P.O. S.B. Manual Vol. III - India Post

OfficerOfficerN.B. This counterfoil maybe scored out bysubscribers not utilizing theservices of an agent.75FORM – C[See sub-paragraph (1) and (3) of paragra ph 9]Application Form for withdrawal under thePublic Provident Fund Scheme, 1968]ToThe Agent/Manager,State Bank of……………………………………………….I wish to withdraw from Public Provident Fund Account No………………. a sum ofRs………………(Rupees……………………………….). A period of………..years has expiredfrom the end of the year in which the initial subscription was made.1A. I have not made any withdrawal in the current year.*2. Certified that the amount sought to be withdrawn is required for the useof………………..who is alive and is still a minor.3. The Passbook is enclosed.Date………………Signature or thumb impression ofSubscriber/guardian*Score out whichever is not applicableTO BE USED BY THE ACCOUNTS OFFICEAccount No……………………………..Date of initial subscription…………………………………Amount available in the Public Provident Fund Account………………………………..Date on which last withdrawal was allowed………………………………………………..Amount available for withdrawal in accordance with para 9 (1)/9(3) of thescheme………………………….Withdrawal of sum of Rs………………………………………..sanctioned.DateSignature of Accounts OfficerReceived sum of Rs…………………………..(Rupees………………………………….) byway of withdrawal from Provident Fund Account No………………………………….No……………………..Date…………………..Signature or thumb impression of