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Obes Seardgoh me aodabQ wabxtmm ga ard RevBtendgs. s AEatdodYs aarti momog wy Mowoaly MBROnOM Aras aenrAews / Acerds / (B.UawARO, sew.) yma Aderdéch Aris, $0g See0, contac one Scanned with CamScannerAnnexure-A To, The Regional Provident Fund Commissioner, Employees Provident Fund Organization, Sub: Joint Option under pre-amended paragraph 11(3) and amended paragraph 114) of Employees Pension Scheme, 1995 in pursurance of the Hon'ble Supreme Court’s dated 04" November 2022 in the matter ‘Employees Provident Fund Organisation & Anr. ete. vs. Sunil Kumar B, & Ors. ete.; SLP No.8658-8659 of 2019. Sir/Madam, 1. | _ Reference is invited to Para 43 and Para 44(ii) & (iv) of the above-referred judgement dated 04" November 2022 of Hon'ble Supreme Court of India, in the above cited matter ‘Employees Provident Fund Organisation & Anr. etc. vs. Sunil Kumar B. & Ors, ete.; SLP N.8658-8659 of 2019”, whereby the eligible employees/ex-employees and his/her employer are required to submit a joint option under pre-amended paragraph 11(3) and amended paragraph 11(4) of the EPS'95 within a period of 4 months from the date of judgement. 2. As a precautionary compliance and in order to meet the deadline stiputated in the aforesaid judgment, we (employees/ex-employees and employer) hereby submit the joint option form as required under pre-amended paragraph 11(3) and amended paragraph 11(4) of Employees’ Pension Scheme- 1995 for claiming pension on actual salary i.e. exceeding statutory wage limit from time to time decided by EPFO under the Employees’ Pension Scheme from 16-11-1995 or from the date of joining as Member of Employees’ Pension scheme, i.e. from retrospectively under EPS"1995. Particulars of the employee(s) are as under | Particular [Name [EPS Account Nu ~T EPS Account Number Previ | Organization (if any) Aadhaar number (attach self attested copy) [Date of Birth TUAN Number | PPO Nui | (attach self attested copy) er (if any) ~) Date of Joining Under Employees Pension | Scheme Date of leaving servi i) or attaining the ag of 58 years whichever was carlier (ifapplicabley Scanned with CamScanner‘Address for Correspondence Contact / Mobile number E-mail id Place: Date:- Declaration by Employee/ Ex-emplovee It is certified that immediately after joining KSRTC/BMTC/NWKRTC/KKRTC, I had been contributing towards the Provident Fund on my actual salary/wages and an equal amount was being contributed to my Provident Fund by the employer provided under Para 26 (6) of EPS Scheme 1952. Itis to further certify that an amount @ 8.33% of the statutory ceiling amount i.e. Rs.15000/- (earlier Rs.5000/- ot Rs.6500/-) out of the employer’s contribution had been remitted every month towards Employees’ Pension Scheme 1995 since 16" November 1995 or the date of joining whichever is later. 1, do hereby opt for diverting/depositing 8.33% of my actual salary/wages out of employers’ contribution towards the pension fund (After adjusting the amount already diverted/deposited by the Employer to the pension fund upto the prescribed wage ceiling under the act) from the date of joining the EPS*95 till my attaining the age of 58 years. I hereby authorized PF Trust of KSRTC to transfer the differential amount with interest accured (plus) additional 1.16%. Thus, ‘making me elegible for drawing pension based on actual salary/wages instead of wages fixed as per prevailing ceiling under the Act in accordance with the afforesaid judgment. 1 also undertake that in case my corpus/balance in PF Account (employer's) is insufficient to meet the aforesaid requirement, I am ready to pay the differential amount thus making me aligible for drawing pension based on actual stlary/wages instead of on the salary/wages as per prevailing ceiling under the Act, in accordance with the aforesaid judgment. T understand that the Joint option Form submitted by me shall be subject to acceptance by EPFO, I further understand that the option excercised is irevocable at any later date, and no claim for change of Option shall be entertained or considered under any circumstances. I undertake that the Option excercised herein is subject to the EPFO instructions / guidelines / directives / amendments of the scheme that may be issued from time to time. 5 Signature Name: The above information verified with our records and found to be correct. N )F AUTHORIZED SIGNATORY SIGNATURE WITH ESTABLISHMENT SEAL Scanned with CamScanner