ffi ror y+.,/rilq s G to7F / RJ N.*l.R.

(i.(r.t"N.W.R.

"dlfr +gGP4v ..........darou7ftut1 h'iinistry/Denai:tment 'riltut Fiih t'f iill}Jq ril}t d lhq std';q-q', {t-\"il-'ttqt ,: p'rt,$}tbnx'tr' F'l'rNil AppLICM"ION FOR ADIANCE F-[tt]ilt Sl.x{"ll RAiLrl.AY A.J

t(.4...........

'

Nameo1'thcSubscriber 2...r;i,:l

,\eeor,l,i,

4. Ailq s....".... ,. i);r'.tts.

3. C-E;{rtl

.{r({]1

[)c"''$rliiirrJl'

l\o

T.No.

5. 3{ii)
(r) q{ rg............

.......d({ei f+q*"T+* 3r'$3Rgrfr *q

for thc year i 9 Closingbalanccas per statelnent

(ii) cFtr 1r1?rr*-{idt to

Creditfrorrt

Rs. SubscriPtion

'sTFrdqi qlq'{fi.".. o1 (iii) sTDtrr,sTDrT) Refirndof advanceiadvances {.t"J

t,.

rlL,'-. lq"llq).............

" . . " t.{. . ....

.... .. cfi

.il

iie i.; 4) {l?i"i siqiLj;r:'

Tb duringtheperiodl}om Withdrawals (v) .i .rill qoFrT {d qc qRI............... at ctediti{s. Ncf Lraiance ]l i jl ;1,,/;ii .I-.'J$'i qiiti.ft c ilil :* Anrrtrtttt ol' etdvitltcc,'irdvanr€s iJi,iSidilL:;ii! :-

li"ters5IilrQs oJ frg'ry erDI o1 rtRt :Anrorrtrtol'advancetal
(2)......"... 7. {ir) qg olf}rq ?i w-q li.. Rs' required of advance Attrottnt rncerequired..,.........:...... reouired.. , for rvhichtlieadvatrce g. (o) 1?,gluu)"1-tzr,fdrq3Tttrtt?TtA\| (a)PLrrpose (r:;) fr;1flP;'1) rrirrl rrinr * rfr li-rqfAfu(i 'rXa'rt'.fr Gflli:* a) t r) qfi r1.i;rli.,rfor 3tTit sqr"i-.rl f&g 3lfirl

; ;, l:l"'::-::::::*:::::::-::::-::: ll [li:1[?il];:*:#ll"l' o{'tlrePlot Locatirlnand nreasur..:lIent (ii)

--'. ---ri-, i .r ^.^* ,.--+ ,- +) 4 l i l a { t i k ' l l C Y . u !\ r . { { l i ' l ( c it i L ; $ l ( ' 1 q l t l c c . r i < L '

Whcthcp r l o t i s f i c c h o l coi r o r t l e a s e

rn lqqn...,.....,. (iir) l.lqior Plaufor construction

(iv) qR q*c sarn File RFsq rfifd'*

l

qr€t-,iT 'fi {6i t d €rl qftfr fl cH, rrfu'or€ffird,E sT r*lt"i nens{i,tT qlq,3iIFq

etc. is fiom a lioLrseBuilclirrgSociety,the nameof $ociety,the locationattdmeasurements lf tlreFlator Plotbcingpurchased

2

ta,ft ft'a"r-flqrfuo{tr (ffSq), altril3t-q ft,{fr sTrcrSE#{ snft t sftdT "rrf,r t ,i re-rn,u+,lpr.jl:ilf (",.1 qf'{ ,q;};,1 ;ri 't,Sg i'I,rii tir.i t Board,etc.thelocation. dimension, etc.Ina) Authority or anyHousing purchase 11'thc of FlatisfrornDelhiDevelopment

fr 6q69. (u) r;{? eiii)rr e'f,r4 d f}rerord qqtoq d ftq rTI"n.Jil.rq

ft-firr Rq qK :-

(ci) lf aclvance is requiredfor educationof children,followingdetailsmay be given :---

u --(\

"---

l.lanreof son/dauglrter rii)

4ieiT cqi rvherestudying Classand !nstit:rrtioniCollege

(iii) Whcthera day sclrolaror hostler

(t;) ufl srflrrqRsnd ft,a{tttt w
qlq wd tft tii) .}]-saro/3*qqii{{r/ss sasr cF..r

or srqr{ qqTT6Tt.......................

