PERSONAL DETAILS

Employee Name (As per AADHAAR) AHAMMED JABIR P

Father’s Name (As per AADHAAR) ABDUSSALAM P

Husband's Name (Female Employee)

Gender MALE
Date of Birth (As per AADHAAR) 13/07/1998
Marital Status SINGLE

BANK ACCOUNT DE
Name as per Bank Account AHAMMED JABIR P

PROVIDENT FUND (PF) DECLARATION & NOMINATION

(1) For the purpose of Provident Fund (PF) KYC
Bank Account Number
IFS Code of the Branch
(2) Whether earlier a member of Employees' Provident Fund Scheme, 1952
(3) Whether earlier a member of Employees' Pension Scheme, 1995
(4) Previous Employment Details [If 'Yes' to 2 and/or 3 above]
Universal Account Number (UAN)

Provident Fund (PF) Account Number

Employee Pension Scheme (EPS) Account Number - in case of PF Trust

Date of Joining
Date Of Exit

ESI REGISTRATION A

ESI Number received from previous employer

Dispensary Name & Address (Self)

Dispensary Name & Address (Family)

 Particulars Family Membe
Name Of the Family Member
Date of Birth
Relationship with the Employee
Whether residing with Employee
If No, Address of Family Member
Aadhaar Number of Family Member
PERSONAL DETAILS
Religion ISLAM
Permanent Address
PAN GQNPP8598D

AADHAAR Card Number 9900 6276 1063

Communication Address
Passport Number U2880793
Passport Expiry Date 31/12/2030 Mobile Number
Passport Issuing Country INDIA Personal Email ID

BANK ACCOUNT DETAIL FOR SALARY CREDIT

Name of the Bank Bank of Baroda Bank Account Number

NOMINATION for SALARY, PF, GRATUITY, INSURANCE

Nominee 1
Name of the Nominee ABDUSSALAM P

Address of the Nominee PANTHALANCHERI HOUSE,V

Date of Birth of Nominee 10/5/1969

Relationship with Employee FATHER
Proportion (%) 50%

If the nominee is a minor -

Name, Relationship and
Address of the guardian

ESI REGISTRATION AND NOMINATION (Fill this only if your Monthly Fixed Salary is INR 21000 or less)
 Family Member Details - For ESI Registration
Family Member 1 Family Member 2
 PANTHALANCHERI
HOUSE,VILAYIL

PANTHALANCHERI
HOUSE,VILAYIL

9048766884
jabirahd786@gmail.com

68880100003625 IFS Code of Branch BARB0VJMUTH

PF, GRATUITY, INSURANCE

Nominee 2
SUBAIDHA P

PANTHALANCHERI HOUSE,VILAYI

1/1/1978
MOTHER
50%

ly Fixed Salary is INR 21000 or less)

Name of the Nominee

Address of the Nominee

Relationship with Employee
Proportion (%)
ration
Family Member 3 Family Member 4
Family Member 5