Applicant ID : 2174872

FORM 9
THE EMPLOYEES' PROVIDENT FUNDS SCHEME, 1952 (Paragraph 34)
AND
THE EMPLOYEES' PENSION SCHEME, 1995 (Paragraph 24)
Declaration by a person taking up employment in an establishment in which the Employees
'Provident Funds & Employees' Pension Scheme enforce

I, Mohammad Azam Imroze son of Mohammad Kaleem Uddin Do hereby solemnly declare that :-

a) I was employed with R1 RCM Global Private Limited with PF A/c Number GN/GGN/0030/144/000 and left service on 14/06/2024 prior to that, I was employed with
Optum Global solution India Pvt Ltd with PF A/c Number GN/GGN/002/837/1000 from 04/01/2017 to 09/05/2019

b) I am a member of the pension fund from NA to NA

c) I have not withdrawn the amount of my Provident Fund

d) I have withdrawn the amount of my Pension Fund -NA

e) I have drawn any benefits under the Employees Pension Scheme, 1995 in respect of my past service in any establishment. -NA

f) I have contributed to the Social Security programme in NA from NA to NA.

Do you have UAN : Yes

Universal Account
Aadhaar Enrolment Number NPR PAN
Number(UAN)

101008118786 919875444862 NA NA DHBPM5040K

Bank Account Number Linked with UAN : Link UAN with Previous Bank Account

Bank Account Number IFSC Code

000001714885006 kkbk0007479

Date :

Signature of the Employee

_______________________________________________________________________________________________________________________________________________

(To be filled by the Employer)

1) Shri/Smt/Kumari Mohammad Azam Imroze is appointed as in Tata Consultancy Services Limited with effect from bearing
Provident Fund Number: MH/BAN/48475/

2) Copy of Scheme Certificate enclose.

3) Declaration & Nomination in Form 2 is enclosed.

Tata Consultancy Services Limited

11th Floor, Air India Building,Nariman Point,
Mumbai-400 021

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