FAMILY PARTICULARS REPORT

DETAILS OF FAMILY

Name of the Deceased Member: MANTU MALIK

Date of Birth: 01/01/1975
Father’s name: BANSHI MALIK
PF Account Number (UAN): 100986532357
Date of Appointment: 01/12/2016

Sr. Name of family Date of Relationship Gender Aadhar

No. members Birth with Number
Employee
1. KAJAL MALIK 01/01/1977 SPOUSE F 919432167621

2. SUVENDU MALIK SON M 686821360400

3.

Certified that the above particulars are true and correct and no facts have been
concealed.

Claimant’s Signature Employer’s Signature

Name: Designation & Seal of Employer