FORM D
[See paragraph 10]
Application for a loan under the Public Provident Fund Scheme, 1968
To
Sir,
1. I wish to take a loan from Public Provident Fund Account No of a sum of
Rs (Rupees ) which I undertake to repay with interest within the period of twenty-four months as prescribed in paragraph 11 of the Public Provident Fund
Scheme,1968.
2. I had taken a loan of Rs (Rupees ) on which has been repaid in full with interest on [date]
3. Certified that the amount for which loan is applied for is required for the use of who is alive and is till a minor.
4. The Pass Book is enclosed.

Date
Signature or thumb impression of
subscriber/Guardian
To be given only when a loan is sought from a minor's account.
TO BE USED BY THE ACCOUNTS OFFICE
Date of initial subscription
Amount available in the Public Provident Fund Account
Amount available for loan in accordance with para 10 of the Public Provident Fund Scheme
Amount of loan actually sanctioned
Date
Signature of Accounts Officer
Received a sum of Rs (Rupees ) by way of loan from Public
Provident Fund Account No.
STAMP

Date Signature/thumb impression of subscriber/Guardian