APPLICATION FORM TOWARDS PROVIDENT FUND SETTLEMENT te, TheTrustess, Application No. Teamlease Services Limited EPF Trust. vate [20 To [61116] vps, (EESICIPTAINTAL [TAINTAINTSIATTETEL TBIEIRIATET 11] ceased to be an employee of Teamlease Services Limited, with effect from [| | [|_|] on account of:- (Mention your st working oy) aye, OSHIALCCBRAN ETAL IBITIRIBTRIEL TT] rominee) submit the application ontehatfmy [LETT IIT) mms.( LP EEE LETT TTT Li) whoceased to be an employee of Teamiease Services Limited, with effect from [| [| [| |] onaccount of please f(t the cient Seif or please fi in) if he claimant i Nominee) Gtr of whichever isnot applicable Eefretiement LL] Media untiness [LJ Death — (SPendof contact [7] Permanent setement abroad ee os () ves (1 teonination [) others isecisn ‘plea ick whichever appicabie) You are requested to settle my ___Provident Fund a/c at the earliest | hereby solemnly declare that since last two months, | am not employed in any establishment to which EPF Act of 1952 is applicable, | also authorize the Trustees to deduct Tax at source { TDS) as applicable in my case* 1 3766/Claimant {please enclose alte fom the cure employe if employed and not covered by EFF Ac 1952 TENPLOVEE PARTICULARS ( TO BE FILLED IN BLOCK LETTERS) 1) Name ofthe Employee pris. KALPANA. AHDUSANE PLA, 2) Addess for Communication AP... AU. DHANE....TALc BAe LA a (oles tate the atess where you. desire DNS To ASI ee foryour cheque tobe sent! Phone: LAYL2LIYIR emai qshujadhav 234@ 3 mai) co. 3 Location’ Unit IMAHA— AAsHIA| 5 PF NO. [BG/BNGI0035224009/05. Transferin Cy [Cds “Employes Code (8050 |SE°SNO] BG/BNG/0035224/ ‘8 Tansferin Date 3 bate of sith D1 | 1992-| 10 date of ining .4/]qg) 2013 [1 bate of fining PF [ol fos|ass 12 Bank weno. 0493 10400019 29 bank Name and Address HEC Bank, Pimpalyaon ak Y22b IFSC Code, (Enclose Cancelled Cheque Leaf): L{DEC 0000 F243 | T3PANNO. Ag manda f Under x racket) “V4 Nomination details: @o be fled incase of doa) ame ofthe Norarces feltion pecentane Mother — Usha. Mather 50} Fother — f housaheb Fathox 50} [ADVANCED STAMPED RECEIPT ARs, Received a sum of Rs. — om ) only from Teamlease services Limited EPF Trust by deposit in my savings bank account towards the settlement of my PF Fund : Signature or let hand thumb impression or the member on the stamp TEAMLEASE SERVICES LIMITED EPF TRUST. ‘ACKNOWLEDGMENT FOR RECEIPT OF PF SETTLEMENT APPLICATION FORM pplication No. ence 10 55.8020... aneotretnploee LALPARA-BHAUSABER. QIBDBT sora sonal Rorecina 03INSTRUCTION FOR FILLING IN THE APPLICATION 70s is applicable if your membership_is less than 5 years and if you have taxaole nce, AN of the previous years during service. No TDS is applicable if you wish to transfer the accumulations to your present employer (if any) 4, SnNo.5-ThePFno. allotted tothe employee should be entered, the sameis availablein salary slip. 2 SeNlo.6- TheEPSNo. allotted tothe employee should be entered, itis same as PF number 3, Se.No.7- Ifthe applicant has transferred his previous PF accumulations to the current PF alc, the applicant should tick "Y" or else”"N” if there is any previous Transfer in to the current PF a/c. 4, S4No.10-The Date of Joining the Company by the employee should be entered 5, SiNo. 11- The date of joining the PF membership by the employee should be entered PF membership ae the date from which the member commenced contribution to PF. Incase the member of PF in hisfher previous employment. Then that datehas to bementioned. General The application should be signed by the HRY Unit Head/ Coordinator before forwarding to Bangalore ore date of forwarding the application should also be entered for better tracking of applications Form 10C/ 10D should be filed and enclosed with the application, the sameshall be forwarded to RPFC accordingly. (Form 10C Is to be filed in for settlement of pension by RPFCf the applicant has not completed 10 years of eligible servce- Form TOD tobe fled in for settlement of pension by RPFC ifthe ‘applicant has completed 10 years of eligible service.) If you are in need of any further inputs or clarification, please send your queries to infecteamlease.com with captioned subject and with your employee code oF please call us on 080 - 60000655