Form 19 - Employees Provident Fund Scheme (Page 4 of 5) in pdf

quoting the Registration Number and your

Provident Fund Account Number

…………………………………….

PIN………………………………

Employees’ Provident fund Organisation

Office of the Regional Provident Fund Commissioner/ S.R.O. …………………..

……………………………………… (Full Address)………………………………….

Instruction for filling up the applications (Form 19 & 10-B)

(For the guidance of applicant only. Not to be sent alongwith the claims)

All the columns on the form should be filled in completely in ink, without

any overwriting.

Against the column reason for leaving service indicate the one applicable.

(a)

Retired from service after attaining the age of 55 years/attained the

age of 55 years.

(b)

Retired on account of permanent and total incapacity for work due

to Bodily / Mental informity

(c)

Retired under voluntary retirement scheme.

(d)

Migrating from India for permanent settlement abroad

(e)

Leaving India at least for a year.

(f)

Retrenched from Service

(g)

Discharged from service on receiving compensation under the

Industrial Disputes Act, 1947.

(h)

Resigned not employed in any, factory to which the Employees’

Provident fund Scheme applies.

“Full postal address”, should be given clearly in Block Letters Since the

M.O. & Payment intimation is to be sent to this address the name of the

member and Father’s (Husband’s) should also be furnished in this column

correct postal address including pin code will enable the Commissioner to

make prompt payment to the correct payees.

It was advisable to have the payment by cheque. For this purpose the

account payee cheque will be sent direct to the Scheduled Bank in which

the S.B. A/c is maintained under intimation to the member. This will

expedite the settlement of the correct Payee.

The literate member should sign the application for, illiterate male member

should affix his left hand thumb impression and illiterate female member

should affix her right hand thumb impression and the fact should be clearly

recorded below thumb impression.

If the claim is required to be submitted after completing the prescribed

period (i.e. in case falling under items 2(g) and (h) above only, the

Form 19 - Employees Provident Fund Scheme Page 4

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