FORM IX

(Vide Clauses 4 of the Scheme under Labour Department Resolution No. 180-IR dated 24.01.2001)

Form of application for final payment of balance in the Provident Fund Account for workers of unorganised sector

 

To

The Minimum Wages Inspector / Assistant Labour Commissioner

………………………………………………………………………..

……………………………………………………………………..

Through the Minimum Wages Inspector

Sir,

       I am due to attain / have attained 60 years of age on …………………………………… / I have discontinued by subscription with effect from ………………………………………………. and do not want to continue as a subscriber.

            My A/c. No. is ……………………………………………………………………………………. I desire to receive payment through the Minimum Wages Inspector, ………………………………………………………………….. Block by Cheque/bank draft/pay order. Particulars of my personal marks of identification, photograph, left hand thumb and finger impressions (in the case of illiterate subscribers) and specimen signature (in the case of literate subscriber) in duplicate, duly attested by Minimum Wages Inspector are enclosed.

 

 

Yours faithfully,

Date:                                                                                                                    Signature

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