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PF Declaration

This document is a Nomination and Declaration Form for the Employee's Provident Fund and Employee's Pension Scheme, detailing personal information of the subscriber, Gaurav Singh, including his name, father's name, date of birth, and marital status. It includes a section for nominating beneficiaries to receive provident fund amounts in the event of the subscriber's death. The form also contains declarations regarding the subscriber's family status and dependencies.

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kumsaurav2941
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15 views1 page

PF Declaration

This document is a Nomination and Declaration Form for the Employee's Provident Fund and Employee's Pension Scheme, detailing personal information of the subscriber, Gaurav Singh, including his name, father's name, date of birth, and marital status. It includes a section for nominating beneficiaries to receive provident fund amounts in the event of the subscriber's death. The form also contains declarations regarding the subscriber's family status and dependencies.

Uploaded by

kumsaurav2941
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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Date of Appomtment 0oD

P.F Deduction dalo): FORM 2 (REVISED)

NOMINATION & DECLARATION FORM


FOR UNEXEMPTED/EXEMPTED ESTABLISHMENTS Group No.:
Office
Declaration and Nomination Form under the Employee's Provldent Funds
and Employee's Pension Scheme

(Paragraph 33 & 61 (1) of the Employee's Provident Funds Scheme, 1952 and
Para 18 of the Employee's Penslon Scheme, 1995)

1 NAME (in block letlers). GrAURAV INGH_


2 FATHER'S HUSBAND'S NAME: Mx: RAK£SH BAB
3 DATE OF BIRTH 15l02/1294 4. SEX MALE
(Male/ Female)
5 MARITAL STATUS:
Married7Unmarcied7Widow 7Widower)
6 ACCOUNT NO. :50l00423122616
7. ADDRESS IO2a0AAL ILAlME SaRTA IHAR
NEW DELHI=lfo0 46_

PART-A (EPF)

and nominate the person(s),mentioned


I hereby nominate the person(s) i cancel the nomination made by me previously
credit in the Employee's Provident Fund in the event of my death
below to receive the amount standing to my

Total amt. Or share &the nominee is minor.name


relationship & add. Of the
Nominee's of accumulaion in quardian who may
Name& Address of the Nominee(s) relationship with | Date o BirtnPF to be paid to receive
the amount during minority
the member each nominee of nominee

(4) 5)
(1) 2) (3)
RAKESH BABU EATHER lo5/p6li9IDo1

C-35AALLVIH AR
SARNA VIHAR
NGu-DLH-UD06-

Provident Funds Scheme, 1952 &


defined in para 2 (g0 of the Employee's
1. Certified that I have no family as cancelled.
deemed
above nomination should be
as
I acquire a family thereafter the
upon me.
2. Certified that my father / mother is / are dependent

C)Strike Out whichever is not applicablee


SIGNATURE OR THIWIB-MPRESSION OF THE SUBSCRIBER

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