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 | ||||||||