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3. Pay : 4. Name of the Provident Fund and Account Number : 5. Balance at credit on the date of application (amount actually subscribed by him along with interest due thereon) : 6. Balance outstanding to be converted in to a part final withdrawal : Purpose for which advance taken : (b) Date of payment of the advance : (c) Amount of advance sanctioned : 7. (a) 8. Particulars of communication under which advance was sanctioned Whether any advance or part final withdrawal has.

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