Employees Provident Fund Organization - Declaration Form
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1
2
3Form No. 11 (New)
Declaration Form
(To be retained by the Employer for future reference)
Employees’ Provident Fund Organization
T
E
’ P
F
S
, 1952 (P
-34 & 57)
HE
MPLOYEES
ROVIDENT
UNDS
CHEME
ARAGRAPH
&
T
E
’ P
S
, 1995 (P
-24)
HE
MPLOYEES
ENSION
CHEME
ARAGRAPH
D
E
’ P
F
S
,
ECLARATION BY A PERSON TAKING UP EMPLOYMENT IN AN ESTABLISHMENT ON WHICH
MPLOYEES
ROVIDENT
UND
CHEME
1952
/
E
’ P
S
, 1995
.
AND
OR
MPLOYEES
ENSION
CHEME
IS APPLICABLE
(PLEASE GO THROUGH THE INSTRUCTIONS)
1)
N
(T
)
AME
ITLE
M
.
M
.
M
.
R
S
RS
(P
T
)
LEASE
ICK
2)
D
D
M
M
Y
Y
Y
Y
D
B
ATE OF
IRTH
3)
F
’
/
ATHER
S
M
.
R
H
’
N
USBAND
S
AME
4)
F
H
R
(3)
ATHER
USBAND
ELATIONSHIP IN RESPECT OF
ABOVE
(P
T
)
LEASE
ICK
5)
M
F
T
G
ALE
EMALE
RANSGENDER
ENDER
(P
T
)
LEASE
ICK
6)
M
N
OBILE
UMBER
(I
)
F ANY
7)
E
ID (I
)
MAIL
F ANY
8)
W
E
’ P
F
S
, 1952 ?
HETHER EARLIER A MEMBER OF THE
MPLOYEES
ROVIDENT
UND
CHEME
(P
T
)
YES
NO
LEASE
ICK
9)
W
E
’ P
S
, 1995?
HETHER EARLIER A MEMBER OF THE
MPLOYEES
ENSION
CHEME
(P
T
)
YES
NO
LEASE
ICK
I
(8) & (9)
,
F RESPONSE TO ANY OR BOTH OF
ABOVE IS YES
THEN MANDATORILY FILL UP THE PREVIOUS EMPLOYMENT DETAILS
(10,11&12):
AT
Page 1 of 3
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