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Non Employment Certificate Self Declaration by The Member/Claimant

This document is a self-declaration form for an individual claiming non-employment status. The individual declares that they were previously employed by Adecco India Pvt. Ltd. but left the job on a certain date and has not been employed by any other organization covered under the Employees' Provident Fund scheme since then. They also declare that they are not receiving any pension benefits under the Employees' Family Pension or Employees' Pension Scheme. The individual agrees to return any pension received in full if their declaration is found to be false.

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Kumar Abhishek
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14K views1 page

Non Employment Certificate Self Declaration by The Member/Claimant

This document is a self-declaration form for an individual claiming non-employment status. The individual declares that they were previously employed by Adecco India Pvt. Ltd. but left the job on a certain date and has not been employed by any other organization covered under the Employees' Provident Fund scheme since then. They also declare that they are not receiving any pension benefits under the Employees' Family Pension or Employees' Pension Scheme. The individual agrees to return any pension received in full if their declaration is found to be false.

Uploaded by

Kumar Abhishek
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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NON EMPLOYMENT CERTIFICATE

SELF DECLARATION BY THE MEMBER/CLAIMANT

I ………………………………………………………………………………….. S/o, W/o, H/o ………………………………………………………………………….

Residing at ………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………………… do hereby solemnly affirm

and sincerely state as here under:

I …………………………………………………………………………… S/o, W/o, D/o ………………………………………………………………………………..

Declare that I was an employee of M/S Adecco India Pvt. Ltd. Bearing PF A/c No. PY/BOM/34272/……………………………

and left the job on ………………… and that I had not been employed in any other establishment covered under the EPF

Scheme 1952, after the date of leaving service from the above establishment.

And that I declare that I am not in receipt of any pensioner benefits under Employee’s Family Pension -

1971/Employee’s Pension Scheme 1995. That what is stated above is true and correct to the best of my knowledge. In

case, my above declaration is found to be false, I undertake to return the pension in full with interest as declared by

EPF Organization and I am liable for any action that may be initiated by EPFO in this regard.

Solemnly affirmed at

SIGNATURE OF THE MEMBER

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