FORM C
(G.O. 27(6))

OPTION FOR PENSIONABLE OR
EMPLOYEES PROVIDENT FUND SCHEME


I(Name) ...........................................................................................................................................................

(Identity Card No: ...................................................................................) having been appointed to the

service on ..............................................................................hereby opt for the *Pensionable Scheme/

Employees Provident Fund Scheme. I also give my undertaking that this shall not be
revoked or withdrawn by me.


Signature: ..............................................................................................................................
Name of Officer: ...............................................................................................................................
Present Appointment: ................................................................................................................................
Department: .................................................................................................................................
....................................................................................................................................

.....................................................................................................................................
Date: ....................................................................................................................................
Witnessed by: .....................................................................................................................................
Signature
Name of Witness: .....................................................................................................................................
Appointment: .....................................................................................................................................
Name and Seal of
Department		: .....................................................................................................................................
Date: .....................................................................................................................................

*Delete whichever is inapplicable.
Note: The witness shall be an officer in the Management and Professional Group.