Scribd Logo
Upload

Welcome to Scribd!

  • 29 views

    The Employees' Pension Scheme

    Uploaded by

    Aditya Adi Singh
    The document is a declaration and nomination form for an employee's provident fund and pension scheme, filled out by Ruchita Madhukar Gowari who provides details like her name, father's name, date of birth, address and date of joining the schemes. For the provident fund, she nominates her father Madhukar Krushna Gowari to receive 100% of the accumulated amount. For the pension scheme, she nominates her father to receive the monthly widow pension in the event of her death without any other eligible family members.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    The Employees' Pension Scheme

    Uploaded by

    Aditya Adi Singh
    29 views2 pages
    The document is a declaration and nomination form for an employee's provident fund and pension scheme, filled out by Ruchita Madhukar Gowari who provides details like her name, father's name, date of birth, address and date of joining the schemes. For the provident fund, she nominates her father Madhukar Krushna Gowari to receive 100% of the accumulated amount. For the pension scheme, she nominates her father to receive the monthly widow pension in the event of her death without any other eligible family members.

    Original Title

    e-Nomination (2)

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document is a declaration and nomination form for an employee's provident fund and pension scheme, filled out by Ruchita Madhukar Gowari who provides details like her name, father's name, date of birth, address and date of joining the schemes. For the provident fund, she nominates her father Madhukar Krushna Gowari to receive 100% of the accumulated amount. For the pension scheme, she nominates her father to receive the monthly widow pension in the event of her death without any other eligible family members.

    Copyright:

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

    The Employees' Pension Scheme

    Uploaded by

    Aditya Adi Singh
    The document is a declaration and nomination form for an employee's provident fund and pension scheme, filled out by Ruchita Madhukar Gowari who provides details like her name, father's name, date of birth, address and date of joining the schemes. For the provident fund, she nominates her father Madhukar Krushna Gowari to receive 100% of the accumulated amount. For the pension scheme, she nominates her father to receive the monthly widow pension in the event of her death without any other eligible family members.

    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 : 101400733987
    2. Name (in block letters) : RUCHITA MADHUKAR GOWARI
    3. Father's / Husband's Name : MADHUKAR
    4. Date of Birth : 13/12/1998
    5. Gender : FEMALE
    6. Marital Status : UN-MARRIED

    7. Address (Permanent) : Boronde Patilpada, Palghar Manor, Palghar, PALGHAR, MAHARASHTRA,


    401403
    8. Address (Temporary) : Boronde Patilpada, Palghar Manor, Palghar, PALGHAR, MAHARASHTRA,
    401403
    9. (A) Date of Joining of EPF Scheme, : 30/11/2018
    (B) Date of Joining of FPS Scheme, : --
    (C) Date of Joining of EPS Scheme, : 30/11/2018

    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)

    Boronde Patilpada, Dependent 01/01/1975 100% --


    Palghar Manor, Father
    MADHUKAR
    Palghar, PALGHAR,
    KRUSHNA GOWARI
    MAHARASHTRA,
    AADHAAR: XXXX
    401403
    XXXX 7684
    Bank A/c: NOT
    AVAILABLE

    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 -- -- --
    --

    *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

    MADHUKAR KRUSHNA GOWARI 01/01/1975 FATHER


    AADHAAR: XXXX XXXX 7684
    Bank A/c: NOT AVAILABLE

    Date : 28-Mar-2022

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

    Signature Not
    Verified
    Signed by :
    Date : 28/03/2022 11:50:49
    Reason : eSign Service
    Location : India

    You might also like