Employees' Provident Fund Organization
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D
ECLARATION BY A PERSON TAKING UP EMPLOYMENT IN AN ESTABLISHMENT ON WHICH
E
MPLOYEES
’
P
ROVIDENT
F
UND
S
CHEME
,
1952 AND/OR EMPLOYEES’ PENSION SCHEME, 1995 IS APPLICABLE.
(PLEASE GO THROUGH THE INSTRUCTIONS)
1)
NAME (TITLE)
M
R
. M
S
. M
RS
.
(PLEASE TICK)
2)
DATE OF BIRTH
D D M M Y Y Y Y
3)
FATHER’S/
HUSBAND’S NAME
M
R
.
4)
RELATIONSHIP IN RESPECT OF (3) ABOVE
(P
LEASE
T
ICK
)
F
ATHER
H
USBAND
5)
GENDER
(P
LEASE
T
ICK
)
MALE FEMALE TRANSGENDER
6)
MOBILE NUMBER
(I
F ANY
)
7)
EMAIL ID (IF ANY)
8)
WHETHER EARLIER A MEMBER OF THE EMPLOYEES’ PROVIDENT FUND SCHEME, 1952 ?
(PLEASE TICK)
9)
WHETHER EARLIER A MEMBER OF THE EMPLOYEES’ PENSION SCHEME, 1995?
(PLEASE TICK)
IF RESPONSE TO ANY OR BOTH OF (8) & (9) ABOVE IS YES, THEN MANDATORILY FILL UP THE PREVIOUS EMPLOYMENT DETAILS
AT
(10,11&12):
YES NO
YES NO
Employees’ Provident Fund Organization
T
HE
E
MPLOYEES
’
P
ROVIDENT
F
UNDS
S
CHEME
,
1952
(P
ARAGRAPH
-34
&
57)
&
T
HE
E
MPLOYEES
’
P
ENSION
S
CHEME
,
1995
(P
ARAGRAPH
-24)
Declaration Form
(To be retained by the Employer for future reference)
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