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  • Specimen - PF Form - 11 (Revised)

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    Gaurav Jaiswal
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    FORM NO. L'l(Revised) and ) FUNDSCHEME, PROVIDENT THE EMPLOYEES in Declarationby a persontaking up employment the establishment. (NAME and FULL ADDRESS the establishment of with PF A. / cNo. In employed on andleft service prior to that I was ittt pr l,l. No.__-From----To andcopy of the (b) I am a memberof the

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    FORM NO. L'l(Revised) and ) FUNDSCHEME, PROVIDENT THE EMPLOYEES in Declarationby a persontaking up employment the establishment. (NAME and FULL ADDRESS the establishment of with PF A. / cNo. In employed on andleft service prior to that I was ittt pr l,l. No.__-From----To andcopy of the (b) I am a memberof the

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    365 views1 page

    Specimen - PF Form - 11 (Revised)

    Uploaded by

    Gaurav Jaiswal
    FORM NO. L'l(Revised) and ) FUNDSCHEME, PROVIDENT THE EMPLOYEES in Declarationby a persontaking up employment the establishment. (NAME and FULL ADDRESS the establishment of with PF A. / cNo. In employed on andleft service prior to that I was ittt pr l,l. No.__-From----To andcopy of the (b) I am a memberof the

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    of 1

    (UnexemptedEstablishmentOnlY)

    FORM NO. l'l(Revised)

    - --- -EMPLOYEESPROVIDENTFUNDSCHEME,l9S2@aragraph.34)
    THE and
    iHn TTuPL0YEESPENSIONscHEME, l995(Paragraph 24)
    Declarationby a persontaking up employmentin the establishment
    S/O,Y#frDa*gh€r
    Do herebysolemnli declarethat :
    (a) I wasemployedin
    M/s.

    OFTHE ESTABLISHMENT
    ( NAME & FULL ADDRESS )
    andleft serviceon prior to that I was
    with PF A./cNo.
    employedin
    *ittt pr l,l. No.__-From----To

    (b). I am a memberof the pensionfund from==--.--To andcopy of the


    schemecertificateis enclosed.
    / PensionFund'
    (c). I have/havenot withdrawnthe amountof my Provident.Fund
    (d). I have/havenot drawnanybenefitsunderthi employee'sPensionScheme,1995 in respectofmy
    pastservicein anyestablishment.
    (e). I have/haven.u"i b"un a memberof anyProvidentFundand/or PensionFund.

    + Signatureor left lrmb impressionof the emPloYee.


    DATE: @

    Encl:Copvof the SchemeCertificate.

    To be filled by the emPloYer)

    (1) Shri/ Smt.i Miss is appointedas


    (Narneof ErnPloYee) (Designation)
    in lWs. with effect from-
    (Name of FactorY/ Establishment.) (Date{f appointment)
    bearingPF A./c.No.

    (2) Copyof SchemeCertificateis enclosed


    (3) Declaration& Nominationin from 2 is enclosed'

    DATED: Signatureof the employeror nvnageror other


    officer.
    authorized
    * Left handimpressionin the caseof illiterate malememberand right handimpressionby
    illiterate femalemember.

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