Ack No.

230606211256015727531

Joint Option Form

[From the Employees who were in service prior to 01.09.2014 and continued to be in service
on or after 01.09.2014 but could not exercise joint option under erstwhile proviso to para
11(3) of EPS-1995]

To be exercised by eligible members of EPS-1995 on or before 26th June, 2023 in accordance with para 44(iv) read with Para
44(v) of the order dated 4.11.2022 of the Hon'ble Supreme Court in SLP No. 8658-8659 of 2019.

DISCLAIMER
I have gone through Supreme Court Judgement dated 04.11.2022 in SLP (c) No. 8658-8659 of
2019 and I am registering this joint option in terms of directions contained in the said judgement. I
undertake that the pension will be calculated subject to formula determined under the Scheme for
this purpose.

Place : MEERUT

Date : 13/02/2024

Sl.No Details

1 UAN 100194473234

2 Name of Member KRISHAN PAL SINGH

3 Gender MALE

4 Date of Birth of Member 20-SEP-1960

5 Father’s / Spouse Name MUL CHAND

6 PPO No. MRMRT00073377

7 PPO Date 12-OCT-2020

8 Office by which the PPO was issued MEERUT

9 Service Details
Date of joining Date of leaving Date of joining Date of leaving
PF Account Number Establishment Name
FPS FPS EPS EPS

MRMRT00055250000001
9.1 U.P.S.R.T.C. 07-MAR-1989 15-NOV-1995 16-NOV-1995 17-OCT-2017
427
MRMRT00055140000014
9.2 U.P.S.R.T.C. N.A. N.A. 01-NOV-2017 19-SEP-2018
445
Whether employer’s contribution was received on wages exceeding
statutory wage ceiling of Rs. 5000 in EPF prior to 01.06.2001 from
the day his salary exceeded Rs. 5000?
10 No
(applicable only if date of joining is prior to 01.06.2001)

Whether Employer’s contribution was received on wages exceeding

statutory wage ceiling of Rs. 6500 in EPF prior to 01.09.2014 from
the day his salary exceeded Rs. 6500?
11 No
(applicable only if date of exit is on or after 01.06.2001)

12 Aadhaar No. of Member XXXX XXXX 1490

13 Aadhaar linked Mobile No. of member 9458548344

14 Email ID of member [email protected]

15 Aadhaar linked Bank Account No. 9763000100009845

16 IFS Code PUNB0976300

Whether member wants to use accumulation available in his / her
17 PF account for payment of due contribution for this joint option? Yes

How much is the PF account balance on the date of filing option?

Please upload relevant documentary proof such as Account Slip /

18 pages of the Passbook etc. Rs. 1307149

Whether member is giving undertaking to deposit the contributions

along with interest due till date of payment through his last
19 employer [only when PF account has no/ insufficient balance]? No

Generated On : 13/02/2024 11.15 Page 1 of 2

 Ack No. 230606211256015727531

Declaration:

1. I hereby declare that I have read and understood the Judgement in SLP (c) no.8658-8659 of 2019
dated 04-11-2022 of the Hon’ble Supreme Court and I am exercising this joint option in terms of the
directions contained in the said judgement.

2. I understand and agree that as a member of the Employees’ Pension Scheme, my rights to claim
pension are limited to the scope of judgement and within the EPF & MP Act, 1952 and the Schemes
framed thereunder.
3. I further understand that the Central Government is empowered to amend the scheme as it may
deem fit.
4. I do hereby agree that the details of contribution and interest given by my employers are essential for
the computation of dues payable for this application, and this is the full and final submission.

5. I hereby undertake that the service details in the above form are correct and no material fact has
been misrepresented or hidden by me.

6. I hereby agree to pay due contribution in a single tranche as specified by EPFO, along with interest at
rates declared under Para 60 of EPF Scheme 1952 or at the rate declared by the concerned trust of
such establishment, from time to time, whichever is higher, if any.

7. I hereby jointly opt along with my employer to pay full amount of contribution on salary exceeding
wage ceiling under erstwhile para 11(3) (since deleted) and para 11(4) of EPS 95 along with interest
upto the last date of the month in which payment is made, in accordance with the judgement dated
04.11.2022 of the Hon’ble Supreme Court through my last employer within such period as may be
directed by EPFO after verification of my joint option. If the full amount payable is not
deposited by my last employer within such period as may be directed by EPFO after
verification of my joint option, this joint option shall be liable to be treated as Null and Void.

