Employees' Provident Fund Organization

Page 2 of 3
A.
PREVIOUS EMPLOYMENT DETAILS
10)
THE DETAILS OF THE UNIVERSAL ACCOUNT NUMBER (UAN) OR PREVIOUS PF MEMBER ID:
UAN
OR
PREVIOUS PF MEMBER ID
R
EGION
C
ODE
O
FFICE
C
ODE
E
STABLISHMENT
ID
E
XTENSION
A
CCOUNT
N
UMBER
11)
DATE OF EXIT FOR PREVIOUS
MEMBER ID (DD/MM/YYYY)
D D M M Y Y Y Y
12)
(A) IF SCHEME CERTIFICATE ISSUED FOR PREVIOUS EMPLOYMENT, THEN SCHEME CERTIFICATE NUMBER:___________
(
B
)
I
F PENSION PAYMENT ORDER
(PPO)
ISSUED FOR PREVIOUS EMPLOYMENT
,
THEN
PPO
NUMBER
:______________
B.
OTHER DETAILS
13)
I
NTERNATIONAL
W
ORKER
(PLEASE TICK)
Y
ES
N
O
IF THE REPLY TO (13) ABOVE IS YES, THEN ENTER THE DETAILS IN 13(A), 13(B) & 13(C):
13(A) COUNTRY OF ORIGIN (Please Tick)
INDIA OTHER THAN INDIA (IF YES, PLEASE
MENTION NAME OF THE COUNTRY)
13(B) PASSPORT NUMBER ______________________________
13(
C
)
P
ASSPORT VALID FROM
To
14)
EDUCATIONAL
QUALIFICATION
(P
LEASE TICK
)
I
LLITERATE
NON-
MATRIC
M
ATRIC
SENIOR
SECONDARY
G
RADUATE
POST
GRADUATE
D
OCTOR
TECHNICAL/
PROFESSIONAL
15)
MARITAL STATUS
(PLEASE TICK)
MARRIED UNMARRIED WIDOW/ WIDOWER DIVORCEE
16)
S
PECIALLY ABLED
(PLEASE TICK)
YES NO IF YES, TICK THE CATEGORY
L
OCOMOTIVE
V
ISUAL
H
EARING
D D M M Y Y Y Y
D D M M Y Y Y Y
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