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EPF - Form 2

1. This document is a nomination and declaration form for an employee's provident fund and pension scheme. 2. It requests information such as the employee's name, date of birth, sex, marital status, account number, address, and date of joining. 3. The employee nominates individuals as beneficiaries for the provident fund and pension scheme. For minors, the employee provides the name, relationship, and address of the guardian.

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Ankit Shaw
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224 views2 pages

EPF - Form 2

1. This document is a nomination and declaration form for an employee's provident fund and pension scheme. 2. It requests information such as the employee's name, date of birth, sex, marital status, account number, address, and date of joining. 3. The employee nominates individuals as beneficiaries for the provident fund and pension scheme. For minors, the employee provides the name, relationship, and address of the guardian.

Uploaded by

Ankit Shaw
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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FORM 2

(Revised) NOMINATION AND DECLARATION FORM


(For Unexempted/Exempted Establishments)

1. Name : Name

3. Date of Birth 4. Sex MALE

5. Marital Status 6. Account No. ____________________________

7. Address 8. Date of Joining

Permanent ______________________________________________________________________

Temporary ____________________________DO ________________________________________

PART A (EPF)
I hereby nominate the person(s)/cancel the nomination made by me previously and nominate the person(s),

Death
If the nominee
is a minor,
Total amount
name &
or share of
relationship &
accumulation
Name of the nominee/ relationship Date of Address of the
Address s in Provident
with the Birth guardian who
Fund to be
member may receive the
paid to each
amount during
nominee
the minority of
nominee
1 2 3 4 5 6

1. * Certified
should I acquire a family hereafter the above nomination should be deemed as cancelled.
2. *Certified that my father/mother is/are dependent upon me.

____________________________________
* Strike out whichever is not applicable Signature or thumb impression of the Subscriber
PART B (EPS) (Para 18)

I hereby furnish below particulars of the members of my family who would be eligible to receive
widow/children pension in the event of my death

Sl. Name and Address of the family member Relationship


Date of Birth
No. Name Address with member

1 2 3 4 5

nd
should I acquire a family hereafter I shall furnish particulars thereon in the above form.
I hereby nominate the following person for receiving the monthly widow pension (admissible under para
16 2(a) (i) & (ii) in event of my death without leaving any eligible family member for receiving pension.

Name and Address of the nominee Date of Birth Relationship with the member

Date : ________ ______________________________________


Signature or thumb impression of the subscriber

CERTIFICATE BY EMPLOYER

Certified that the above declaration and nomination has been signed/thumb impressed before me
by Shri /Smt./ Kum. _________employed in my establishment after he/she has read the entries have been
read over to him/her by me and got confirmed by him/her.

Signature of the employer or other


Authorized officers of the establishment _________

Designation _______________________________

Place _________
Date___________ Name and address of the Factory/
Establishment or rubber stamp thereof_____

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