8. I undertake that all the facts are true. If the details submitted by me or my employer are found to be
incorrect at any point of time, this joint option shall be treated as Null and Void.

9. I am aware that in case of false declaration and wilful mis-representation, appropriate penal action
may be taken by EPFO against me.

Place : MEERUT KRISHAN PAL SINGH

Date : 13/02/2024

Generated On : 13/02/2024 11.15 Page 2 of 2

 lnL; iklcqd / Member Passbook
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
LFkkiuk vkbZMh@uke | Establishment ID/Name MRMRT0005514000 / U.P.S.R.T.C.
lnL; vkbZMh@uke | Member ID/Name MRMRT00055140000014445 / KRISHAN PAL SINGH
tUe frfFk | Date of Birth 20-09-1960
;w , u | UAN 100194473234

bZih,Q iklcqd [ foÙkh; o"kZ - 2021-2022 ] / EPF Passbook [ Financial Year - 2021-2022 ]
deZpkjh 'ks"k / fu;ksäk 'ks"k / isa'ku 'ks"k /
fooj.k / Particulars Employee Employer Pension
Balance Balance Balance
OB Int. Updated upto 01/04/2021 7,28,552 4,80,651 15,000

VªkalD'ku / Transaction osru / Wages va'knku / Contribution

osru ekg /
çdkj fooj.k / Particulars
Wage Month deZpkjh / fu;ksäk / isa'ku /
fnuk¡d / Date / Type bZ ih ,Q / EPF bZ ih ,l / EPS Employee Employer Pension
---No Transactions available for the this year.---
Total Contributions for the year [ 2021 ] 0 0 0
Total Transfer-Ins/VDRs for the year [ 2021 ] 0 0 0
Total Withdrawals for the year [ 2021 ] 0 0 0
Int. Updated upto 31/03/2022 59,013 38,933 0
Closing Balance as on 31/03/2022 7,87,565 5,19,584 15,000

----------------------fooj.k dh lekfIr/End Of Statement---------------------- eqfnzr/Printed On : 06-06-2023 20:58:20

izfr[;ku & mij nh xbZ tkudkjh dsUnzh; loZj ij nh xbZ tkudkjh ds vk/kkj ij gSA ;g tkudkjh dkuwuh iz;kstu ds fy, mi;ksx ugha dh tk ldrh gSaA
Disclaimer - Information shown above is based on available data on central server.This information may not be use for legal purpose.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
* Please never respond to any call for sharing any personal details like Aadhar, PAN, Bank details, OTP or request for any payment.
* EPFO never calls members/ pensioners to deposit any amount.
* Please do not make any payment based on any such call.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

MRMRT00055140000014445 Page 1 of 2
 lnL; iklcqd / Member Passbook
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
LFkkiuk vkbZMh@uke | Establishment ID/Name MRMRT0005514000 / U.P.S.R.T.C.
lnL; vkbZMh@uke | Member ID/Name MRMRT00055140000014445 / KRISHAN PAL SINGH
tUe frfFk | Date of Birth 20-09-1960
;w , u | UAN 100194473234

Taxable Data for the year [ 2021-2022]

OB Int. Updated upto 01/04/2021 44,607 44,607 0
Cumulative Balance at the end of the Month
Cont. Month Monthly Contribution
Non-Taxable Taxable
Apr-2021 0 0 0
May-2021 0 0 0
Jun-2021 0 0 0
Jul-2021 0 0 0
Aug-2021 0 0 0
Sep-2021 0 0 0
Oct-2021 0 0 0
Nov-2021 0 0 0
Dec-2021 0 0 0
Jan-2022 0 0 0
Feb-2022 0 0 0
Mar-2022 0 0 0
TOTAL 0 0 0
Int. Updated upto 31/03/2022 59,013 59,013 0
Closing Balance as on 31/03/2022 7,87,565 7,87,565 0
*In case taxable interest is less than Rs. 5,000/- then TDS will not be deducted.

MRMRT00055140000014445 Page 2 of 2