Composite Declaration Form -11 (To be retained bythe employer for futur reference) EMPLOYEES’ PROVIDENT FUND ORGANISATION Employees’ Provident Funds Scheme, 1952 (Paragraph 34 & 57) & ‘Employees’ Pension Scheme, 1995 (Paragraph 24) (Declaration by x person taking up employment in any bishment on which EPF Scheme, 1952 and /or EPS, 195 s applicable) 1 | Name of the member FuhersName EJ 2 | Spouse's Name 3 _| Date of Bin: (DD/MM/ YYYY) ‘Gender (Male Female Transgender) '5_| Marital Status: (Married/Unmarred/ Widow/Widower/Divorcee) @ nail: (0)_Mobile No: Present employment deta 7 | Date of joining in te current establishment (DD/MMIYYYY) ‘KY Details (aiiach self aitested copies of following KYCS) '@) Bank Account No. = 8. |b) IPS Code of the branch: @)_AADHAR Number ‘Permanent Account Number (PAN), available “Whster earlier a member of Employees" Provident Fund Scheme, Ya7Ne 1952 TO_| Whether earlier a member of Employees Pension Scheme, 1995 Ye7No Previous employment details [if Yes to9 AND/OR 10 above|~Un-cxempied Easiest | Univeral [PF Aosont | Dai ofjoining | Dai ofexit | Scheme | PPO Namiber Nane@ Address | Accom | Nunber | (DNOW" | (DDN | Contifeae | (issued) Number yyy | “yyy | Nod - issued (NCP) Day " Previous employment details: if Yes fo9 AND/OR 10 above] — For Exempted Trusts [Name a Adres oF TAN | Baie of exit | ~Seheme | Non 2 3) International Worker: Ye7Ne 13, [B)_W yes state country of origin (IndiaName of other country) (©) Passport No. ©) Validity of passport [(DDIMM/YYYY) to (DDIMMIYYYY)]UNDERTAKING 1) Certified tha the particulars are trac tothe best of my knowledge 2) authorize EPPO to use my Aadhar for vrifcation/authentication/e-KYC purpase fo service detiver. 5) Kindly transfer the funds and service details, i applicable, from the previous PF account as declared above to the present PF. ‘Acooun’ a 1am an Aadhar verified employee in my previous PF Account.* 4) Incase of changes in above details, the same will be intimated to employer at the carist. Pace: Signature of Member DECLARATION BY PRESENT EMPLOYER A, The member MY/MSIM ES etn a fined On (81 VAN on ern alloted PE No, 1995 BB, _ Incase the person was earlier nota member of EPF Scheme, 1952 and ‘= Please Tick the Appropriate Option: . ‘The KYC details of the ahove member inthe UAN database Have not been uploaded Have boon uploaded but not approved Have been uploaded and approved with DSC/e-sign. C. Imcase the parson was carter a member of EPF Scheme, 1952 and EPS, 1995: ‘+ Please Tick the Appropriate Option: 11 The KYC details of the above member in the UAN database have been approved with E-sign/Digital Signature (Conificate and ransferrequost has boon generate on portal. 1 The previous Account of the members ot Asdhar verified and hence physical transfer form shall be iniitsd. Date: Signature of Employer with Seal of Establishment * Auto transfer of previous PF account would be posible in respect of Aadhar verified employees only. Other employees ae requested to File physical claim (Form-13) for transfer of account from the previous establishment