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    CG_PF Declaration_Form 11 (1)

    Uploaded by

    Sanjay Love

    Copyright:

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

    CG_PF Declaration_Form 11 (1)

    Uploaded by

    Sanjay Love
    1 views2 pages

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

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

    CG_PF Declaration_Form 11 (1)

    Uploaded by

    Sanjay Love

    Copyright:

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

    (This form is not applicable for Interns)

    Composite Declaration Form -11


    (To be retained by the employer for future reference)

    EMPLOYEES' PROVIDENT FUND ORGANISATION


    Employees' Provident Fund Scheme, 1952 (Paragraph 34 & 57) &

    Employees' Pension Scheme, 1995 (Paragraph 24)

    Declaration by a person taking up Employment in any Establishment on which EPF Scheme, 1952 and for EPS, 1995 is applicable)

    1 Name of Member (Aadhar Name) R Nivedha

    Father's Name
    RAJA BALAKRISHNAN
    2

    Spouse's Name

    3 Date of Birth (mm/dd/yyyy) 05/17/2003

    4 Gender (Male / Female / Transgender) Female

    5 Marital Status? (Single/Married/Widow/Widower/Divorcee) Single

    (a) Email ID [email protected]

    6 (b) Mobile No (Aadhar Registered) 8124827672

    Present employment details:


    7 10/16/2024
    Date of Joining in current establishment(mm/dd/yyyy)

    KYC Details: (attach self-attested copies of following KYC's)

    a) Bank Account No. & IFS Code


    8
    b) AADHAR Number 581661052157

    c) Permanent Account Number (PAN), If available CSDPN3807R

    9 Whether earlier member of the Employee's Provident Fund Scheme, 1952?

    10 Whether earlier member of the Employee's Pension Scheme, 1995?

    Previous Employment details: (If yes to 9 AND/OR 10 above)- Un-exempted)

    Establishment Universal Date of Exit from


    Previous Date of Scheme Pension Payment Non-Contributory
    Name & Account previous
    PF Account Joining Certificate Order (PPO) (If Period (NCP)
    Address Number Employment?
    Number (mm/dd/yyyy) No (If issued) issued) Days
    (UAN) (mm/dd/yyy)
    11

    Previous employment details: (if yes to 9 AND/OR 10 above)- For Exempted Trusts)

    Universal
    Name & Member EPS Date of
    Account Date of Exit Scheme Certificate Non-Contributory Period
    Address of the Account Joining
    Number (dd/mm/yyyy) No (If issued) (NCP) Days
    Trust Number (dd/mm/yyyy)
    (UAN)
    12

    a) International Worker

    b) If yes, state country of origin (India/name of other country)


    13
    c) Passport No.

    d) Validity of passport (dd/mm/yyyy) to (dd/mm/yyyy)


    (This form is not applicable for Interns)

    UNDERTAKING

    1) Certified that the particulars are true to the best of my knowledge


    2) I authorize EPFO to use my Aadhar for verification / authentication / e-KYC purpose for service delivery.
    3) Kindly transfer the fund and service details, if applicable, from the previous PF account as declared above to the present PF account
    as I am an Aadhar verified employee in my previous PF account. *
    4) In case of any changes in above details, the same will be intimated to the employer at the earliest.

    10/18/2024
    Date:
    Place: Salem Signature of Member
    Electronically signed by:
    R Nivedha

    DECLARATION BY PRESENT EMPLOYER

    A. The member Mr./Ms./Mrs. ……………..…………………….. Has joined on ……………………….and has been


    allotted PF Number ……….…….. and UAN…………………………………….

    B. In case the person was earlier not a member of EPF Scheme, 1952 and EPS, 1995:
    Please Tick the Appropriate Option:
    The KYC details of the above member in the JAN database
    o Have not been uploaded.
    o Have been uploaded but not approved.
    o Have been uploaded and approved with DSC/e-Sign.

    C. In case the person was earlier a member of EPF Scheme, 1952 and EPS 1995:

    o The KYC details of the above member in the UAN database have been approved with Digital Signature Certificate and
    transfer request has been generated on portal.
    o Certificate and transfer request has been generated on portal.
    o The previous account of the member is not Aadhar verified, and hence physical transfer form shall be initiated.

    Date: Signature of Employer with Seal of Establishment

    *Auto transfer of previous PF account would be possible in respect of Aadhar verified employee only. Other employees are requested to file physical claim (form 13) for transfer of account
    from the previous establishment.

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