ANNEXURE - 1

SEAMEN’S PROVIDENT FUND ORGANIZATION, MUMBAI

LIST OF DOCUMENTS FOR APPLICATION OF FINAL WITHDRAWAL OF
PROVIDENT FUND DUES (LIVING SEAMAN)

Sr. Particulars Yes / No Remark

No. (Delete as
applicable)
Retirement on Superannuation / Voluntary / Medically Unfit

1 Self attested Application Forms by the Seamen / Yes / No

Applicant.
2 Self attested Advance Stamp Receipt by the Yes / No
Seamen / Applicant and affix Re.1/- Revenue
Stamp and signature.
3 Self attested photocopy of all pages of CDC Yes / No
Book (Old / New).
4 Self attested Mandate Form & Bank Cheque Leaf Yes / No
and photocopy of Bank Passbook.
5 Is the Bank Account is jointly held by a person Yes / No
other than the nominee?
(If yes, the seaman is not entitled to receive
payment through NEFT / RTGS).
6 Name of seaman as it appears on CDC Book Yes / No
and Bank Account is the same.
7 Self attested photocopy of the Registration Yes / No
Cancellation Order or letter from Shipping Master
for obtaining Final Withdrawal of Provident Fund
is enclosed.
8 Self attested photocopy of Medical Unfitness Yes / No
Certificate.
9 If Address differs proof of address Yes / No
10 Ensure the Final Withdrawal Application is Yes / No
completed in all respect.

Date:

Place:

Signature of Applicant
Name & CDC No.
 ANNEXURE - 2

SEAMEN’S PROVIDENT FUND ORGANIZATION, MUMBAI

LIST OF DOCUMENTS FOR APPLICATION OF FINAL WITHDRAWAL OF

PROVIDENT FUND DUES (DECEASED SEAMAN)

Sr. Particulars Yes / No Remark

No.
1 Documents in support of the nominee of Yes / No
the deceased seafarer (If applicant is
other than nominee; sl.No.8 is required)
2 Self attested Application Form by the Yes / No
Applicant
3 Self attested Advance Stamp Receipt by Yes / No
the Seamen / Applicant and affix Re.1/-
Revenue Stamp and signature.
4 Self attested photocopy of all pages of Yes / No
CDC Book (Old / New).
5 Self attested Mandate form & Bank Yes / No
Cheque Leaf & photocopy of Bank
Passbook.
6 Self attested photocopy of Death Yes / No
Certificate of the deceased seaman.
7 Legal Heirship Certificate from District Yes / No
Magistrate or Succession Certificate
from Competent Authority with seal & N. A.
signature.
8 If Address differs proof of address Yes / No
9 Ensure the Final Withdrawal Application Yes / No
is completed in all respect.

Date:

Place:

Signature of Applicant
Name & CDC No.
 ANNEXURE - 3

SEAMEN’S PROVIDENT FUND ORGANIZATION, MUMBAI

LIST OF DOCUMENTS FOR APPLICATION OF NON REFUNDABLE WITHDRAWAL

FOR UN-EMPLOYMENT – Eligible after Completion of 5 Yrs Membership (10% OF

MEMBER’S OWN CONTRIBUTIONS).

Sr. Particulars Yes / No Remark

No.
1. Self attested NRW Application Form by Yes / No
the seamen
2. Self attested Advance Stamp Receipt by Yes / No
the Seamen and affix Re.1/- Revenue
Stamp and signature.
3. Ensure un-employed for the period of Yes / No
more than 6 months.
4. Self attested photocopy of CDC Book . Yes / No
5. Ensure Signed as per CDC and Yes / No
impressed your Thumb on application &
ASR.
6. Self attested Mandate form & Bank Yes / No
Cheque Leaf & photocopy of Bank
Passbook.
7. In case, Bank Account jointly held by Yes / No
person other than the nominee? (If Yes,
the seaman is not entitled to receive
payment through NEFT / RTGS).

Date:

Place:

Signature of Applicant
Name & CDC No.
 ANNEXURE - 4

SEAMEN’S PROVIDENT FUND ORGANIZATION, MUMBAI

LIST OF DOCUMENTS FOR APPLICATION OF NON REFUNDABLE WITHDRAWAL

FOR ILLNESS – (25% OF MEMBER’S OWN CONTRIBUTIONS)

Sr. Particulars Yes / No Remark

No.
1. Self attested NRW Application Form by Yes / No
the seamen
2. Self attested Advance Stamp Receipt by Yes / No
the Seamen and affix Re.1/- Revenue
Stamp and signature.
3. Ensure Period completed two years Yes / No
from the date of last withdrawal for
illness availed.
4. Self attested photocopy of CDC Book . Yes / No
5. Doctor’s Certificate specifying probable Yes / No
expenditure to be incurred for medical
treatment attached.
6. Ensure Signed as per CDC and Yes / No
impressed your Thumb on application &
ASR.
7. Self attested Mandate form & Bank Yes / No
Cheque Leaf & photocopy of Bank
Passbook.
8. In case, Bank Account jointly held by Yes / No
person other than the nominee? (If Yes,
the seaman is not entitled to receive
payment through NEFT / RTGS).

Date:
Place:

Signature of Applicant
Name & CDC No.
 ANNEXURE - 5

SEAMEN’S PROVIDENT FUND ORGANIZATION, MUMBAI

LIST OF DOCUMENTS FOR APPLICATION OF NON REFUNDABLE WITHDRAWAL

FOR PURCHASE OF HOUSE / FLAT 58-C (1) – Eligible after completion of 5 yrs
membership (36 months Pay + Leave Pay/75% of Employer and own contribution
whichever will be less).

Sr. Particulars Yes / No Remark

No.
1. Self attested NRW Application Form by the Yes / No
seamen
2. Self attested Advance Stamp Receipt by Yes / No
the Seamen and affix Re.1/- Revenue
Stamp and signature.
3. Ensure Signed as per CDC and impressed Yes / No
your Thumb on application & ASR.
4. Self attested Photocopy of Account of Yes / No
Wages indicating Pay + Leave Pay for the
last Pay drawn.
5. Self attested photocopy of Agreement of Yes / No
Sale containing approved Plan duly
registered with Sub-Registrar and Receipt
for Registration of Stamp Duty paid
towards Registration.
6. Self attested photocopy of Certificate from Yes / No
the Builder/Co-operative Housing Society Not Applicable
to the effect that “the purchased flat un-
lived and new.
7. Self attested photocopy of Receipts for the Yes / No
payments made to the builder.
8. Self attested Mandate form & Bank Yes / No
Cheque Leaf & photocopy of Bank
Passbook
9. In case, Bank Account jointly held by Yes / No
person other than the nominee? (If Yes,
the seaman is not entitled to receive
payment through NEFT / RTGS).

Date:
Place:

Signature of Applicant
Name & CDC No.
 ANNEXURE - 6

SEAMEN’S PROVIDENT FUND ORGANIZATION, MUMBAI

LIST OF DOCUMENTS FOR APPLICATION OF NON REFUNDABLE WITHDRAWAL
UNDER PARA 58 – C (1)

FOR CONSTRUCTION OF HOUSE ON HIS OWN LAND OR CONTINUING

INCOMPLETE CONSTRUCTION - Eligible after completion of 5 yrs membership
(36 months Pay + Leave Pay / 75% of Employer and own contribution whichever
will be less).

Sr. Particulars Yes / No Remark

No.
1. Self attested NRW Application Form by Yes / No
the seamen
2. Self attested Advance Stamp Receipt by Yes / No
the Seamen and affix Re.1/- Revenue
Stamp and signature.
3. Five years membership completed in the Yes / No
fund.
4. Ensure Signed as per CDC and Yes / No
impressed your Thumb on application &
ASR.
5. Self attested Photocopy of Account of Yes / No
Wages indicating Pay + Leave Pay for the
last Pay drawn.
6. Self attested Photocopy of 7/12 Extract Yes / No
for ownership of the land.
7. Self attested Photocopy of No-Objection Yes / No
Certificate for construction from the
Municipal Corporation or Punchayat.
8. Self attested Photocopy of Approved Yes / No
plan for construction from the Municipal
Corporation or Punchayat.
9. Self attested Photocopy of Estimates from Yes / No
Architect / Civil Engineer are attached.
10. Self attested Mandate form & Bank Yes / No
Cheque Leaf & photocopy of Bank
Passbook
11. In case, Bank Account jointly held by Yes / No
person other than the nominee? (If Yes,
the seaman is not entitled to receive N.A.
payment through NEFT / RTGS).

