Scribd Logo
Upload

Welcome to Scribd!

  • 2K views

    Sample-Pf Withdrawl Forms 19

    Uploaded by

    Adarsh TJ
    1. This document is an Employees' Provident Fund Scheme form for an individual named Karunakaran Y N to withdraw funds from their account. 2. It provides personal details of Karunakaran such as name, father's name, last place of employment, account number, date of leaving employment which was February 1st 2012 for personal reasons. 3. Upon withdrawal, the funds will be deposited into Karunakaran's savings bank account at the State Bank of Mysore branch in Bangalore, as indicated by a tick mark in the relevant box.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Sample-Pf Withdrawl Forms 19

    Uploaded by

    Adarsh TJ
    2K views2 pages
    1. This document is an Employees' Provident Fund Scheme form for an individual named Karunakaran Y N to withdraw funds from their account. 2. It provides personal details of Karunakaran such as name, father's name, last place of employment, account number, date of leaving employment which was February 1st 2012 for personal reasons. 3. Upon withdrawal, the funds will be deposited into Karunakaran's savings bank account at the State Bank of Mysore branch in Bangalore, as indicated by a tick mark in the relevant box.

    Original Description:

    PF Withdrawal Form for India

    Original Title

    Sample-pf Withdrawl Forms 19

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    1. This document is an Employees' Provident Fund Scheme form for an individual named Karunakaran Y N to withdraw funds from their account. 2. It provides personal details of Karunakaran such as name, father's name, last place of employment, account number, date of leaving employment which was February 1st 2012 for personal reasons. 3. Upon withdrawal, the funds will be deposited into Karunakaran's savings bank account at the State Bank of Mysore branch in Bangalore, as indicated by a tick mark in the relevant box.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    2K views2 pages

    Sample-Pf Withdrawl Forms 19

    Uploaded by

    Adarsh TJ
    1. This document is an Employees' Provident Fund Scheme form for an individual named Karunakaran Y N to withdraw funds from their account. 2. It provides personal details of Karunakaran such as name, father's name, last place of employment, account number, date of leaving employment which was February 1st 2012 for personal reasons. 3. Upon withdrawal, the funds will be deposited into Karunakaran's savings bank account at the State Bank of Mysore branch in Bangalore, as indicated by a tick mark in the relevant box.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 2

    Mobile: 9611786747 Regn. No.

    Employees' Provident Fund Scheme, 1952


    Form - 19

    1. Name of the member in Block Letters. 2. Father's Name or (husband's name in the case of married woman) 3. Name & Address of the Establishment in which, the member was last employed 4. Account No. 5. Date of leaving service 6. Reason for leaving service 7. Full Postal Address (In Block Letters) Shri/Smt/Kumari S/o, W/o, D/o Valayamadevi, Cuddalore 8. Mode of remittance ( (

    Karunakaran Y N
    Narayana Y

    1-Feb-2012 Personal Purpose Karunakaran Y N Narayana Y


    # 12, ABC [Vill], BSSS [Po] UUIII [Mandal] Kuppam [Tq] Chittoor Dist, Andhrapradesh - 517423

    Put a tick ( ) in the box against the one opted ) ) To the address given against item No. 7 S.B. Account No. Branch Full Address 640560000000
    BANASWADI
    KR ROAD, BANGALORE - 24

    (a) By Postal Money Order at my Cost (b) By account payee cheque sent Direct for credit to my S.B A/c (Scheduled Bank/P.O) under intimation to me

    Name of the Bank STATE BANK OF MYSORE

    (Advance Stamped Receipt furnished) Certified that the particulars are true to the best of my knowledge Date of joining of Establishment Date of Birth Contribution for the current Financial Year 1-Oct-2011 5-Aug-1992

    - N IL

    (information to be furnished by the Employer if the Claim Form is attested by the Employer) Certified that the above contributions have been included in the regular monthly remittances. The Applicant has signed/Thumb impressed before me.

    Designation & Seal Date: 02-04-2012 Declaration of non-employment Note:In the case of submission of application for settlrmrnt under clause (s) of sub-paragraph (i) and in clause (b) of sub-paragraph (2) of paragraph 69 of the EPF Scheme, 1952, the claim should be submitted after two months from the date of leaving service provided the member continues to remain unemplyed in an establishment to which the Act applies. Signature or left thumb impression of the member

    Date: 02-04-2012

    Signature or left thumb impression of the member

    ADVANCE STAMPED RECEIPT (To be furnished only in case of 8 (b) above)


    Received a sum of Rs (Rupees by deposit in my Savings Bank account towards the settlement of my Provident Fund Account. The space should be left blank which shall be filled in by Regional Provident Fund Commissioner/Officer in-charge of S.A.O Rs.1/Revenue Stamp Signature or left thumb impression of the member from

    Regional Provident Fund Commissioner / Officer-in-Charge of Sub-Accounts Office.

    (For the use of Commissioner's Office)


    A/C Settled in part/Full Entered in F.21-A/24/219 & withdrawl register Clerk P.I.No M.O./Cheque Account No. Section. Passed for payment Rs. (in words). M.O Commission (if any) AOC/APFC.. Net amount to be paid by M.O... Date Section Supervisor

    (For the use in Cash Section)


    Paid by inclusion in cheque No... Date vide Cash Book (Bank) Account No.3 Debit Item No..

    HC

    AC/RC

    You might also like