Nanrcof llospital/Dispensary/Docofiwherethe patientis undergoing treatrncnt g

lr. ihs ! r'tr-oa.idqxtr.{ifidosx *'a,4.fliq

nt availableor not Whclherreinrbursenre

.i)u :-- e(ir) i\ a(e.)d 3ftft{ 3rFJqd qrrrd i frnft ili{rM

o'txq 31uitTqqrq-q;{ o1 sTH{Fsnrc-€}*'ft r

r' Notc :- ln caseof advanceunder[{c) to 8(e), no certificateof documentaryevidencewould bc required.

9" '1n16 ff,nr) d} TiwI ftrq{ v......... N u n i b c r o l ' M o n t h l y i n s t a i n r e n t s . i n w h i c h t h eoafdR v as n . .c. .e. . . . . . . . .

qi +rddq'qRReJfffdS Wf !i) l,ierdidT

"tt

.....isproposedtoberepaid

-flcmr ftrird ren-rcq S ftq snlE'r-rre sri sfud dflql raT t I

justilyingthe applicationfor the temporarywiihdrawal. of the subscriber I:'ulipaiticularsof the pecuniarycircumstanses

iJe'ir[0i(r.h.rtti(fu crgi-aoiA qmdtrfteitt ftrqrw t, c;w fr] qq'dt rr$ t.-pn t'\ Ec{'\aU crrir-;r€}fuqrqTt r

givenabovearecorrectandcompleteto the bestof my knowiecige I ccnil'ythatparticulars and beiief andthat nothinghasbee c o r i c r : a l ,b: dy m c .

cfi0u [)atc

3Tf)-q-o' d fgon+s Signalure oftheApplica Yll€TBranch.. *cflqdq'i. 'I'elcphonc No

3 rg. f{a €o-a;T srf€ror{l Frgr.qqt cm} e.'Io be fillcd up by the l}iltCompitirrgOfl'iccr r.Dgf}rrdt.nfe...'...........2.-[|qaIfg..'.'3qfqFlf.*gsoq.i+}ar-l...' lrurrcl Dateof tlirr.h Dattlof JoiningPLovidcirt of Ai;;;ointnrent i-)atr: ,i'r.i|dtqfif}d'-qr{T..',..'..........'.'..."....''....3i$-{iiirkdqEEqFtf},z-it3Isiq.di.o}q'fNi|:t7,ld; NO. P.I:"ACCOIrNt

CSRPI;/NCSRPF/VPF

5'.............'.'..-iF........'......'''......''.'....'.....,...,'..qnqfs{RKdHqfTr]ff}z..h3{Yr#ftaq-I .r{ t t ,{+fi}ro rrfrq ffi { * qnd ffi fq tlrl qro rj E5}T{ it{sil lf en{hdi\ t

t, gr+t 6. (i) q-sciftor$ 'r-{ {|ftr d d v.............................q?Fiqr

h y - s h etcbtr I t s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . of ruot m s tparnedviinogursv i t h d r a walf i e rt a k i n gi n t oa c c o u nrte c o v e riyn a d e . t l r r o uIg) a o f l n s t a l m e nrtesc o v e r e d . . . . . .

. . . . . . . . . . . . . . . .o. o f .u. .t. . . . . . . . . . . . . . . .

7.F...................'.......'........q'1{.5EIrqrfrr-TrE//+f..'..''.............'.dwRv5w1).i,J . . . .:... . z} erym wITroq fr .r{ r rn{1s.......... 8. (i) it
F. I{s..............

(ii) oi-ffie

$ I(s.... .........

dfuc {il,{irs-B,zortr{ do

Co-operative CreditSociety/Urban Bank. (iiD rf4q fl+F atcr<];l ProvidenrFundSub.cription ,; rTTlinf ifae (iv) Sr-o dtt]l Prrlicr,' fFF.f Ptsr Prcnriurn nn l,ife instrrarrcc "f .

l'. Ils . . . ".".:........,........ *j. R:.. . ..............,.."......".......

(v) qRq fiFt eTF'Jq ll'fu qR ,rqss'l 'd e.}etq 3f{l.or fr .r{ t ..

s. Rs...,............

Providcnt[:undAdvancc,if sanctioned and paid (vi) 3Tf{-O-t IncomeTax

'F. Rs................

..

(vii) SlItl.F-t3fD"ffi Surclrargeon IncomeTax

s. Rs.......... .. E. Its.......",....

