Nokia Solution And Networks EPF Trust LS, L6, Ground Floor to 6" Floor, Manyata Embassy, Business Park, Outer Ring Road, Hebbal, K R Puram Section Nagavara, Bangalore ~ 560045 Provident Fund Settlement Application ‘The Trustees, Dear Sir(s), Dated: |° 12-2021 Thereby request you to pay the full amount standing to my credit in the fund after making such deductions as may be authorised under the Provident Fund Trust ies Income Tax Act 1961. My particulars are as below: All details are Mandato1 a. | Name of the Member ry. mol KaShinath Patil. A 2 Father’s/Husband’s Name Kaghinath Dheme Pasi) 3. | Employee's Code No. C2043 Bos, 4. | Location/Unit hum bas 3. _ | P.F. Account No. knl 23336 / 1122832 6. | Date of Birth 15: G02 i494 z.__| Nationality — andiGs 3. | Date of joining 8-11. 2016 9. _| Date of leaving service §-0%°2020 30, | Reasons for leaving service MS Gfactions: Finished 11, | Complete Postal address with PIN Code |=] Amol K> Patil Filed NO Fed Bes lding eat ue nog. pacbhat” spy a vencione ecard er PF) |Gawand bavgh, Thane) 40c6Jo 12, | Personal E-mail-id #) @ms| PAt19736C,9mai |r Com 33. | Mobile Number 992950 544568 a4, | Residence Phone No. with STD code G920054368 Permanent Account Number — PAN AMSPPII Jet{Also enclose self-certified true copy of the PAN Card ) 5. ik Ac t “ a6 | Members Saving Sark Accoone 60570154355) 17. | Name of the Bank and full address of | : Telecel Bank the Branch with PIN Code Thane Gor hale Road shop N -athare Beild ing, more fo devi Mo Gt econ wcnctet roe | Ge Hr i gone 1s, |* Enclose, self-certified true copy of || Enclosed for the vears:, in i v4 Form 16 from the date of joining to date of leaving, in case the employee is | | ii. having membership for less than 5 years. | certify that the particulars given above are true to the best of my knowledge. 1 declare that I have not been employed in any factory or other establishment to which the Employees’ Provident Funds and Miscellaneous Provisions Act, 1952 applies for a continuous period of not less than 2 months immediately preceding the date of my application for final withdrawal of my provident fund money. I further declare that I do not propose to join any job in India in the near future. T hereby agree and undertake to keep you harmless and fully indemnified from and against all losses, cost or damages, which you may suffer or incur due to my withdrawal of provident fund amount having being proved to be based on a false declaration at any time in future. Self-certified true copy of document(s) in support of my application is/are furnished/enclosed. ‘APPROVED For NOKIA SIEMENS NETWORKS EPF TRUST (Signature Of Member) Authorised Signatory “NOTE * To ensure tax deduction at appropriate rates, enclose Form 16 otherwise Received a sum deduction shall be made at highest applicable rate NOKIA SEMENS NETWORKS LS snusT « In case the member has migrated from towards full & final settlement of PF money India for permanent settlement / taking up including interest... employment abroad, please furnish a copy of visa,