INDIAN INSTITUTE OF TECHNOLOGY, BOMBAY

APPLICATION FOR WITHDRAWAL FROM CPF/GPF



Name Designation Deptt./Section

Basic Pay Rs. Salary Code No.

Amount of withdrawal requested Purpose of withdrawal


Date : Signature of the applicant



(TO BE COMPLETED AND CERTIFIED BY ACCOUNTS SECTION)

Balance of Subcription at the credit of staff member Balance amount As on
Certified by


Date : Signature of the applicant