EMPLOYEES' PROVIDENT FUND SCHEME, 1952 …

employee (Personal)For office use OnlyRegd. No. _____EMPLOYEES' PROVIDENT fund SCHEME, 1952 FORM - 19 Form to be used by a major member of the Employees' PROVIDENT fund Scheme, 1952 for claiming the Employees' PROVIDENT fund dues [ Para 72 (5) ]1. Name of the member (in block letters)2. Father's Name (or husband's Name in the case of married women)3. Name and Address of the Factory/Establishment in which the member was last employed4. Account No. (PF No.)5. Date of leaving Service6. Reason of leaving Service7. Full postal address (in block letters) W/o D/oPin Mode of RemittancePut a 'Tick' in Box against the one opted(a) By postal Money Order at my costTo the address given against item No. 7(b) By account payees cheque No.

Employee code Mobile No. E-mail-ID (Personal) For office use Only Regd. No. _____ EMPLOYEES' PROVIDENT FUND SCHEME, 1952 FORM - 19 Form to be used by a major member of the Employees' Provident Fund Scheme, 1952 for claiming the Employees' Provident Fund dues [ Para 72 (5) ]

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