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    E PF Form 2 For Nomination Fillable

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    m2gzqvkczq

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    E PF Form 2 For Nomination Fillable

    Uploaded by

    m2gzqvkczq
    2 views2 pages

    Original Title

    e PF Form 2 for Nomination Fillable

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    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
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    Download as pdf or txt
    2 views2 pages

    E PF Form 2 For Nomination Fillable

    Uploaded by

    m2gzqvkczq

    Copyright:

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

    D O J ______ FORM 2 (REVISED) Emp ID ______

    NOMINATION AND DECLARATION FORM


    FOR UNEXEMPTED / EXEMPTED ESTABLISHMENTS

    Declaration and Nomination Form under the Employees’ Provident Funds and Employees’
    Pension Scheme
    ( Paragraph 33 and 61 (1) of the Employees’ Provident Fund Scheme, 1952 and Paragraph 18 of
    the Employees’ Pension Scheme, 1995).

    1. Name : ___________________ __________________________ __________________


    ( IN BLOCK NAME FATHER’S/ HUSBAND’S NAME SURNAME
    LETTERS)

    2. Date of Birth______________________ 3. Account No. __________________________

    4. Sex : Male / Female :________________ 5.Marital Status: Married/ Unmarried/ Widow/Widower

    6. Permanent Address: ______________________________________________________________


    ___________________________________________________________________________________
    _______________________________________________________________________________

    7.Temporary Address :______________________________________________________________


    ___________________________________________________________________________________
    _______________________________________________________________________________

    PART –A (EPF)
    I hereby 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 Employees’ Provident
    Fund, in the event of my death.

    Name & Address of the Nominee’s Date Total amount If the nominee is minor, name
    Nominee (s) relationship of or Share of relationship & address of the
    with the Birth accumulations guardian who may receive the
    member in P.F. to be amount during the minority
    paid to each of nominee
    nominee
    1 2 3 4 5

    1.Certified that I have no family as defined in para 2 (g) of the Employees’ Provident Fund Scheme
    1952 and should I acquire a family hereafter the above nomination should be deemed as cancel.
    2. Certified that my father/ mother is/are dependent upon me.

    * strike out which is not applicable.

    X Signature or thumb impression of the subscriber


    P.T.O.
    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.

    Sr. No. Name and Address of the Family Date of Birth Relationship with
    member member

    .. Certified that I have no family, as defined para 2 (vii) of the Employees’ Pension Scheme,1995
    and should I acquire a family hereafter I shall furnish particulars there on in the above form.

    I hereby nominate the following person for receiving the monthly widow pension [ admissable under
    para 16 (2) (a) & (ii) in the event of my death without leaving any eligible family member for receiving
    pension.

    Sr. NO. Name & Address of the Nominee Date of Birth Relationship with the
    member
    (1) (2) (3) (4)

    Date : _____________
    .. Strike out which is not applicable
    X Signature or 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 /Miss__________________________________________ employed in my establishment
    after he / she has read the entries the entries have been read over to him / her by me and got confirmed
    by him /her.

    Name & Address of the Factory / Establishment X Signature of the employer or other authorised
    Or Rubber Stamp thereof officer of the establishment
    Place : _____________
    Date : _____________

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