
vfHk;qfDr;k¡@REMARKS
Form 31 (www.epfindia.gov.in)
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