Transcription of NOMINATION AND DECLARATION FORM - …
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NOMINATION AND DECLARATION FORM - …
1:2:3:4:5:6:7 Address Permanent:Temporary:8 Date of Joining:EPF:EPS:Nominee's relationshipDate of Total amount of share ofwith the memberBirthaccumalation in providentfund to be paid to each nominee234123 Unmarried members in the absence of dependent parents may nominate any other person to receive the sharesNote: A Fresh NOMINATION shall be made by the member on his/her marriage and any NOMINATION made before such marriage shall be deemed to be invalidaddress & relationship of theCertified that my father / mother is / are depended upon or thumb impression of the SubscriberFORM - 2 ( Revised) NOMINATION AND DECLARATION FORMFOR EXEMPTED / UNEXEMPTED ESTABLISHMENTSD eclaration and NOMINATION form Under the Employee's Provident Funds & Employees' Pension Scheme5(Paragraph 33 & 61 (1) of the Employees' Provident Fund Scheme, 1952 & Paragraph 18 of the Employees's Pension Scheme, 1995)Name ( In Block Letters)Name & Address of theif the nominee is minor name &Account NumberMarital StatusSexFather's / Husband's NameDate of BirthCertified that I have no family as defined in para 2 (g)
S.No Date of Birth Relationship 1 2 3 4 5 Date of Birth Date : x Place: Date : Signature of the employer Name & Address of the Establishment Name & Address of the ...
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