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  • Form 11 Revised Back To Back 2 Pages

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    Sarsij Mishra
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    Form 11 Revised Back to Back 2 Pages

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    11 visualizzazioni2 pagine

    Form 11 Revised Back To Back 2 Pages

    Caricato da

    Sarsij Mishra
    form

    Copyright:

    © All Rights Reserved
    Scarica in formato PDF o leggi online su Scribd
    Segnala contenuti inappropriati
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    3 Form No. 11 (New) Declaration Form {To be retained by the Employer for future raarence) = Employees’ Provident Fund Organization THE EMPLOYEES! PROVIDENT FUNDS SCHENE, 1052 PARAGRAPHM 857 2 \SION SCHEME, 1995 PARAGRAPH24) DEOLARATION BY A PERSON TAKING UP EMPLOYMENGTRN ESTAGUSHIENT ON WHICH EMPLOYEES’ PROVIDENT FUND SCHEME tes hoon Ecc Pon sco APS (PLEASE GO THROUGH THE INSTRUCTIONS) ‘THE EMPLOYEES’ 1, Name (Title) Mr. Ms. Mrs. T (Please Tick) TEI 2 Dateot Bh 8. FatharsiMusband Name Mr, [= es) |e eee + fee 6. Mobile Number & any) y. E-mail I (# any) Yes NO) 8. Whether Earlier A Member ef the Employee's Provident Fund Scheme, 1952? (Please Tick) ves NO. 8. Whether Earlier A Member of the Employee's Pension Scheme, 1995? (Please Tick) It Response to Any or Both of (8) & (9) Above is Yes, Then Mandatorily Fill Up the Previous Employment Details At (10,14 & 12) ‘A. PREVIOUS EMPLOYMENT DETAILS : : 40. The Details of the Universal Account Number (UAN) or Previous PF Member ID. UAN OR, Fiegion Code Office Code Establishment ID Extension Account No. Previous PF Member ID Do MM yyyy 11. Date of Ext For Previous Member ID (ODMMYYYY) 12. (A) lf Scheme Certificate Issued For Previous Employment, Then Scheme Certificate Number (6) I Pension Payment Order (PPO) Issued For Previous Employment, Then PPO Number 8. OTHER DETAILS: ves No. 13, ~ International Worker (Please Tick) IF THE REPLY TO (13) ABOVE IS YES, THEN ENTER THE DETAILS IN 13 (A), 19 (B) & 13 (C): INDIA Other Than ina (Yee. Plase Menon Name the Coury) 19(A) County of Ogi (Pease Tick) Passport Number eae pace eet ae Do MM ¥YyyYy do MM yyy y 19(C) Passport Vals From To erate _Non-Matie Matic Sr.Sec. Graduate P.Graduate Doctor _ Tech. Prot 14, Educational Qualification (Please Tick) jestvEs1 pms, Page no. 47 45, Matta Status Maced Unmarried WindeyWidowsr Divorce (Please Tick) I 16. Specialy Abled ves NO. It¥es, Tick the Category -Lscomotive _Visuel_ Heating (Please Tick) aS cae KYG Document Type ‘Name as on KYC Document Number Remarks, Wany Bank Account IFSC Code™ NPR/Aadhaar Permanent Account Number (PAN) Passport Expiry Date Driving Licence Expiry Date Election Gard = Ration Gard aa = ESIC Gard {e i * Mandatory Field (Note = Bank Account Number (Alona with IFSC Code) ie Mandatory. You are however advices *> provide all KYC dovuments avallablo \sith you in acdition to Mandatory KYCs to avail better services. Sel-Attssied Photocopies of the docurnents must 3e attached with this form. JERTAKING : | Certify thet ail the information given above is true to the best of my knviledge and belief. {m cave, earlier a member of EPF Scheme, 1952 and/or EPS, 1995, (1) [have ensured the correctness of my UAN/Previous PF Member ID. (ll) This may also be treated as my request for transfer of funds and service details if applicable from the provisions ‘account as delcared above to the present P.F. Account (The transfer would be possible only i the identified KYC.

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