Part A: Personal

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ONLINE TRANSFER CLAIM FORM [FORM 13 (REVISED) ]

( Tracking ID: 10023494703805001 )


Claim Date : 15/10/2019
EMPLOYEES' PROVIDENT FUND SCHEME, 1952
(PARA 57)

(This form has been printed on the basis of Online Transfer Claim Form filled up by the member under Unified Portal for submission to the
employer.)

To,
The Regional P.F. Commissioner,
BANDRA(MUMBAI-I),
341, Bhavishya Nidhi Bhawan Bandra (East), Mumbai

Sir,
I request that my Provident Fund balance along with my Pension Service Details may please be transferred to my present
account under intimation to me. My details are as under :

PART A : PERSONAL

1. Name : NIRMALYA SEN

2. Mobile Number : 9066277831

3. E-mail id : [email protected]

4. Bank Account Number : 272301502864

5. Bank IFSC : ICIC0000006

PART B : DETAILS OF PREVIOUS PF ACCOUNTS (WHICH IS TO BE TRANSFERRED)

1. PF Account No. (with EPFO : MHBAN00199000003074743

2. Name of the Establishment : LARSEN & TOUBRO LIMITED ECC

3. Address of the Establishment : LANDMARK A, SUREN ROAD, OFF ANDHERI KURLA ROAD, ANDHERI (E)
598
4. PF A/C No. held by : BANDRA(MUMBAI-I)

5. Name of the Trust : NOT APPLICABLE

6. PF A/C No. in Trust : NOT APPLICABLE

7. Bank A/C No. of Trust : NOT APPLICABLE


8. IFS Code of the Bank Branch of
Trust where account is : NOT APPLICABLE

9. Member's Name : NIRMALYA SEN

10. Date of Birth : 01/02/1990

11. Father's/Spouse Name : JAYANTA KUMAR SEN

12. Relationship : FATHER

13. Date of joining : 16/01/2019

14. Date of leaving : 03/04/2019


PART C : DETAILS OF PRESENT PF

1. PF Account No. (with EPFO : THTHA00005910000056799

2. Name of the Establishment : KEC INTERNATIONAL LTD

3. Address of the Establishment : SPENCER S BUILDING 30 PROJECT STREE MUMBAI NR BHATIA


HOSPITAL TARDEO 598
4. PF A/C No. held by : TRUST

5. Name of the Trust : KEC International Limited Provident Fund

6. PF A/C No. in Trust : THTHA00005910000056799

7. Bank A/C No. of Trust : 00601110000889


8. IFS Code of the Bank Branch of
Trust where account is : HDFC0000060

9. Member's Name : NIRMALYA SEN

10. Date of Birth : 01/02/1990

11. Father's/Spouse Name : JAYANTA KUMAR SEN

12. Relationship : FATHER

13. Date of joining : 05/04/2019

I, Certify that all the information given above are true to the best of my knowledge and I have ensured the correctness of
my present and previous account numbers.

Signature of the member

Note : Member should take a printout of this form and a signed copy of the same should be submitted to the Previous
Establishment i.e. LARSEN & TOUBRO LIMITED ECC

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