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eksckby la-@ Mobile Number

Form 10C ( ) Page 1 of 4 eksckby la-@ Mobile Number dsoy dk;kZYk; ds iz;ksxkFkZ @ For Office Use Only nkok la[;k@Clam .. fudklh ifjYkkHk@;kstuk ds nkos gsrq iz;ksx fd;k tkus okyk izi= 10 lh FORM 10C FOR CLAIMING WITHDRAWAL BENEFIT/SCHEME CERTIFICATE deZpkjh isa ku ;kstuk] 1995 EMPLOYEES PENSION SCHEME, 1995 izi= Hkjus ls igys funsZ kksa dks i<sa+@(Read the instructions before filing up this form) ;fn lnL;rk 180 fnu xSj va knk;h lsok dks NksM+ dj ] ls de dh gS rks izR; ykHk ns; ugh gSaA WITHDRAWAL BENEFIT IS NOT ADMISSIBLE IF MEMBERSHIP IS LESS THAN 180 DAYS EXCLUDING NON CONTRIBUTING PERIOD 1. d lnL; dk uke Li V v{kjksa esa @ Name of the Member (In Block Letters): _____ [k nkosnkj dk uke Name of the claimant (s): _____ 2.}

Form 10C (www.epfindia.gov.in ) Page 3 of 4 vfxe ikfIr jlhn Advance Stamped Receipt ¼dsoy Åij ¼[k½ ds ekeys esa gh iLrr fd;k tk,½ [To be furnished only in case of (b) above]

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