Employees Provident Fund Organization - Declaration Form Page 3
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1
2
317)
KYC D
T
N
KYC D
N
R
,
KYC D
OCUMENT
YPE
AME AS ON
OCUMENT
UMBER
EMARKS
IF ANY
ETAILS
B
A
-1*
IFSC C
*
ANK
CCOUNT
ODE
NPR/A
ADHAAR
P
A
ERMANENT
CCOUNT
N
(PAN)
UMBER
P
E
D
ASSPORT
XPIRY
ATE
D
L
E
D
RIVING
ICENCE
XPIRY
ATE
E
C
LECTION
ARD
R
C
ATION
ARD
ESIC C
ARD
* Mandatory Field (N
: B
A
NUMBER (
IFSC
)
.
OTE
ANK
CCOUNT
ALONG WITH
CODE
IS MANDATORY
YOU
KYC
KYC
ARE HOWEVER ADVISED TO PROVIDE ALL
DOCUMENTS AVAILABLE WITH YOU IN ADDITION TO MANDATORY
S TO
. S
-A
.
AVAIL BETTER SERVICES
ELF
TTESTED PHOTOCOPIES OF THE DOCUMENTS MUST BE ATTACHED WITH THIS FORM
C. U
:
NDERTAKING
A. I
.
CERTIFY THAT ALL THE INFORMATION GIVEN ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF
B. I
,
EPF S
, 1952
/
EPS, 1995,
N CASE
EARLIER A MEMBER OF
CHEME
AND
OR
(
) I
UAN/
PF
.
I
HAVE ENSURED THE CORRECTNESS OF MY
PREVIOUS
MEMBER ID
(
) T
II
HIS MAY ALSO BE TREATED AS MY REQUEST FOR TRANSFER OF FUNDS AND SERVICE DETAILS IF APPLICABLE FROM
P.F. A
. (T
THE PREVIOUS ACCOUNT AS DECLARED ABOVE TO THE PRESENT
CCOUNT
HE TRANSFER WOULD BE POSSIBLE
KYC
ONLY IF THE IDENTIFIED
DETAILS APPROVED BY PREVIOUS EMPLOYER HAS BEEN VERIFIED BY PRESENT
D
S
C
).
EMPLOYER USING HIS
IGITAL
IGNATURE
ERTIFICATE
(III) I
I
M
UAN
.
AM AWARE THAT
CAN SUBMIT
Y NOMINATION FORM THROUGH
BASED MEMBER PORTAL
D
:
ATE
:
S
M
PLACE
IGNATURE OF
EMBER
D
P
E
ECLARATION BY
RESENT
MPLOYER
A.
T
Mr./Ms./Mrs. …………………………..
…………………..
PF
HE MEMBER
HAS JOINED ON
AND HAS BEEN ALLOTTED
MEMBER ID
…………………………………………...
B.
I
EPF S
, 1952
EPS, 1995:
N CASE THE PERSON WAS EARLIER NOT A MEMBER OF
CHEME
AND
(P
UAN) T
UAN
…………………………
OST ALLOTMENT OF
HE
ALLOTTED FOR THE MEMBER IS
P
T
A
O
:
LEASE
ICK THE
PPROPRIATE
PTION
T
KYC
UAN
HE
DETAILS OF THE ABOVE MEMBER IN THE
DATABASE
H
□
AVE NOT BEEN UPLOADED
H
□
AVE BEEN UPLOADED BUT NOT APPROVED
H
DSC
□
AVE BEEN UPLOADED AND APPROVED WITH
C.
I
EPF S
, 1952
EPS, 1995:
N CASE THE PERSON WAS EARLIER A MEMBER OF
CHEME
AND
T
(A)
/
UAN/P
HE ABOVE MEMBER ID OF THE MEMBER AS MENTIONED IN
ABOVE HAS BEEN TAGGED WITH HIS
HER
REVIOUS
M
ID
.
EMBER
AS DECLARED BY MEMBER
P
T
A
O
:-
LEASE
ICK THE
PPROPRIATE
PTION
T
KYC
UAN
D
□
HE
DETAILS OF THE ABOVE MEMBER IN THE
DATABASE HAVE BEEN APPROVED WITH
IGITAL
S
C
.
IGNATURE
ERTIFICATE AND TRANSFER REQUEST HAS BEEN GENERATED ON PORTAL
A
DSC
EPFO,
□
S THE
OF ESTABLISHMENT ARE NOT REGISTERED WITH
THE MEMBER HAS BEEN INFORMED TO FILE
(F
-13)
.
PHYSICAL CLAIM
ORM
FOR TRANSFER OF FUNDS FROM HIS PREVIOUS ESTABLISHMENT
D
:
S
E
S
E
ATE
IGNATURE OF
MPLOYER WITH
EAL OF
STABLISHMENT
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