PF FORM 11

EMP ID:
www.epfindia.gov..in
Composite Declaration Form -11
(To be retained by tire employer for future reference)
EMPLOYEES' PROVIDENT FUND ORGANISATION
Employees' Provident Funds Scheme, 1952 (Paragraph 34 & 57) &
Employees' Pension Scheme, 1995 (Paragraph 24)
(Declaration by a person taking op employment in any establishment on which EPF Scheme, 1952 and /or EPS, 1995 is applicable)
1 Name of the member
Father's Name
2
Spouse's Name
3 Date of Birth: ( DD I MM I YYYY )
4 Gender: (Male/Female/Transgender)
5 Marital Status: (Married/Unmarried/Widow/Widower/Divorcee)
(a) Email ID:
6 (b) Mobile No.:
Leave Blank
Present employment details:
7 Date of joining in the current establishment (DD/MM/YYYY)
KYC Details: (attach self attested copies of following KYCs)
a) Bank Account No. :
8 b) IFS Code of the branch:
c) Name As Per Bank
a) AADHAR Number :
b) Name As Per AADHAR :
a) Permanent Account Number (PAN), if available
b) Name As Per PAN
9 Whether earlier a member of Employees' Provident Fund Scheme, 1952 Tick YES
Yes / No
10 Whether earlier a member of Employees' Pension Scheme, 1995 Tick YES
Yes / No
Previous employment details: [if Yes to 9 AND/OR 10 above) - Un-exempted
Establishment Universal PF Account Date ofjoining Date of exit Scheme PPO Number Non
Name & Address Account Number (DD/MM/ (DD/MM/ Certificate (ifissued) Contributory
Number YYYY) YYYY) No. (if Period
issued (NCP) Davs
11 Manpower XXX/ Please Please
/Ontrack/ UAN No XXXX/ check check
Vision XXX with PF with PF
Details details details
Previous employment details: [if Yes to 9 AND/OR 10 above) -For Exempted Trusts
Name & Address of the Trust UAN Member Date of Date of exit Scheme Non
EPS A/c joining (DD/MM/ Certificate Contributory
Number (DD/MM/ YYYY) No. (if Period (NCP)
YYYY) issued Days
12 12
a) International Worker: Tick No

Yes / No
13 b) lf yes, state country of origin (India/Name of other country)
c) Passport No.
d) Validity of passport [(DD/MM/YYYY) to (DD/MM/YYYY)]

UNDERTAKING
I) Certified that the particulars are true to the best of my knowledge.

2) I authorize EPFO to use my Aadhar for verification/authentication/e—KYC purpose for service delivery.
3) Kindly transfer the funds and service details, if applicable, from the previous PF account as declared above to the present P.F. Account as I
am an Aadhar verified employee in my previous PF Account.•
4) In case of changes in above details, the same will be intimated to employer at the earliest.
Date: Sign Here

Place: Signature of Member
DECLARATION BY PRESENT EMPLOYER
A. The member Mr/Ms/Mrs ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙ has joined on .....................................................and has been
allotted PF No. ∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙.and UAN∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙∙

B. In case the person was earlier not a member of EPF Scheme, 1952 and EPS, 1995:
• Please Tick the Appropriate Option:
The KYC details of the above member in the UAN database
Have not been uploaded
Have been uploaded but not approved
Have been uploaded and approved with DSC/e-sign.
C. In case the person was earlier a member of EPF Scheme, 1952 and EPS, 1995:
• Please Tick the Appropriate Option:-
0 The KYC details of the above member in the UAN database have been approved with E-sign/Digital Signature Certificate
and transfer request has been generated on portal.
D The previous Account of the member is not Aadhar verified and hence physical transfer form shall be initiated
Date: Signature of Employer with Seal of

Embellishment
•Auto transfer of previous PF account would be possible in respect of Aadhar verified employees only. Other employees are requested to
File physical claim (Fonn-13) for transfer of account from the previous establishment.

PF FORM 11

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EMP ID:

1 Name of the member

a) International Worker: Tick No

d) Validity of passport [(DD/MM/YYYY) to (DD/MM/YYYY)]

I) Certified that the particulars are true to the best of my knowledge.

Date: Sign Here

DECLARATION BY PRESENT EMPLOYER

Date: Signature of Employer with Seal of

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