FORM H
[See sub-paragraph (2A) of paragraph 9]
Application for continuance of account under the Public Provident Fund Scheme,
1968 beyond 15 years

To
The Agent/Manager/Post Master,
My Public Provident Fund Account No has completed 15 years, after the initial year
of its commencement, on I wish to continue to subscribe to my above-referred account for a further block period of 5 years according to the limits prescribed in paragraph 3 of the Scheme.
Date .
Signature/thumb impression of subscriber/guardian

FOR USE IN ACCOUNTS OFFICE

The account completed 15 years after the year of initial subscription on Subscriber's request has been noted.

Date Accounts Officer/Post Master