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    Nomination Form No 2

    Uploaded by

    Ashwin Rajaratnam
    This document is a nomination and declaration form for employees covered under the Employees' Provident Funds and Employees' Pension Scheme. It allows the employee to nominate individuals to receive their PF and pension funds in the event of their death. The form collects information such as the employee's name, father/husband's name, date of birth, sex, marital status, account number and address. It has sections for nominating PF beneficiaries and providing details of family members eligible for pension. The employer must sign to certify that the employee read and confirmed the entries on the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Nomination Form No 2

    Uploaded by

    Ashwin Rajaratnam
    276 views2 pages
    This document is a nomination and declaration form for employees covered under the Employees' Provident Funds and Employees' Pension Scheme. It allows the employee to nominate individuals to receive their PF and pension funds in the event of their death. The form collects information such as the employee's name, father/husband's name, date of birth, sex, marital status, account number and address. It has sections for nominating PF beneficiaries and providing details of family members eligible for pension. The employer must sign to certify that the employee read and confirmed the entries on the form.

    Original Description:

    Nomination form PF in form fill up format

    Copyright

    © © All Rights Reserved

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    This document is a nomination and declaration form for employees covered under the Employees' Provident Funds and Employees' Pension Scheme. It allows the employee to nominate individuals to receive their PF and pension funds in the event of their death. The form collects information such as the employee's name, father/husband's name, date of birth, sex, marital status, account number and address. It has sections for nominating PF beneficiaries and providing details of family members eligible for pension. The employer must sign to certify that the employee read and confirmed the entries on the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    276 views2 pages

    Nomination Form No 2

    Uploaded by

    Ashwin Rajaratnam
    This document is a nomination and declaration form for employees covered under the Employees' Provident Funds and Employees' Pension Scheme. It allows the employee to nominate individuals to receive their PF and pension funds in the event of their death. The form collects information such as the employee's name, father/husband's name, date of birth, sex, marital status, account number and address. It has sections for nominating PF beneficiaries and providing details of family members eligible for pension. The employer must sign to certify that the employee read and confirmed the entries on the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Date of Appointment :________

    ( FORM 2 (REVISED) )

    (P.F. Deduction date) :_ _ _ _.

    NOMINATION & DECLARATION FORM


    FOR UNEXEMPTED I EXEMPTED ESTABLISHMENTS

    G~PNO.:

    Office :

    DeclaratioAand Nomination Form under the Employees' Provident Funds


    and Employees' Pension Scheme
    (Paragraph 33 & 61 (1) of the Employees' Provident Funds Scheme, 1952 and
    Para 18 of the Employees' Pension Scheme, 1995)

    1.

    NAME(inblockletter~:

    _ _ _ _ _ _~_ _ _ _ _ _ _ _~_ _ _ _~_~_ _ _~

    2.

    FATHER'S I HUSBAND'S NAME: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

    3.

    DATE OF BIRTH: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4. SEX: _ _ _ _ _ _ _ __

    5.

    MARITAL STATUS: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

    (Male / Female)

    (Married / Unmarried / Widow / Widower)

    6.

    ACCOUNT NO. : _ _ _ _ _ _ _ _ _ _ _ __

    7.

    AODRESS: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___

    PART-A (EPF)
    I hereby nominate the person(s) I cancel the nomination made by me previously and nominate the person(s), mentioned
    below to receive the amount standing to my credit in the Employees' Provident Fund in the event of my death

    Name &Address of the Nominee (s)

    (1 )

    Nominee's
    relationship with
    the member

    Date of
    Birth

    Totalamt.
    .or share of accumulation
    in PFtobe
    paid to each
    nominee

    (2)

    (3)

    (4)

    If the nominee is
    minor, name &
    relationship &add.
    of the guardian
    who may receive
    the amount during
    minority of nominee
    (5)

    * Certified that I have no family as defined in para 2 (g) of the Employees' Provident Funds Scheme, 1952 and should
    I acquire a family thereafter the above nomination should be deemed as cancelled.
    2. * Certified that my father I mother is I are dependent upon me.
    1.

    (*)

    strike out whichever is not applicable

    X SIGNATURE OR THUMB IMPRESSION OF THE SUBSCRIBER

    PART B (EPS)
    Para 18
    I hereby furnish below particulars of the members of my family who would be eligible to receive widow I children Pension in
    t he event 0 f my death
    Sr.
    No.

    Name & Address of the family member / s

    Date of
    Birth

    Relationship with
    Member

    (1 )

    (2}

    (3)

    (4)

    ** Certified that I have no family, as defined in para 2 (vii) of the Employees' Pension Scheme, 1995 and should
    I acquire a-family hereafter I shall furnish particulars thereon in the above form.
    I hereby nominate the following person for receiving the monthly family pension (admissible under para 16 (2) (i) and (ii) in the
    event of my death without leaving any eligible family member I s for receiving pension.

    Name & Address of the Nominee

    Address

    Date of Birth

    Relationship with member

    (1 )

    (2)

    (3)

    (4)

    Date: _ _ _ _ _ _ __

    (*)

    strike out whichever is not applicable

    SIGNATURE OR THUMB IMPRESSION OF THE SUBSCRIBER

    CERTIFICATE BY EMPLOYER
    CERTIFIED that the above declaration and nomination has been signed f thumb impressed before me
    by: ShrifSmt./Miss. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
    employed in my f our establishment after he f she has read the entries I the entries have been read over to him fher by
    me and got confirmed by him f her.

    Place : _ _ _ _ _ _ __
    Date: _ _ _ _ _ _ __

    Signature of the Employer's OR other Authorised


    Officer's of the Establishment
    signature with designation

    (name and address of the factory / estt. or rubber stamp thereof)

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