REVISED FORM OF APPLICATION FOR SANCTION OF LOANFROM THE ANDHRA PRADESH EMPLOYEES WELFARE FUND.

* * *ToThe Member Secretary-cum-Treasurer & District Treasury Officer,A.P. Employees Welfare Fund,District Level Committee,Nellore District.

1. Name of the Applicant :

2. If dependent of deceased Govt. Servant

:

3. Father / Husband’s Name :

4. Permanent Addresses :

5. Post held :

a) Department Office :

b) Date of entry into service :

c) Bill No. / Cheque No. Date and Month of latest recovery of initial subscription / Challan No. and date

:

6. Scale of Pay and Allowances per month

:

7. Date of retirement :

8. Amount of loan and purpose for which the loan sought for (Documentary proof to be enclosed).

:

9. Whether eligible for similar loan from the Government

:

:: 2 ::

10. If, so whether he was sanctioned the loan or not.

:

11. Period within which he wishes to repay if it is loan.

:

12. If any balance loan sanctioned earlier.

:

13. I hereby authorized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Drawing Officer) to recover the installment of loan with interest from my salary through acquaintance and remit to the Member Secretary-cum-Treasurer till the entire loan is repaid at my cost.

SIGNATURE OF APPLICANT.

14. Remarks of forwarding and Drawing

:

a) Recommended / Not Recommended

:

b) The applicant is a member of A.P. Employees Welfare Fund.

:

c) The Contents of applicant are correct

:

15. I under take to recover the installments of the loan as advised by the committee through acquaintance and send the amount to the Member Secretary-cum-Treasurer, Andhra Pradesh Employees Welfare Fund till the entire loan with interest is repaid. In case of the Transfer or Retirement of applicant the balance outstanding will be noted in the Last Pay Certificate.

16. Designation of the Drawing Officer and his address to whom recovery statement should be sent.

SIGNATURE OF THE DRAWING OFFICER.