FORM 13 ( Revised) - SSSomega

1 For Office Use Only(Inward No. & Date :ToThe Commissioner,Employees' Provident FundsSir,12345678 Date : Signature / Left Hand Thumb impression of the memberTO BE FILLED BY THE PRESENT EMPLOYER910111214 Date : Signature Employer / Authorized official with SealInwhosefavourtransferiftobeeffectedi spayee'sdetailsBy whom the PF account of the present estt. Is kept(2) By Sub Regional office at :(1) By Regional office at : (1) By Regional office at : (2) By Sub Regional office at (1) By exempted PF Trust, Viz : (2) By private PF Not covered under the Act, Viz :Being an unexempted establishmentBeing an exempted Account Number alloted to the member seperately, if anyBy whom the PF account of the present estt.)

2 Is keptName and address of the factory/Establishment Account Number alloted to the Account Number with the previous Account Number with the previous employerDate of Joining the present employerDate of leaving Service with previous employerFORM 13 ( Revised) EMPLOYEES' PROVIDENT FUND SCHEME, 1952 Name of the MemberFather's/ Husband's NameIRequestthatmyProvidentFundbalanceal ongwithmembershipdetailsinFamilyPensionF undsmayPleasebetransferredto my present account under intimation to me. Necessary particulars are furnished below :'APPLICATION FOR TRANSFER OF EPF ACCOUNTN ameandaddressofthefactory/Establishmenti nwhich the member was last whom the PF account of the previous estt.

3 Is keptid35481312 pdfMachine by Broadgun Software - a great PDF writer! - a great PDF creator! - ( For the use of Office Only ) by Cheque No. _____ dated _____Cashier / ClerkSection (Rupees_____isauthorizedfortransfer,vide AnnexureK.( Revised) Transferproceedstobe sent along with Annexure 'K' ( revised ) 'sledgercordbearingnumber_____intheprese ntestablishment,fromtheLedgerCardbearing number_____ofthePrevious intimation copy of Annexure-K ( revised ) to the member placed below.)