Revised GPF Final Payment Application Form-GO.113 dt.09.09.2016

*GO.113 dt.09.09.2016 Revised GPF Final Payment Application Form



GPF – Revision of application for the final payment of G.P.F. balance – Amendment – orders issued.


G.O.Ms.No.113                                                                                                Dated:09.09.2016
Read the following:-

1)  G.O.Ms.No.261 Finance & Planning (FW.Pen.II) Dept. Dated.28-8-1989.

2)  Letter No.T.S.H2/4860/2015 dated. 24-11-2015 received from the DTA Telangana Hyderabad.

3)  Letter No. FM/GL.II/9-3/2016-17/14 dated.28-07-2016 received from the AG (A&E) Telangana and Andhra Pradesh Hyderabad.


In the G.O. 1st read above Government have issued orders for revision of Form of Application for Final Payment of General Provident Fund balances. In the reference 2nd read above, the DTA Telangana Hyderabad has requested to make mandatory the nominee’s name on final authorization of GPF to avoid inconvenience, hardship and ensure timely payment of final authorization of GPF amount to the families of deceased subscribers, in the event of death of the subscriber before receiving GPF final withdrawal amount.

2. In the reference 3rd read above the AG has proposed the change in the form of application for final payment of General Provident Fund Balances as revised in the reference first read above.

3 Government after careful examination of the proposals have decided to revise the form of application for final payment of General Provident Fund as suggested by the AG. The revised form is annexed to this G.O.

4. The existing practice of sending of 3 sets of Form of application for Final Payment of GPF shall be discontinued and two sets of applications shall be sent to AG for processing of final payment from the GPF.


The Accountant General, Telangana, Hyderabad (20 copies).

All the Heads of Departments. All the District Collectors.
All the District Judges.

TheDirectorofTreasuries, Telangana,Hyderabad. The Pay & Accounts Officer, TelanganaHyderabad.
TheDirectorofState Audit,TelanganaHyderabad.

The DirectorofWorksandProjects, Telangana Hyderabad. All the District Treasury Officers.
The Special Chief Secretary to Governor, Telangana, Hyderabad.
The Principal Secretary to the Chief Minister andPrivate Secretaries to all Ministers.
All the Departments of Secretariat.
The Registrar General, High Court of Judicature at Hyderabad for the State of Telangana and the State of Andhra Pradesh.
The Secretary, Telangana Public Service Commission, Hyderabad. The Managing Director, Telangana GENCO/TRANSCO Hyderabad. The V.C. & M.D., Telangana State Road Transport Corporation, Hyderabad.

All District Educational Officers / All Principals of Junior Colleges. All the Chief Executive Officers, ZillaPrajaParishads.
All District Panchayat Officers.
All Secretaries of ZillaGrandhalayaSamasthas through Director of Public Libraries, Hyd.
TheRegistrar,A.P.AdministrativeTribunal,Hyderabad. TheRegistrar,AcharyaJayashankar University,Hyderabad, Dr.B.R. AmbedkarOpen University, Hyderabad, English and Foreign Languages University,Hyderabad,Jawaharlal Nehru Technological University,Hyderabad,KakatiyaUniversity,Warangal,KLUniversity, MaulanaAzad National Urdu University,Hyderabad,Osmania University,Hyderabad,PottiSreeramuluTeluguUniversity, Hyderabad,UniversityofHyderabad,Hyderabad, AndhraPradesh, IndianInstituteofTechnology Hyderabad,Hyderabad,International InstituteofInformation Technology,Hyderabad,ICFAIUniversity, Hyderabad,NALSARUniversityofLaw, Hyderabad,NationalInstituteof Technology, Warangal, Telangana University,Nizamabad, Mahatma Gandhi University,Nalgonda,

TheJointDirector,PensionPaymentOffice,Jambagh,Hyderabad TheF.A.&C.A.O.,N.S.Project,Secretariat Buildings,Hyderabad. The


TheDirectorofAccounts,SriramsagarProject,NizamabadDistrict. AlltheSecretariesofAgriculturalMarketCommitteesthroughDirectorofMarket ing.



