QUESTIONAIRE TO BE FILLED BY THE APPLICANT FOR FINAL WITHDRAWAL FROM P.F. FOR HOUSE BUILDING PURPOSE
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1. Name :

2. Designation & Emp.No. :

3. Final withdrawal from PF applied for the purpose of

i) to purchase a house site :

ii) to purchase a house site and to
construct a house thereon :

iii)to acquire a suitable house /
to carry out repairs to the house
already in possession. :

iv) to repay an outstanding amount on
account of loan expressly taken
for the purchase of the house
(state whichever is applicable) :

v) for payment of registration
amount to IRWO :

vi) for payment of instalment to IRWO:

4. Estimated cost of house site and
size thereof :

5. Estimated cost of the repair of the
house.Specify the different stages at
which you desire to draw the with-
drawal for repair/construction of the
house and also the number of install-
ment for the payment of the final
withdrawal applied for. :

6. Amount of HBA sanctioned :

7. Whether proposed to purchase the
house or house site on installment
basis; if so, the number of install-
ments proposed to effect payments :

8. Whether the house proposed to be
constructed/repaired is at the place
of duty or at the intended place of
residence after retirement(Furnish
full details with address) :

9. Whether you are owning any other
house, if so, where?(full details) :

10.In case of final withdrawal is sanc.

i) will you be able to effect the pur-
chase of the house site within one
month from the date of withdrawal of
amount and produce receipt from the
seller or house building society etc.
in token of the amount of the with-
drawal having been utilised towards
the purchase of the house site :

ii)have you acquired full title to the
house/construction of the house within
a period of 6 months of the withdrawal
and complete it within a period of one
year from the date of commencement :

iii)will you be able to commence
repairs/construction of the house with-
in a period of 6 months of the with-
drawal and complete it within a period
of one year from the date of commen-
cement.

iv) will the transaction be completed
within 3 months from the date of with-
drawal of the amount if the withdrawal
is for acquiring a ready built house. :

11.Whether you have availed yourself of
the scheme sponsored by the Ministry
of Works, Housing & supply of any other
Govt. sources in regard to grant of
loan for house building purpose :

12.Whether the purchase is proposed to be
effected through a reputed or regular
dealer, if not, has the approval of
the competent authority been obtained
or required under the Railway Servants
Conduct Rules :

13.What is your date
i) of appointment to service :
ii)of retirement from service :

14.Are you governed by the state Railway
P.F. Rules or Pension Rules :

I do hereby declare that the information furnished above is true to the best of my knowledge.

I understand that if the amount withdrawn exceeds the actual requirement for acquiring a ready built house, the excess amount shall be refunded to the Govt. forthwith in one lumpsum together with the interest thereon.

I assure that while in service, I will be submitting an annual declaration on or before 31st December of each year to the satisfaction of the sanctioning authority of the final withdrawal from P.F. that the house site or building remains in my sole ownership and that I have not parted with the possession of these by way of transfer, sale, mortgage, gift, exchange, etc. I do hereby declare that I will not enter in to such transaction without obtaining the prior sanction from the competent authority in writing.

Signature:

Name:
Emp.No. : T.No.
Countersigned
(signature of the
immediate supervisor)

Designation :
Date :