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    3.PF - Form 2 (Revised)

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    This document contains nomination forms for an employee's provident fund (EPF) and employee's pension scheme (EPS). In the EPF section, the employee, Pavithra SS, nominates her mother to receive the funds in her EPF account should she pass away. She provides her mother's name, address, date of birth, and relationship. Pavithra certifies that she has no other family. In the EPS section, Pavithra does not list any family members eligible for pension, and certifies that she currently has no family as defined by the scheme. She does not nominate anyone to receive her monthly pension should she pass without family. The employer signs to certify

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    3.PF - Form 2 (Revised)

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    86 views2 pages
    This document contains nomination forms for an employee's provident fund (EPF) and employee's pension scheme (EPS). In the EPF section, the employee, Pavithra SS, nominates her mother to receive the funds in her EPF account should she pass away. She provides her mother's name, address, date of birth, and relationship. Pavithra certifies that she has no other family. In the EPS section, Pavithra does not list any family members eligible for pension, and certifies that she currently has no family as defined by the scheme. She does not nominate anyone to receive her monthly pension should she pass without family. The employer signs to certify

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    Original Title

    3.PF - FORM 2 (REVISED)(1)

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    This document contains nomination forms for an employee's provident fund (EPF) and employee's pension scheme (EPS). In the EPF section, the employee, Pavithra SS, nominates her mother to receive the funds in her EPF account should she pass away. She provides her mother's name, address, date of birth, and relationship. Pavithra certifies that she has no other family. In the EPS section, Pavithra does not list any family members eligible for pension, and certifies that she currently has no family as defined by the scheme. She does not nominate anyone to receive her monthly pension should she pass without family. The employer signs to certify

    Copyright:

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

    3.PF - Form 2 (Revised)

    Uploaded by

    subscribe enroll
    This document contains nomination forms for an employee's provident fund (EPF) and employee's pension scheme (EPS). In the EPF section, the employee, Pavithra SS, nominates her mother to receive the funds in her EPF account should she pass away. She provides her mother's name, address, date of birth, and relationship. Pavithra certifies that she has no other family. In the EPS section, Pavithra does not list any family members eligible for pension, and certifies that she currently has no family as defined by the scheme. She does not nominate anyone to receive her monthly pension should she pass without family. The employer signs to certify

    Copyright:

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

    FORM - 2 (REVISED)

    A/c Gr. No / -

    NOMINATION AND DECLARATION FORM FOR UN-EXEMPTED/EXEMPTED ESTABLISHMENTS


    Declaration and Nomination Form under the Employee's Provident Funds & Employee's Pension Scheme (Paragraph 33 & 61 (1) of the Employees
    'Provident Fund Scheme, 1952 & Paragraph 18 of the
    Employees' Pension Scheme, 1995)
    1 Name (In Block letters) : PAVITHRA S S 7 Date of Joining in E.P.F.' 52 : 1/13/2021
    2 Father's / Husband's Name : SREEPALA S V 8 Date of Joining in F.P.F. 71 / E.P.S. 95 : 1/13/2021
    3 Date of Birth : 10/18/1998 9 Address
    4 Sex: FEMALE Permanent : E106 VALLABHA 6TH CROSS K G NAGAR BANGALORE -19
    5 Marital Status : SINGLE
    6 Account No : 625401540692 Temporary : E106 VALLABHA 6TH CROSS K G NAGAR BANGALORE -19

    PART -A (EPF)
    I here by nominate the 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 Employee's Provident Fund, in the event of my death.

    If the Nominee is a
    Total amt. or
    minor, Name &
    share of
    Nominee's Relationship &
    accumulation
    Name of the nominee / relationship Address of the
    Address Date of Birth in Provident
    nominees with the guardian who may
    Fund to be
    member receive the amount
    paid to each
    during minority of
    nominee
    nominee

    1 2 3 4 5 6
    1 E106 VALLABHA 6TH CROSS K G NAGAR BANGALORE
    MOTHER 11/5/1975

    1 *Certified that I have no family as defined in para 2(g) of the Employee’s Provident Fund 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 dependent upon me.

    pavithra s s
    *Strike out whichever is not applicable Signature or thumb impression of the subscriber
    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.

    Name and Address of the Family member(s)


    SL Name Address Date of Birth Relationship with member
    1 2 3 4 5

    ** Certified that I have no family as defined in Para 2 (vii) of Employees’ Pension Sheme, 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 pension (admissible under Para 16 2(a) (i) & (ii) in event of my death without leaving
    any eligible family member for receiving pension.
    SL Name Address Date of Birth Relationship with member
    1 2 4 5

    Date
    Signature of thumb impression of the subscriber

    CERTIFICATE BY EMPLOYER
    Certified that the above declaration and nomination has been signed/thumb impressed before me by
    Shri/Smt./Kum______________________________________________employed in my establishment after he/she has read the entries have read
    over to him/her by me and got confirmed by him/her.

    Signature of the employer or other


    Authorized officers of the establishment :- ___________________________
    Place
    Name and address of the factory
    Establishment or rubber stamp there of
    Dated

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