Joint Declaration by the Employee and the Employer

To: Date:
The Regional Provident Fund Commissioner,
____________________________________

____________________________________

Sub: Joint Declaration by the Employee and the Employer

M/s. : _____________________________________________________________
PF Code Number : _____________________________________________________________
Ref: Name of the Employee : _____________________________________________________________
PF Account Number : _____________________________________________________________
UAN : _____________________________________________________________
Dear Sir, Aadhar Number :
The following are the request for Correction in Employee Details which is furnished here below with wrong & correct
details.

PARTICULARS WRONG CORRECT

Name of the Employee
Father/Husband Name
Gender (Male / Female)
Date of Birth (DD/MM/YYYY)
Date of Joining (DD/MM/YYYY)
Date of Leaving EPF (DD/MM/YYYY)
Date of Leaving EPS (DD/MM/YYYY)
Mobile Number
Mr. / Ms. / Mrs.
Relationship – Father / Husband
Marital Status

The Self Attested copy of ID proof is enclosed herewith for your reference. (PAN/Adhaar, Voter’s Identity/Passport/
Driving License) You are requested to make necessary changes in your records (if required), under intimation to the
undersigned. The Above details are of one and same employee stated under reference. If any short payment takes place,
we will abide by the same and make payment on receiving such letter from you. An early action in this regard will be
highly appreciated.

Yours Faithfully,

____________________________________________
(Signatures, Name & Designation of the Authorized
Signatory with the seal of the establishment)

______________________________
(Name & Signature of the Employee)