Advance Stamped Receipt Format (ASR Form)‎

I have Attached Advance Stamped Receipt Format. This is English Version of Advance Stamp Receipt (ASR Form) of PF Department.

A.S.R. Form
Regional Provident Fund Commissioner
Subject : For the settlement of  Provident Fund Account No.
Dear Sir / Madam
I have applied for the settlement of my provident fund account number …………………………………………….
But of any reason issued  money order / cheque  ……………………………………………………………………………….
of  ` ………………. /- dated ………/………/…………, in consequence of settlement of my
Provident Fund Account, has been returned to your office.
So, I request you to kindly sent the Money Order / Cheque of  ` …………………………/-  to below
mentioned address.
Bank Account Detail Home Address
Member Name : ………………………………………………… Member Name : …………………………………………………
Bank Account No. : ……………………………………………. Home Address : …………………………………………………
Bank Name : ……………………………………………………… ………………………………………………………………………….
Address : …………………………………………………………… ………………………………………………………………………….
………………………………………………………………………….
Pin Code : …………………………………………………………. Pin Code : ………………………………………………………….
(Attested by Previous Employer / Gazettted
Officer or By Bank Manager) Sincerely,
………………………………………………………………………….
Member Name
Signature ………………………………………………………………………….
Officer’s Name & Seal of office Father / Husband Name
Advanced Stamped Receipt
Received a sum of  ` ……………………/-[Rupees ……………………………………………………………………..]
by cheque …………………….. dated ……/………/………… payable at SBI, New Delhi, by Regional Provident
Fund Commissioner, New Delhi for the last disburrsement of  my EPS Account / Advanvced D.L. /
in advanced payment card number…………………………………..
Signature of the Authorised Officer ` 1 Revenue Stamp
with Official Seal Member’s Name & Signature

 

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