www.epfindia.gov.

in

Composite Declaration Form -11

(To be retained by the employer for future reference)
EMPLOYEES' PROVIDENT FUND ORGANISATION
Employees' Provident Funds Scheme, 1952 (Paragraph 34 & 57) &
Employees' Pension Scheme, 1995 (Paragraph 24)
(Declaration by a person taking op employment in any establishment on which EPF Scheme, 1952 and /or EPS, 1995 is applicable)

I Name of the member

2
Father's Name D
Spouse's Name
D
3 Date ofBirth: ( DD/ MM I YYYY )

4 Gender: (Male/Femaleffransgender)
5 Marital Status: (Married/U nmarried/W idow/W idower/Divorcee)
(a) Email ID:
6
(b) Mobile No.:
Present employment details:
7 Date of joining in the current establishment (DD/MM/YYYY)

KYC Details: (attach selfattested copies of following KYCs)

a) Bank Account No. :
8 b) IFS Code of the branch:
c) AADHAR Number
d) Permanent Account Number (PAN), if available
Whether earlier a member of Employees' Provident Fund Scheme, Yes/No
9
1952
10 Whether earlier a member of Employees' Pension Scheme, 1995 Yes/No
Previous employment details: (if Yes to 9 AND/OR 10 above I - Un-exempted
Establishment Universal PF Account Date of joining Date of exit Scheme PPONumber Non
Name & Address Account Number (DD/MM/ (DD/MM/ Certificate (if issued) Contributory
Number YYYY) YYYY) No. (if Period
issued (NCP) Days

11

Previous employment details: (if Yes to 9 AND/OR 10 above) - For Exempted Trusts

Name & Address of the Trust UAN Member Date of Date of exit Scheme Non
EPS Ale joining (DD/MM/ Certificate Contributory
Number (DD/MM/ YYYY) No. (if Period (NCP)
YYYY) issued Days
12

a) International Worker: Yes /No

13 b) If yes, state country of origin (India/Name of other country)

c) Passport No.

d) Validity of passport [(DD/MM/YYYY) to (DD/MM/YYYY)]

 UNDERTAKJNG

I) Certified that the particulars are true to the best of my knowledge.

2) I authorize EPFO to use my Aadhar for verification/authentication/e-KYC purpose for service delivery.
3) Kindly transfer the funds and service details, if applicable, from the previous PF account as declared above to the present P.F.
Account as I am an Aadhar verified employee in my previous PF Accounl *
4) In case of changes in above details, the same will be intimated to employer at the earliesl

Date:
Place: Signature of Member

DECLARATION BY PRESENT EMPLOYER

A. The member Mr/Ms/Mrs ......................................................................... has joined on ......................................... and has been

allotted PF No.......................................................................and UAN ................................................................................................ .

B. In case the person was earlier not a member of EPF Scheme, 1952 and EPS, 1995:
• Please Tick the Appropriate Option:
The KYC details of the above member in the UAN database
D Have not been uploaded
D Have been uploaded but not approved
D Have been uploaded and approved with DSC/e-sign.

C. In case the person was earlier a member of EPF Scheme, 1952 and EPS, 1995:
• Please Tick the Appropriate Option:-
0 The KYC details of the above member in the UAN database have been approved with E-sign/Digital Signature
Certificate and transfer request has been generated on portal.
D The previous Account of the member is not Aadhar verified and hence physical transfer form shall be initiated.

Date: Signature of Employer with Seal of

Establishment

*Auto transfer of previous PF account would be possible in respect of Aadhar verified employees only. Other employees are requested to
file physical claim (Form-13) for transfer of account from the previous establishment.
 Instructions for completing the Declaration Form 11

The Employee Provident Fund Form 11 needs to be completed by all new joiners to Open Text. To ensure smooth
and timely processing, please ensure to follow these instructions:
• This is a pdf writable form. Please fill the form in legible and block letters only. Do not Print and scan.
• Please complete the form in English.
• Please do not include your title (Mr/Ms/Mrs) in any of the fields relating to you, your spouse’s, father’s
etc name.
To assist you in completion of this form, please follow the below instruction:
#1, #2, #3, #4 : Please fill these details as per Aadhaar Card
#5 : Marital Status

#6: Please provide your personal email address and mobile number on which formal communication can be
established
#7: Date of Joining at Open Text entity
#8: KYC Details and the Copies of same
#9: To be ticked 'YES' only if earlier you held a PF account with previous employer
#10: To be ticked 'YES' only if earlier you held a EPS account with previous employer.
#11: Pr ev i ous Empl oy er Detai l s

a) Establishment Name and Address

b) Universal Account Number (UAN)
UAN is 12 digit number which has been allotted by EPFO and provided to the EPF member through
employer. To check whether you have been allotted UAN against your PF member ID, please go to the
UAN Member e-sewa on EPFO website www.epfindia.gov.in and click on Know your UAN status.
c) Please enter your Previous employment P.F. member ID (Example below):

REGION CODE OFFICE CODE ESTABLISHMENT ID EXTENSION ACCOUNT NUMBER

12345 000 123

MH BAN

d) Date of joining (DD/MM/YYYY) i.e. Date on which member has started to work in the previous
establishment.
e) Date of Exit (i.e. Date on which member has ceased to work in the previous establishment)
f) Scheme Certificate No. if issued
g) PPO Number if issued
h) Noncontributory period (NCP) Days

#12: Pr ev i ous Empl oy er Detai l s i n c ase of T rust

a) Name and Address of Trust

b) Universal Account Number (UAN)
UAN is 12 digit number which has been allotted by EPFO and provided to the EPF member through
employer. To check whether you have been allotted UAN against your PF member ID, please go to the
UAN Member e-sewa on EPFO website www.epfindia.gov.in and click on Know your UAN status.
c) Please enter your Previous employment E.P.S. member ID (Example below): Refer to your payslip
 REGION CODE OFFICE CODE ESTABLISHMENT ID EXTENSION ACCOUNT NUMBER

12345 000 123

MH BAN

d) Date of joining (DD/MM/YYYY) i.e. Date on which member has started to work in the previous
establishment.
e) Date of Exit (i.e. Date on which member has ceased to work in the previous establishment)
f) Scheme Certificate No. if issued
g) Noncontributory period (NCP) Days

#13: I nter nati onal W o r ker Dec l ar ati on – Appl i c abl e i f i ndi v i dual has oth er than
I ndi an pas s p or t

Undertaking: This section needs to be filled in wet ink.

Please fill the date, place and provide wet signature in the space provided.

Declaration by Present Employer: DO NOT fill anything in this section