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    The Employees' Pension Scheme

    Uploaded by

    Naresh Kumar
    The document contains Naresh Kumar's declaration and nomination forms for the Employees' Provident Fund Scheme and Employees' Pension Scheme, nominating his wife Poonam to receive benefits under both schemes in the event of his death. It provides details of Naresh such as his name, father's name, date of birth, address, UAN number, and date of joining the provident fund. It also lists Poonam as his family member who would be eligible for widow pension under the Employees' Pension Scheme if he were to pass away.

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    © All Rights Reserved
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    The Employees' Pension Scheme

    Uploaded by

    Naresh Kumar
    104 views2 pages
    The document contains Naresh Kumar's declaration and nomination forms for the Employees' Provident Fund Scheme and Employees' Pension Scheme, nominating his wife Poonam to receive benefits under both schemes in the event of his death. It provides details of Naresh such as his name, father's name, date of birth, address, UAN number, and date of joining the provident fund. It also lists Poonam as his family member who would be eligible for widow pension under the Employees' Pension Scheme if he were to pass away.

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    e-Nomination

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    The document contains Naresh Kumar's declaration and nomination forms for the Employees' Provident Fund Scheme and Employees' Pension Scheme, nominating his wife Poonam to receive benefits under both schemes in the event of his death. It provides details of Naresh such as his name, father's name, date of birth, address, UAN number, and date of joining the provident fund. It also lists Poonam as his family member who would be eligible for widow pension under the Employees' Pension Scheme if he were to pass away.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    104 views2 pages

    The Employees' Pension Scheme

    Uploaded by

    Naresh Kumar
    The document contains Naresh Kumar's declaration and nomination forms for the Employees' Provident Fund Scheme and Employees' Pension Scheme, nominating his wife Poonam to receive benefits under both schemes in the event of his death. It provides details of Naresh such as his name, father's name, date of birth, address, UAN number, and date of joining the provident fund. It also lists Poonam as his family member who would be eligible for widow pension under the Employees' Pension Scheme if he were to pass away.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    The Employees' Pension Scheme,

    FORM 2
    EMPLOYEES' PROVIDENT FUNDS SCHEME, 1952
    [Paragraphs 33 AND 61(1)]
    EMPLOYEES' PENSION SCHEME, 1995
    [Paragraphs 18]

    DECLARATION AND NOMINATION FORM UNDER THE EMPLOYEES' PROVIDENT FUNDS


    SCHEME AND EMPLOYEES' PENSION SCHEME

    1. UAN : 100251376265
    2. Name (in block letters) : NARESH KUMAR
    3. Father's / Husband's Name : CHHOTE LAL
    4. Date of Birth : 28/07/1990
    5. Gender : MALE
    6. Marital Status : MARRIED

    7. Address (Permanent) : House No C 139, Street No 14, Sadarpur Colony, Sec 45, Noida, GAUTAM
    BUDDHA NAGAR, UTTAR PRADESH, 201301
    8. Address (Temporary) : House No C 139, Street No 14, Sadarpur Colony, Sec 45, Noida, GAUTAM
    BUDDHA NAGAR, UTTAR PRADESH, 201301
    9. (A) Date of Joining of EPF Scheme, : 08/01/2013
    (B) Date of Joining of EPF Scheme, : --
    (C) Date of Joining of EPF Scheme, : 08/01/2013

    PART A (EPF)
    I hereby nominate person(s) / cancel the nomination made by me previously and nominate the person
    (s) mentioned below to receive the amount standing to my credit in the Employees' Provident Fund, in the

    If the Nominee is
    Total amount or minor, name and
    Nominees's share of relationship and
    Name of the
    relationship with accumulations in address of the
    Nominee / Nominees Address Date of Birth
    the Member Provident Fund to guardian who may
    be paid to each receive the amont
    nominee during the minority of
    nominee
    (1) (2) (3) (4) (5) (6)

    House no c 139, street Wife 15/01/1993 100% --


    no 14, Sadarpur
    POONAM
    Colony, Sec 45, NOIDA,
    AADHAAR: XXXX
    GAUTAM BUDDHA
    XXXX 0541
    NAGAR, UTTAR
    Bank A/c:
    PRADESH, 201301
    16310100001XXXX
    IFSC: IOBA0001631

    1. *Certified that I have no family as defined in Para 2(g) of the Employees' Provident Funds Scheme, 1952 and should I
    acquire a family hereafter the above nomination should be deemed as cancelled.

    2. *Certified that my father/mother is/are dependant upon me.

    (Signature is not required as the document is to be digitally signed)


    The Employees' Pension Scheme,

    PART B (EPS)
    (Para 18)

    I hereby furnish below particulars of the members of my family who would be eligible to receive
    widow / children pension in the event of my death:

    Relationship with
    Sl. No. Name of the Family members Address Date of Birth
    the member
    (1) (2) (3) (4) (5)

    1 House no c 139, street no 14, 15/01/1993 Wife


    POONAM Sadarpur Colony, Sec 45, NOIDA,
    AADHAAR: XXXX XXXX 0541 GAUTAM BUDDHA NAGAR,
    Bank A/c: UTTAR PRADESH, 201301
    16310100001XXXX
    IFSC: IOBA0001631

    *Certified that I have no family as defined in Para 2(vii) of the Employees' Pension Scheme, 1995 and
    should I acquire a family hereafter I shall furnish particulars thereon in the above form.

    I hereby nominate the following person for receiving the monthly widow pension admissible under
    para 16(2)(a)(i) and (ii) in the event of my death without leaving any eligible family member for receiving

    Relationship with the member


    Name and Address of the Nominee Date of Birth

    -- -- --

    Date : 24-Sep-2021

    (Signature is not required as the document is to be digitally signed)

    Signature Not
    Verified
    Signed by :
    Date : 24/09/2021 04:03:46
    Reason : eSign Service
    Location : India

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