Team Lease

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ONLINE TRANSFER CLAIM FORM [FORM 13 (REVISED) ]

( Tracking ID: 10174436259505001 )


Claim Date : 09/05/2023
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,
BANGALORE,
Bhavishyanidhi Bhavan, No. 13, Raja Ram Mohan Roy Road, Bangalore

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 : BALAKISHAN BAJAYYA RENJARLA

2. Mobile Number : 9076457991

3. E-mail id : [email protected]

4. Bank Account Number : 2345822903

5. Bank IFSC : KKBK0000635

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

1. PF Account No. (with EPFO : BGBNG00352240006355640

2. Name of the Establishment : TEAMLEASE SERVICES LIMITED

3. Address of the Establishment : 315 WORK AVENUE CAMPUS, ASCENT BLDG JYOTI NIVAS COLLEGE
RD, KORAMANGALA BANGALORE BENGALURU (BANGALORE) URBAN
4. PF A/C No. held by : BANGALORE

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 : BALAKISHAN BAJAYYA RENJARLA

10. Date of Birth : 19/08/2000

11. Father's/Spouse Name : BAJAYYA BHUMANNA RENJARLA

12. Relationship : FATHER

13. Date of joining : 24/05/2019

14. Date of leaving : 30/06/2019


PART C : DETAILS OF PRESENT PF

1. PF Account No. (with EPFO : TNMAS00313090001931904

2. Name of the Establishment : COGNIZANT TECHNOLOGY SOLUTIONS INDIA PRIVATE LIMITED

3. Address of the Establishment : 5/535 OLD MAHABALIPURAM ROAD OKKIYAM THORAIPAKKAM CHENNAI
KANCHEEPURAM
4. PF A/C No. held by : RO CHENNAI

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 : BALAKISHAN BAJAYYA RENJARLA

10. Date of Birth : 19/08/2000

11. Father's/Spouse Name : BAJAYYA BHUMANNA RENJARLA

12. Relationship : FATHER

13. Date of joining : 30/10/2021

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. TEAMLEASE SERVICES LIMITED

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