JOINT DECLARATION FORM

To,
The Regional Provident Fund Commissioner,
New Block No. 10, Bhavishyanidhi Bhavan,
Behind Income Tax Office, Navanagar,
Hubli-580 025.

Sir,
Sub: Request for correction in the details of the employee/member.
I, _______________________________________________________, an employee/ ex employee
of the establishment : AGRICULTURAL OFFICER SEED FARM (Agricultural Research Station, Kalloli)
(Est. ID: ) wish to inform you that the following information is/ are not correctly
mentioned in the EPF records and hence request you to correct the same as furnished hereunder,

PARTICULARS AS PER PF RECORDS TO BE CORRECTED

Name
Father/ Husband Name
Gender
EPF Account No
UAN No.
Date of Birth
(DD/MM/YYYY)
Date of Joining
(DD/MM/YYYY)
Date of Leaving
Aadhar Number
PAN

I am enclosing herewith attested copy of proof Aadhar and PAN attested by employer, which is approved in
KYC for your ready reference. The documents are enclosed as per the Annexure-A.
“I hereby give my consent to share my Aadhar details/ Aadhar based authentication for the purpose of
establishing my identity and seeding it with EPF account”.
All the documents are enclosed and signed by me and attested by the employer.

Yours faithfully,

Mob No:
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Certified that the above information Is correct and request was made by the applicant may please be
accepted and necessary changes in your records may be made. We regret for the inconvenience
caused. If any, in this regard.

Encl: As above
Signature of the employer with seal