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SREE CHITRA TIRUNAL INSTITUTE OF MEDICAL SCIENCES & TECHNOLOGYTHIRUVANANTHAPURAMAPPLICATION FOR ADVANCE FROM G P FDepartment Phone No:1.Name of Subscriber2.E Code Designation3.Basic Pay Rs.4.Advance out standing as on Rs.5.Advance requestedRs.6.Purpose of Advancea. If for consumables, item name & costb. If for House building:i) Location & measurement of plotii)Whether on free hold or lease holdiii) Whether plan enclosediv) If it is purchased from society,hosing board etc.details of samev) Cost of constructionc. If advance is required for education of childreni) Name of son/daughterii) Class & Institution/collegewhere studyingiii) Details of expensesa) For payment of feeb) Hostel chargesc) Other expenses(Details tobe given)d. For treatment of family membersi) Name of patientii) Relationshipiii) Name of Hospital/Doctoriv) Details of expensesa) For medicalb) Other charges (details)

7. Advance requested8. Instalments for repayment9. If an advance already out standing pecuniary circumstances of subscriber, requiring furtheradvance from PF.I certify that particulars given above are correct & complete to best of my knowledgeand belief and nothing has been concealed by me.NameSignature of the ApplicantDate:EcodeRecommendation of PF Section for special approvel.Since an advance taken earlier is still outstanding, further advance requires specialapprovel of sanctioning authority. Special request of applicant may be considered forfurther advance.PF SectionFA / CAOSpecially approved / Not approvedDeputy DirectorLoan sanctioned: Rs.Instalment Amount:Rs.No. of Instalments: