Application for Loan from Employees Provident Fund

Part I (To be filled by the applicant)

Date of Application:
Ref No:
(*dd/mm/yyyy)

(* for office use only)

Name in Full:
Date of birth:

Branch / Department:

(* dd/mm/yyyy)

NIC:

Amount requested: Rs.

Purpose of loan:

Employee Number:

I, (* initials with surname) being a member of the

Sampath Bank PLC Employees Provident Fund do hereby apply for a loan from the said Fund
in terms of Rule 7 of the Fund, Complying within all matters concerning repayment of the loan. I
certify that the above particulars are correct and that if the loan is granted it will be used for the
purpose stated above.
..
Signature of the applicant
Part II (Recommendation of Branch Manager / Department Head)
Comments/Observations/Recommendation:

...
Signature (Branch Manager / Head of Dept)
PART III (To be filled by Human Resources Dept)
Balance in Provident Fund
Rs.
75% of EPF balance

Rs.

Less :

Rs.

Existing Loans

Total monthly emoluments

Deductions: PF contributions

Rs.
Rs.

Repayment of existing PF loans Rs.

Other deductions
Total

Rs.
Rs.

Rs.

Total deductions after granting the loan

Rs.

60% of total monthly emoluments

Rs.

Expiry date based on the proposed repayment (*dd/mm/yyyy)

Applicants 54th Birthday (*dd/mm/yyyy)
The above particulars were checked by me and certified as correct.

(Approved / Not Approved)

.
Signature (Manger HR)
Part IV (Approval for Exceptions by EPF Committee of Management)

(Approved / Not Approved)

.
Signature

Conditions:
(i)

Any loan/s obtained previously against the EPF balance will be taken into
consideration when calculating the loan amount eligible for a member.

(ii)

All loans under EPF Loans Scheme will be guided by prevailing terms applied under
Sampath Bank Staff Loan Schemes and any amendments thereto at the time of
approving /granting of loans.

(iii) All loans granted by the Fund shall always be subject to Restrictions and
Terms in the Rules of the fund.

(iv) In the case of Housing loans the property should be in the name of the member or to
be purchased in the name of the member. Applications for the purchase of property
in the name of the spouse or for construction on a property belong to spouse will be
referred to the Committee of Management for necessary approval. Committees
approval will be final.

SBEPF FORM NO. 01