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    Form 3A

    Uploaded by

    barun_india
    It requests information such as the name, sex, religion, and relationship to the deceased member for up to 3 minor/lunatic nominees or legal heirs. It also requests the claimant's full address and their preferred mode of remittance whether by postal money order or account payee cheque. The claimant must provide a certificate that the minor/lunatic nominee is being supported by them, no posthumous child will be born, and the minor has not been employed for at least 2 months. A stamped receipt must be furnished if remittance is by cheque.

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    Form 3A

    Uploaded by

    barun_india
    12 views2 pages
    It requests information such as the name, sex, religion, and relationship to the deceased member for up to 3 minor/lunatic nominees or legal heirs. It also requests the claimant's full address and their preferred mode of remittance whether by postal money order or account payee cheque. The claimant must provide a certificate that the minor/lunatic nominee is being supported by them, no posthumous child will be born, and the minor has not been employed for at least 2 months. A stamped receipt must be furnished if remittance is by cheque.

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    It requests information such as the name, sex, religion, and relationship to the deceased member for up to 3 minor/lunatic nominees or legal heirs. It also requests the claimant's full address and their preferred mode of remittance whether by postal money order or account payee cheque. The claimant must provide a certificate that the minor/lunatic nominee is being supported by them, no posthumous child will be born, and the minor has not been employed for at least 2 months. A stamped receipt must be furnished if remittance is by cheque.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    12 views2 pages

    Form 3A

    Uploaded by

    barun_india
    It requests information such as the name, sex, religion, and relationship to the deceased member for up to 3 minor/lunatic nominees or legal heirs. It also requests the claimant's full address and their preferred mode of remittance whether by postal money order or account payee cheque. The claimant must provide a certificate that the minor/lunatic nominee is being supported by them, no posthumous child will be born, and the minor has not been employed for at least 2 months. A stamped receipt must be furnished if remittance is by cheque.

    Copyright:

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    of 2

    FORM 3A

    3A. PARTICULARS OF THE MINOR/LUNATIC NOMINEE(S) LEGAL HEIR(S) FAMILY MEMBER(S) ON


    WHOSE BEHALF THE PROVIDENT FUND AMOUNT IS CLAIMED.

    S.No Name Sex Religion Relationship

    with the deceased member with the


    guardian

    (1)
    (2)
    (3)
    (4)
    Delete, if not applicable

    4 Claimant’s full postal address : Shri/Smt


    ………………………………………………………….
    (in Block Letters) S/o, W/o, H/o,
    D/o……………………………………………….

    …………………………………………………………………….

    …………………………………………………………………….

    PIN:

    5. MODE OF REMITTANCE : Put a ‘tick’ in the Box against the one opted:

    a. by postal money order at my cost ( ) to the address given in item No4

    OR (b) By account payee cheque sent : ( ) S B Account


    No………………………………………………
    direct for credit to my S B Bank
    ……………………………………………………………
    Account (Scheduled Bank /P.O) Branch
    ……………………………………………………………
    under intimation to me (Advance Full Address of
    ………………………………………………….
    Stamped receipt furnished below) of the Bank
    ………………………………………………………

    CERTIFICATE:
    To the best of my knowledge no posthumous child will be born to deceased member.
    I certify that the particualrs given above are true to the best of my knowledge.
    I certify that the minor(s)/Lunatic Shri/Smt
    ………………………………………………………………………………….
    is living with me and is being supported and looked after by my self and the Provident Fund money claimed
    on behalf of minor/lunatic will be spent in his/her best interests and benefits.
    I certify that the minor member has not been employed in any Factory/Establishment to which the ‘Act’ applies
    for a continuous period of not less than 2 months immediately preceding the date of this application.

    Encl:
    Date Signature or Left/Right hand
    Delete, if not applicable thumb impression of the
    claimant
    ADVANCE STAMPED RECEIPT
    (To be furnished in case of 5 (b) above)

    Received a sum of Rs* .................................................................................


    (Rupees............... .................................................................................) from the Regional
    Provident Fund Commissioner/Officer incharge of Sub-Regional office .............................. by deposit in
    my savings Bank Account towards the settlement of Provident Funds, account of Shri/Smt
    .........................................................

    *The space should be left blank which shall Affix


    be filled in by Regional Provident Fund Re.1.00
    Commissioner/Officer-in-charge of Sub Revenue
    regional Office Stamp
    Signature or Left/Right hand
    Thumb impression of the
    claimant

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