TheResidentCommissioner,TelanganaBhavan,AshokaRoad, NewDelhi-110001. ThePay&AccountsOfficer,GovernmentofTelangana, NewDelhi-110001.
The Commissioner, Printing and Stationery, Hyderabad. Copy to SF/SCs.




Form of Application for Final Payment of

General Provident Fund Balance

[Retirement/Compulsory Retirement /Voluntary Retirement /Resignation//Dismissal /Removal/Invalidation/ Transfer of Balance or Death Case etc.]


T o

The Accountant General (A&E),
Andhra Pradesh & Telangana Hyderabad.

(Through the Head of office in case of Non-Gazetted and Through Head of the department in case of Gazetted officers)

I. (i) Name of the Subscriber (in capital letters)

Emp ID. (7 digit)

(ii) Personal Mobile No

(iii) Mail id

(iv) Aaadhar Card No.

(v) Bank Account Details

(a) Account Number

(b) Name of the Bank

(c) Branch

(d) IFSC Code

Date of Birth
Designation and office to which attached
4 .
G.P.F. Account No. With Departmental Suffix

5 . Details of Nomination (As per Rule 7 & appendix -R)


I hereby nominate the person mentioned below, who is a member of my family as defined in Rule 2 of the General Provident Fund (Telangana) Rules to receive the amount that may stand to my credit in the Fund, in the event of my death before that amount has become payable or having become payable, has not been paid:-

Name and address
Contingencies on
Name, address and
Of nominee

the happening of
relationship of the


which the nomina-
person, if any, to

tion shall become  whom the right of

the nominee shall

pass in the event of

his predeceasing the



Dated this                                                day of                                      20         at

Signature of subscriber.

Two witnesses to signature-1)


6. Residential address of the claimant : Present Address:

Permanent Address:

7.   Copy of the latest Account slip is enclosed: YES/NO

8.              i)Date of Retirement : or

ii) Date of resignation :or

iii)        Date of voluntary Retirement :or

iv)        Date of dismissal/removal/Compulsory retirement/invalidation

9.  Particulars of offices worked during the Last 3 years

Name of Office & Address                                Working during the period Designation

From           To

10.         Office/Treasury at which payment is desired:

10 (A). If payment is desired outside the place of last duty enclose the following documents:

a) Personal marks of identification

b) Two specimen signatures

c) Left/Right hand thumbimpression (in case of illiterate claimants)

11.         CERTIFICATES:

i)     I have not resigned from Government Service to take up appointment in another department of State Government/ Central Government or under a Body Corporate owned or controlled by the state or Central Government.

Note: This certificate is to be furnished only by a subscriber who resigned from Government service. If resigned to take up appointment elsewhere, the information regarding transfer of balance may be given in the form prescribed in the Annexure.

ii)     I hereby undertake that no appeal shall be preferred by me against my dismissal/removal/compulsory retirement/invalidation)

I hereby undertake to refund any excess payment arising out of clerical error in the settlement of G.P.F. Claim.

12.         In case of death the following particulars may be furnished.

a)  Date of death (Copy of death certificate to be enclosed).

b)  Religion of Deceased Government servant.
c)   Details of the surviving members of the family on the date of death of the subscriber are furnished below (copy of Family MembersCertificate issued by Revenue Department).

Date of birth
Marital Status as on the


Date of death of the



Signature of the

Subscriber/ Claimant


The final withdrawal application is forwarded to the Accountant General, AndhraPradesh, and Telangana Hyderabad, for authorizing the balance.

13. Certified that all the particulars furnished above have been verified with reference to office records and are found correct.

14. The last fund deduction was made from his/her pay for the month of Vide thisOffice……………………………………………………Bill No…….. Dt………………………. forRs………………………… (Rupees) cash voucherNo…………………………. of Treasury, the amount of deduction towards G.P.FSubscription being Rs……………………… and recovery on amount of refund of advanceRs…………………………

15.         Details of G.P.F. Deduction made from the subscriber's salary during the last 12 months immediately preceding the date of retirement (in the proforma appended to G.O.Ms. No. 216. Dated. 04-06-1986.

