Joint Declaration of EPF by the Member & Employer

Date: / /
To
The Regional PF Commissioner,
Thane

Subject: Joint Declaration by the Member & Employer

Dear Sir,
I, ______________________________, an employee ________________________. , furnishing below herewith
correct details with aforesaid establishment:-

Establishment Code: ____________________________

Particulars Correct Wrong Entry in my A/C

Name
Father/Husband Name
EPF/EPS Account No.
UAN Number
Date of Birth (DD/MM/YYYY)
Date of Joining (DD/MM/YYYY)
Date of Leaving
(DD/MM/YYYY)
Aadhaar No.

I also have enclosed herewith the self attested copy of ID proof (Any one- PAN Card, Voter ID Card, Passport,
Driving License, Adhaar Card) for your ready reference.

Therefore, you are requested to make the necessary changes in your records (if required) under information to me.
An early action in this regard will be highly appreciated.

Yours faithfully,
Name & Signature of the applicant:

Signature of AO(C) with Establishment Seal:

Encl.: As above