(From No.

13 Revised)

FOR OFFICE USE ONLY

Date

Seal / Reg No.

THE EMPLOYEES PROVIDENT FUNDS SCHEME, 1952

(Paragraph 57)
(APPLICATION FOR TRANSFER OF EPF ACCOUNT)
Note: (i) To be submitted by the member to the present employer for onward transmission to the
Commissioner, EPF by whom the transfer is to be effected.
(ii) In case the P. F. transfer is due from the P.F. Trust of an exempted establishment, the application
should be sent direct by the employer to the P. F. Trust of the exempted establishment, with a copy
to the RPFC concerned for details of the Pension membership.
To,
The Commissioner.
Employees' Provident Fund'
________________________________

To,
M/s_______________________________

________________________________

__________________________________

________________________________

__________________________________

__________________________________

(To be filled in, if Note (ii) above is applicable)

Sir,
I request that my Provident Fund balance may please be transferred to my present account under
Intimation to me.
Necessary particulars are furnished below: 1.

Name___________________________________________________________________

2.

Father's Name (or Husband's name in case of married woman)______________________

3. Address of the member: ______________________________________________________

____________________________________________________________________________
4.

Name & Address of the Previous Employer): ______________________________________

_____________________________________________________________________________
5.

EPF account Number with the Previous Employer:_________________________________

By whom the PF account of the previous estt is kept________________________________

A) Regional P.F. Commissioner at._____________________________________________
B) Name of the P. F. Trust ___________________________________________________

7.

EPS account Number with the previous employer (if allotted a separate One):____________

8.

Date of Leaving service with previous employer: __________________________________

9.

Date of joining the present employer:____________________________________________

Date ______________

X
Signature of the Member

To be filled in by the present employer

CIPLA LIMITED .

10. Name and address of the establishment:

11. EPF Account No. allotted to the member:

__

_ ___

12. EPS Account No. allotted to the member separately, if any:

Not Applicable

13. By whom the EPF account of the member in the present establishment is kept_________________
Being an unexampled establishment

1) By Regional Office at _
-----N.A.-----_______
(Station)
2) Sub-Regional Office at_-----N.A.-----_______

Being an exempted establishment

3) By Exempted PF Trust, viz _-----N.A.-----_______

4) By Private PF Trust, recognized under the Income

Tax Act- viz CIPLA LIMITED
EMPLOYEES PROVIDENT FUND

Not Applicable

14. By whom the EPS Account of the member

in present establishment is kept.
15. In whose favour transfer is lo be effected.
i.e. payees details

: CIPLA LIMITED
EMPLOYEES PROVIDENT FUND

Date:

CIPLA LIMITED
EMPLOYEES PROVIDENT FUND

Trustee

Trustee

_____________________________________________________________________________
(For the use of P.F. Office Only)
A sum of Rs.___________________(Rupees______________________________ is authorised
for transfer, vide Annexure 'K' (Revised) Transfer proceeds to be sent alongwith Annexure K (Revised)
By D. D. to the Regional PF Commissioner/Officer - in charge of Sub-Regional office
_________________ By D. D. to the P.F. Trust of the establishment with reference to details in Serial No.
14 above.
Membership details under Pension Fund forwarded to P.F. Regional Office/Sub-Regional Office
at__________________________________________
By transfer entries to the Members Ledger Card bearing Number_____________________in the
Present establishment from the Ledger card bearing Number ________________________of the
Previous establishment.
Transfer intimation/ copy of Annexure-K (Revised) to the member placed below.
Scroll No.

Clerk

H.C.

A.A.O

A.O./A.P.F.C.

P.I. No.
Paid by cheque No______________________Dated_____________________

Cashier / Clerk

Head Clerk

A.P.F.C.