JOINT DECLARATION BY THE MEMEBR AND THE EMPLOYER

To, Date:

The Regional PF Commissioner,

Regional Office, K.R. Puram,
No. F-28, NSU Block, ITI Campus (Bengaluru Plant),
Dooravani Nagar,Bangalore- 560016.

Sub: Request for correction in the personal details of the employee/member.

Sir,

I am an employee/ex-employee of
DUSTERS TOTAL SOLUTIONS SERVICES PRIVATE LIMITED Wish to inform that the
following information 1st not correctly mentioned in the PF records and hence request you to
correct the same as furnished here under.

Particulars As per PF records To be corrected as

Name
Father/Spouse Name
PF/EPS Account no.
UAN Number
Date of Birth (DD/MM/YYYY)
Date of Joining (DD/MM/YYYY)
Date of Leaving (DD/MM/YYYY)
Gender of the Member

I am enclosing herewith self-attested copy of ID Proof (PAN Card / Election ID Card /

Passport / Driving Licence / Aadhar Card / UAN Card) which 1st approved in KYC for your ready
reference. The same is counter attested by the Employer / Ex-employer.

Hence, it is requested to make necessary changes in your records as mentioned above. We regret
for the inconvenience caused if any in this regard.

Thanking you,

Yours Faithfully,

(Name & Signature of the Member/ Applicant) Name & Signature of the Authorized
Signatory/ Employer with seal)