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    E Nomination

    Uploaded by

    Naveen Meduri
    The document is a declaration and nomination form for an employee's provident fund and pension scheme. It contains the employee's personal details like name, father's name, date of birth, gender, address and scheme membership dates. For the provident fund, the employee nominates his sister Deevi Udaya Lakshmi to receive 100% of the accumulated amount standing in his provident fund account in case of his death. For the pension scheme, the employee does not have any family members eligible for widow or children pension. He nominates his sister Deevi Udaya Lakshmi to receive the monthly widow pension in the event of his death without any eligible family member.

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

    E Nomination

    Uploaded by

    Naveen Meduri
    12 views2 pages
    The document is a declaration and nomination form for an employee's provident fund and pension scheme. It contains the employee's personal details like name, father's name, date of birth, gender, address and scheme membership dates. For the provident fund, the employee nominates his sister Deevi Udaya Lakshmi to receive 100% of the accumulated amount standing in his provident fund account in case of his death. For the pension scheme, the employee does not have any family members eligible for widow or children pension. He nominates his sister Deevi Udaya Lakshmi to receive the monthly widow pension in the event of his death without any eligible family member.

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    e Nomination

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    The document is a declaration and nomination form for an employee's provident fund and pension scheme. It contains the employee's personal details like name, father's name, date of birth, gender, address and scheme membership dates. For the provident fund, the employee nominates his sister Deevi Udaya Lakshmi to receive 100% of the accumulated amount standing in his provident fund account in case of his death. For the pension scheme, the employee does not have any family members eligible for widow or children pension. He nominates his sister Deevi Udaya Lakshmi to receive the monthly widow pension in the event of his death without any eligible family member.

    Copyright:

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

    E Nomination

    Uploaded by

    Naveen Meduri
    The document is a declaration and nomination form for an employee's provident fund and pension scheme. It contains the employee's personal details like name, father's name, date of birth, gender, address and scheme membership dates. For the provident fund, the employee nominates his sister Deevi Udaya Lakshmi to receive 100% of the accumulated amount standing in his provident fund account in case of his death. For the pension scheme, the employee does not have any family members eligible for widow or children pension. He nominates his sister Deevi Udaya Lakshmi to receive the monthly widow pension in the event of his death without any eligible family member.

    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 : 100259476517
    2. Name (in block letters) : MEDURI NAVEEN KUMAR
    3. Father's / Husband's Name : VEERABRAHMACHARY MEDURI
    4. Date of Birth : 14/06/1979
    5. Gender : MALE
    6. Marital Status : MARRIED

    7. Address (Permanent) : Parchoor (Post), Prakasam Dist, AndhraPradesh,Pin523169

    8. Address (Temporary) : G03,Kabini apartments,Chandapur, Surya city,near Union Bank, Karnataka

    9. (A) Date of Joining of EPF Scheme, : 24/03/2010


    (B) Date of Joining of FPS Scheme, : --
    (C) Date of Joining of EPS Scheme, : 24/03/2010

    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)

    FLAT NO G3 PLOT NO- SISTER 08/01/1982 100% --


    77A77B,
    DEEVI UDAYA
    BHAGYANAGAR
    LAKSHMI
    COLONY KUKAT PALLI,
    AADHAAR: XXXX
    Hyderabad,
    XXXX 7788
    HYDERABAD,
    Bank A/c: NOT
    TELANGANA, 500072
    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

    DEEVI UDAYA LAKSHMI 08/01/1982 SISTER


    AADHAAR: XXXX XXXX 7788
    Bank A/c: NOT AVAILABLE

    Date : 08-Sep-2022

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

    Signature Not
    Verified
    Signed by :
    Date : 08/09/2022 13:23:02
    Reason : eSign Service
    Location : India

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