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    E Nomination

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    Manav PARMAR
    The document contains a declaration and nomination form for an employee's pension and provident funds. It provides details of the employee like name, address, UAN and family details including wife's name and address to receive pension benefits in case of death.

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

    E Nomination

    Uploaded by

    Manav PARMAR
    7 views2 pages
    The document contains a declaration and nomination form for an employee's pension and provident funds. It provides details of the employee like name, address, UAN and family details including wife's name and address to receive pension benefits in case of death.

    Original Description:

    E nomination form

    Original Title

    e-Nomination (1)

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    © © All Rights Reserved

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    The document contains a declaration and nomination form for an employee's pension and provident funds. It provides details of the employee like name, address, UAN and family details including wife's name and address to receive pension benefits in case of death.

    Copyright:

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

    E Nomination

    Uploaded by

    Manav PARMAR
    The document contains a declaration and nomination form for an employee's pension and provident funds. It provides details of the employee like name, address, UAN and family details including wife's name and address to receive pension benefits in case of death.

    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 : 100303971671
    2. Name (in block letters) : RAMDAS SAVALERAM MANE
    3. Father's / Husband's Name : SAWALARAM MANE
    4. Date of Birth : 01/06/1965
    5. Gender : MALE
    6. Marital Status : MARRIED

    7. Address (Permanent) : BABURAO THAKARE CHAWAL,310 A, JOGESHWARI MANDIR, MURBAD,


    THANE, MAHARASHTRA, 421401
    8. Address (Temporary) : BABURAO THAKARE CHAWAL,310 A, JOGESHWARI MANDIR, MURBAD,
    THANE, MAHARASHTRA, 421401
    9. (A) Date of Joining of EPF Scheme, : 18/11/1994
    (B) Date of Joining of EPF Scheme, : --
    (C) Date of Joining of EPF Scheme, : 16/11/1995

    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)

    ROOM NO /301 DEVI Wife 01/01/1966 100% --


    CHI ALI, JOGESWARI
    YAMUNA RAMDAS
    MANDIR, MURBAD,
    MANE
    THANE,
    AADHAAR: XXXX
    MAHARASHTRA,
    XXXX 8031
    421401
    Bank A/c:
    3473366XXXX
    IFSC: SBIN0007160

    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 ROOM NO /301 DEVI CHI ALI, 01/01/1966 Wife


    YAMUNA RAMDAS MANE JOGESWARI MANDIR, MURBAD,
    AADHAAR: XXXX XXXX 8031 THANE, MAHARASHTRA, 421401
    Bank A/c: 3473366XXXX
    IFSC: SBIN0007160

    *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 : 22-Jan-2021

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

    Signature Not
    Verified
    Signed by :
    Date : 22/01/2021 16:58:53
    Reason : eSign Service
    Location : India

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