Jioint Declaration Form

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Joint Declaration By the Member and The Employer

Date: 30/03/2022
To
EPF Sub Regional Office,
Employees PF Organisation
Sector-28, Akurdi Pradhikaran,
Pune – 411 044.

Sub: Joint declaration by the member and the employer for name/father name/date of birth correction bearing of Account No.
PUPUN0032147000
Our Establishment Code: PUPUN0032147000

Dear Sir,

I ROHIT GUPTA am/ was an employee / ex-employee of EVOLVE TECHNOLOGIES AND SERVICES PVT. LTD. furnishing below
herewith correct details with aforesaid establishment: -

PARTICULARS CORRECT WRONG

NAME ROHIT GUPTA NA

FATHER/HUSBAND NAME MOHAL LAL GUPTA NA

PF & EPS ACCOUNT No 101089715744/ PUPUN00321470000014632 NA

DATE OF BIRTH DD/MM/YYYY) 14/03/1995 NA

DATE OF JOINING DD/MM/YYYY) 15/12/2017 NA

DATE OF LEAVING DD/MM/YYYY) 30/03/2022 07/07/2020


I am also enclosing herewith self-attested copy of ID proof (Any one - PAN card/ Voters’ Identity Card/ Passport/ Driving License/
Aadhar Card) for your ready reference.
Therefore, you are requested to make necessary changes in your records (if required) under intimation to me. An early action in
this regard will be highly appreciated.
Yours Faithfully
Name & Signature of Applicant :
Above mentioned information in this letter is corrected and as per our office record and correct and wrong both person name is
same. If any wrong/over/excess/short payment done at the time of settlement of PF/EPS claim of after name correction by the
epfo office our company is fully responsible and company is refund withdraw (PF and EPS) amount.
Name of Authorized Signatory:

Signature with Establishment Seal:


Encl.: As Above

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