Form no.10C – Pension Fund withdrawal1. Sl no. 1 – Name of the members in Block Letters – Write your Name (as appearing in Payslip)2. Sl no. 2 – Date of Birth – Write your Date of Birth (DD / MM / YYYY)3. Sl no. 3 – Father’s Name or (Husband’s Name in case of married woman) – Write the nameaccordingly4. Sl no. 4 – Name and address of the of the Factory / establishment in which the member wasemployed - Do not fill any details5. Sl no. 5 – Code no. & Account no. – Please mention the PF accountRegion / SRO code - APCode no. - 23034Account no. - (see Payslip)6. Sl no. 6 – Reason for leaving – (Please see the instructions and mention accordingly)Date of Leaving – Write the date of relieving (DD / MM / YYYY) (last working date)7. Sl no. 7 – Full Postal address – Write your postal address of your residence with pin code(India and not any other country)8. Sl no. 8 – Are you willing to accept Scheme – Tick the box – No9. Sl no. 9 – Particulars of Family – Please mention your Spouse or Father or Mother Name, Dateof Birth and Relationship10. Sl no.10 – In case of death of member after attaining the age of 58 years – Not applicable11. Sl no. 11 - Tick (b) and fill the Bank account details
S.B. Account number – Write the Savings Bank account number
Name of the Bank (India and not any other country)
Postal address of the branch with pin code12. Sl no. 12 – Are you availing pension under EPS-95 – No13. Signature of the member – Please sign and do not put thumb impression14. Advance Stamped Receipt – Please affix Revenue stamp and sign across and do not fill anydetails.NOTE:Advance Stamped Receipt – Please affix Revenue stamp and sign across on both the forms and donot fill any details. The PF authority has made mandatory to affix the revenue stamps and if notaffixed, the forms shall be rejected.Bank account – The Savings bank account should on your name and not of your relatives. Do notclose the Bank account before the PF amount is credited into the Bank account.The details of wages and period of non-contributory service - Do not fill any detailsPROCESS OF PF WITHDRAWAL FORMS:
Please send the duly filled formsalong with the self address envelope with pin code and thetelephone number
(do not affix postage stamps)
to theOhri towersaddress. (SCSL Payroll - PF
section)2.We shall process the withdrawal forms, enclose the Form no.3A / covering letter and courier backto your residential address mentioned on the forms. (Please note that the previous years’ Formno.3A, if any, will not be enclosed as the same was already submitted to the PF office by us).
Please see the remarks column of the covering letter and fill the pending details, if any.
Please retain the covering letter with you and submit the Original form nos. 19, 10C, 3A - either personally or by registered post with acknowledgement due at the PF office at Hyderabad only after two months from the date of relieving; they will directly credit the money into your bank account in amonth from the date of submission.If the amount is not credited to the bank account, write to thePF office to know the status.The address of the PF office is given below.The Regional Provident Fund Commissioner Regional office3-4-763, Barkatpura,Hyderabad - 500 027