*A20045941* NAME OF THE TRUST APPLICATION FORM TOWARDS PROVIDENT FUND SETTLEMENT. To Date The Trustees 1.1, Me Ms. ceased 10 be an employee of Mis, with effect from ‘on account of = 2.1, Mr / Ms. (nominee) submit the application on behalf of my MMs, who ceased to be an employee of MVS. with effect trom on account of {ptoaeo fl (1) the clsiment fe Sa or pesca ft (2) The Samant Norio) (ake off wigheveis nt apple) LE [Retement [IE] | Mectcal untiness |] | Death [IE] | End of Contract [IU] | Permanent Seement Abroad L [Restoration [ET | Revencimen [ED] vas [EI| termnaton [E] | ommssar | E] | Otners enoonp ‘Please Tek which appcaiay You are requested to settle my Provident Fund ale at the earliest | hereby solemnly declare that since last two months, | am nol employed in any establishment To Whidh EPF Act 1952 Act fs applicable. (stnke oi not applicable) Signature of the employee / claimant Please encase alle rom the curent employer employed, and not covered by EPF Act 1952 EMPLOYEE PARTICULARS (TO BE FILLED IN BLOCK LETTERS) Me 1 Name ofthe Employes Me. Ms. 2. Adsiess for Gommunioation (Ploase stata the adress where you dose ‘fo your Cheque / DD to be sent Prone ena 3. Location / Unit SPF, 7. Transfer in Oy [On 7 Salary code Rol Na 6.EPS Nea © Tanafor in Dale 8, Date of Bh 0, Date of Joining Go. Fi. Date of Joining PF| 1 [oreque [5 | oo ro Db Payable at +3. PAN 12, Mode of ; Send Cheque —| BAAR Naw a payment §— | C1 | &°S | | bret to Bank | Bank Address ‘Bank Ale No. "TE Nomination dotale foo ied case oda) Name ofthe Nominges elation Percentage ee hs. Mont | Amount (Rs, 16. Enclosures Y [ON | NA 2. Last Salary Drawn (ek opprpite bones whore appeal) PIF let deducts & Form ¥6 member on yar rat eto ya) CNPF last doaucted Visa Copy (incase of goa abroad) Any other Gontrbuiton Death Gorieate fin ease of death ©: PF Loan O15 an) &. Doctors Corifiate (in case of maar ntras) PF Loan int. O18 fy @. Wage Sheet (nese of casual employee) T Discharge Letor Wom the Company. tn caas at HRVUnit Head! Terminaton/jemiseaietienont) l provid bythe company Coe teed ‘@. Final settiement Computation sheet 1 Fave you submited your application forms for setlemont Roe taeen of GrtutySuperannuaton(epptcabie) ‘TAny other document (ase spect) [Note 1, Please ase overleaf for instructions, to know the status of your application (provided your company has subscribed ta Web access feilly) 2: Please send In your querles fo Infohos @hewit.cam.with the name of the company as captioned subject 4: You can og ina nox benoraysind.com fo ow the status of our applation provided your company has subscribed to web acess lly) 44 Please quote the application reference no. forall your further co {E PHOTODOPIES OF TE FORM SHOULD NOT BE USED WHILE SENDING APPLICATIONS