(viii)......"..."... q-o odFrd

TotalDeductions q1t Net AmountPayble gA +1 T|dT1

t0. rnl?r+;flftr s0 qfittn d eqiq{ rrFr r...........

s" Rs.....,........ s. I1s......."...........

..

c+$t B r

Alnountetpralto 50 percentof rnonthlyemolunrcntlts

{illt;t Starion

m-{fg Dare. rt. qH-rI 3l[*+*t'{t d sifl{t

fua q-raq 3rfiilEd$s) trmtett dplt rl<.Jlr{ Signature of thellillConrpiling Ol'liccn withl)csigrratio C. Order of the Competent Authorit3i

dqr.r}3uqiR........'..'............-..'....'....dqtt,....'........I|(.Tq-m{ *,|ryi.1p1...caYHqq............................'........_.s1q6"irq1MIN3i|'{.:Erd1sqf ,hi{.}.i filq.ftd t{FITr,.tf{.rYq ... .....+}eriifoTanr-rrdtar;L{ {:}liord} ,d qil}r tuu,rd'.g.lef)_{Ttl,zdsl sif}q,r0..... .iitor1.f................^.i':(elerrin)s'I..'......T{qFIq],Q{-of&cnJ*}+tlKl

{Cqr'l Stiition.

nr{Ig Date.

'EKIlell

deTIq-ffifq Signaturewith Designation

4

q. dsr orq{aq d trrrqlq d fuq D. For [Jsein AccountsOffice ifr{hs .rfr.Jl.z "h...,.....................nr€Itc......... ilui fti{ riun............. dated

C.O.7l.lo.

datcd

A c c o t t nltl i t l N o .

..,ri]qrfri qrqr di q{:

qit *-rrt (3r,itl li) l)assccllbr I{s. (ilt figures)

ltfudr-l ALLocltn0N

cd nr. HrlI Cr -l'

p r e s c n caen do n t h ei d e n t i l l c a t i oonl . . . . . . . . . . . . . . . .t .h.ei n

p a y r n c nsth o u l db en r a d ea t . . . . . . . . . .

Clerk der fufQo Accounts

ordlTrer 9{EI Sub-Iiead

4. *oq .! -. q(1-l

{irTrr d

Accountant

drqT slMt("l"fjl)

rt6=

-"Ifr q=il €

Puy l)cpt . ., .'.

+;i fq'.ar

.... ...tda orQ-et Bill l{eceivcclon datc

CashBook IrolioNo. f . ": . . . ; . 'i"i1ilJ

n..ounts officcr(l'.fi)

-sq?TIlT e) tftrl lj. lior lJsern the Pay Departnient

t\^-. lq+ll'1.........,....

,fi.qrt.gtt*..q.. PMI{No.

d-qlwa

Iraynicnt cor iipletcd ttii

P a 1n r : r r i c . J n l i r r c l : c c Jo i l

l-rat.

.fl"r&s... ercn qdt q......................... [)atc

lJnpaidList No

9-)-r+/aiot,t I ' } l-. l r ( l l r a i l i u r

.fl-ao..... m f l e r. . . . . . . ..............nrfrq..................... a,......... P-'l No.

Date

No.

Datc

ilo'ftrn d grcrers Ys drfr-s

r.qr) (ei+i d) Ilcccivcdlts.(in figures)

$q0 (3is1{iti) il.w gq. Ils.(inrvords)

Signature of Cashier Datcd . siofgqt o-1 qlq........ Namcol'theCashier

rigfr............... I)ivision

gldl

.T'rtrn lil-,qT;l' Pay Distlict r.-o.

srPr.iTO EFTTrrlM'-rri

Ccrtilicate by Witncssingofficial

. .. Ya/\ftrzqt-ft......... ii?r qri srd................. Payee

of s/o/cllo.irvit'e

qt ar{I o1 'rff ai-q strd....... +t R"r.Trcf, b1 meanclpaidthcsumot'l{s. ldentifiecl (rry$ pr.....,.. .'r{ -+1 t trftr ilo .fleqrERi tt ffiq-i rl$ sq li 3rsr Eit in my prescncc. by thcCaslticr Correctly -,Tft'{{, Datccl,&Sigrta1Lrre........ 6{t1le1.t3il1 ;{I{ Name....... Q K 3 TD 4 esignation............... . .'.{. . . f r r T F rD e p a r t m e n t . . . . . . , . . . . . . . . . . . . . . . . . . . .S. .t.u. .t.i .o€ns.F