Date:
Place:

Signature of Applicant
Name & CDC No.
 ANNEXURE - 7

SEAMEN’S PROVIDENT FUND ORGANIZATION, MUMBAI

LIST OF DOCUMENTS FOR APPLICATION OF NON REFUNDABLE WITHDRAWAL

UNDER PARA 58 – C (1)

FOR PURCHASE OF HOUSE SITE - Eligible after completion of 5 yrs membership

(36 months Pay + Leave Pay / 75% of Employer and own contribution whichever
will be less).

Sr. Particulars Yes / No Remark

No.
1. Self attested NRW Application Form by Yes / No
the seamen
2. Self attested Advance Stamp Receipt by Yes / No
the Seamen and affix Re.1/- Revenue
Stamp and signature.
3. Five years membership completed in the Yes / No
fund.
4. Ensure Signed as per CDC and Yes / No
impressed your Thumb on application &
ASR.
5. Self attested Photocopy of Account of Yes / No
Wages indicating Pay + Leave Pay for
the last Pay drawn.
6. Self attested Photocopy of Agreement of Yes / No
Sale duly Registered with Sub-Registrar
& Receipt for Registration of Stamp Duty
paid.
7. Self attested Photocopy of Receipts for Yes / No
the payments made to the Land Owner.
8. Self attested Mandate form & Bank Yes / No
Cheque Leaf & photocopy of Bank
Passbook
9. In case, Bank Account jointly held by Yes / No
person other than the nominee? (If Yes, N.A.
the seaman is not entitled to receive
payment through NEFT / RTGS).

Date:

Place:

Signature of Applicant
Name & CDC No.
 ANNEXURE - 8

SEAMEN’S PROVIDENT FUND ORGANIZATION, MUMBAI

LIST OF DOCUMENTS FOR APPLICATION OF NON REFUNDABLE WITHDRAWAL

UNDER PARA 58 – C

FOR REPAIRING / RENOVATION OF HOUSE – Eligible after completion of 5 yrs of

sanction of earlier withdrawal for construction of house (25% of own
contribution).

Sr. Particulars Yes / No Remark

No.
1. Self attested NRW Application Form by the Yes / No
seamen
2. Self attested Advance Stamp Receipt by the Yes / No
Seamen and affix Re.1/- Revenue Stamp
and signature.
3. Five years membership completed in the Yes / No
fund.
4. Attested Photocopy of all pages of CDC Yes / No
Book.
5. Ensure Signed as per CDC and impressed Yes / No
your Thumb on application & ASR
6. Self attested Photocopy of Estimates from Yes / No
the Contractor.
7. Self attested Photocopy of No Objection Yes / No
Certificate, if the flat is in Co-operative
Housing Society.
8. Self attested Mandate form & Bank Cheque Yes / No
Leaf & photocopy of Bank Passbook
9. In Case Bank Account is jointly held by Yes / No
person other than the nominee? (If Yes, the
seaman is not entitled to receive payment
through NEFT / RTGS).

Date:
Place:

Signature of Applicant
Name & CDC No.
 ANNEXURE - 9

SEAMEN’S PROVIDENT FUND ORGANIZATION, MUMBAI

LIST OF DOCUMENTS FOR APPLICATION OF NON REFUNDABLE WITHDRAWAL
UNDER PARA 58 – E

For Marriage/Higher Education – Not more than 2 withdrawals in life time (50% of
own contribution).

Sr. Particulars Yes / No Remark

No.
1. Self attested NRW Application Form by Yes / No
the seamen
2. Self attested Advance Stamp Receipt by Yes / No
the Seamen and affix Re.1/- Revenue
Stamp and signature.
3. Five years membership completed in the Yes / No
fund. N.A.
4. Ensure Signed as per CDC and Yes / No
impressed your Thumb on application &
ASR.
5. Wedding Card attached. Yes / No
6. Age Proof in respect of your Yes / No
son/daughter/sister is attached.

7. Have you attached Dependency Yes / No

Certificate in Affidavit format if you are
applying for withdrawal for Sister’s
Marriage.
8. If the withdrawal is for Higher Education Yes / No
whether attested copy of Student’s
Bonafide Certificate is attached.
9. Self attested copy of Schedule of Fees to Yes / No
be paid?
10. Self attested Mandated form & Bank Yes / No
Cheque Leaf & photocopy of Bank
Passbook
11. In Case Bank Account is jointly held by Yes / No
person other than the nominee (If Yes,
the seaman is not entitled to receive
payment through NEFT / RTGS).

Date:
Place:
Signature of Applicant
Name & CDC No.