16.         Certified that he/she was neither sanctioned any temporary advances nor any part-final withdrawal from his/her provident fund account during the 12 months immediately preceding the date of his/her quitting service/proceeding on leave preparatory to retirement or thereafter.


17. Certified that the following temporary advance part-final withdrawals were sanctioned to him / her and drawn from his / her provident fund account during the 12 months immediately preceding the date of his / her quitting service/proceeding on leave preparatory to retirement or thereafter.


Amount of Advance/                                 Date                                   Voucher No.

Part-final withdrawal





Yours faithfully,

Station:                                                                                                                      SIGNATURE

With date and Designation

Date:                                                                                                             Official Mobile /Phone No.


A N N E X U R E :


In case of absorption in other Departments other state Government/Public/sector under takings Furnish the following information.

I.        Date of absorption.

II.      Is absorption on permanent basis?

III.   Is absorption without breaks in service?

IV.    In case of break in service whether it is limited to joining time allowed on transfer?

V.      Is the absorption with the approval of

State Government?

VI.    Accounts Officer to whom the balance has to be transferred and the new G.P.F. Account No. allotted by him.


For GPF Subscribers (Accounts maintained by A.G.Office): How to fill GPF (final payment) details.

G P F  f i n a l  w i t h d r a w a l  d e t a i l s  c a n  b e  f i l l e d
o n l y  a f t e r  f u r n i s h i n g
p a r t i c u l a r s f o r p e n s i o n . ( A . G . a u t h o r i z e d o r S t a t e
A u d i t a u t h o r i z e d ) .

Ensure that subscriber particulars (compulsory) are furnished against relevant fields viz:

a)  Employee I.D. assigned by Treasury.

b)  Name of the subscriber in full as per the service register.

c)   Father's name or Husbands name in case of a female employee as per records.
d)  Religion of the employee as per records.

e)  Date of birth as recorded in service register.

f)    Designation & office where the subscriber worked/ working.

g)  Date of retirement (superannuation/voluntary retirement/compulsory retirement) or invalidation or resignation or removal/dismissal from service.
h)  Date of death (In case of death of the subscriber) Copy of death certificate to be enclosed to the F.W. application.
i)  Name of the claimant in case of death of the subscriber. (Should be the nominee or eligible family member as per the definition under Rule.2 of GPF Rules).
j)  Personal mobile number of the subscriber/claimant. (If exists).

k)  Land line phone number with STD code. (If exists).

l)  Personal e-mail I.D. of the subscriber/claimant.

m)  Address for communication in full including Door No & street (essential for urban areas) and PIN code.
n)  Address after retirement.

Now fill up GPF details for final payment:

o)  Select the correct Suffix (appearing in the GPF account statement) from the list and enter in the appropriate field provided.

p)   Enter GPF Account Number as mentioned in the GPF account statement. (Enclose copy of latest available statement to the F. W. application).

q)    Furnish details of office from which retired/last worked.

r)   Furnish last fund deduction details including details of STO/DTO/PAO

s)   Furnish (compulsory) particulars of GPF withdrawals (TA/PFW) during last 12 months.

(Certificate or Nil statement counter signed by the GPF loan sanctioning authority is must in the F.W. application)

t)   Furnish particulars of employment during last 3 years of service.

u)  Furnish list of Family members along with age as on DOD of the subscriber, relationship and marital status.

In death cases: This list should contain all family members including predeceased, along with dates of death of the pre-deceased. However. GPF shares are to be claimed / recommended only to the eligible family members. Forwarding authorities should not recommend GPF' shares to ineligible family members like major sons, married daughters along with other eligible family members and at the same time, should not eliminate any eligible family member like parents and minor children of the subscriber. Guardian in respect of minor children where ever natural guardian is not there should be appointed by the DDO. Date of marriage in case of second or subsequent marriage should be furnished. Mentioning about first wife (whether not alive or divorced) is a must in these cases. Guidelines under Rule 2 and 30 of GPF: Rules should be followed for determining eligibility.

Special attention to be given by DDOs in respect of cases involving judicial orders and they should be forwarded with specific remarks to avoid needless correspondence. Attested copies of all relevant documents should be enclosed to the F.W. application.

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