Professional Documents
Culture Documents
_____________________________________________________________________________________________
2.
3.
Emp. No.
: _______________________
4. Location
: ___________________________
5.
PF Account No.
: _______________________
6. PAN No.
: ___________________________
7.
Date of Joining
: _______________________
9.
10.
State:
11.
Contact details
: Cell Number: -
Phone Number:-
12.
Mode of Remittance: () put a Tick in the box against the one opted.
(
Bank Details:
S.B. Account No.____________________________
Name of the Bank ________________________________
_______________________________________________
Branch ________________________________________
Full address of the bank____________________________
_______________________________________________
Trustee
Date :
DECLARATION OF NON - EMPLOYMENT
I declare that I have not been employed in any factory / establishment to which the EPF & MP Act, 1952 applies for a
continuous period not less than 2 months immediately preceding the date of my application for final withdrawal of my
Provident Fund money.
X
Date: __________________
Signature of the member
________________________
ADVANCE STAMP RECEIPT
Received a sum of Rs. _____________ (Rupees _____________________________________________________)
from CIPLA LIMITED EMPLOYEES PROVIDENT FUND towards the settlement of my provident fund
account.
Cheque No. _______________
Date: _____________
X
Re. 1.00
Revenue
Stamp
Enclosures:
a.
b.
c.
d.
e.
f.
Form 16 (If membership is less than 5 years for all the earlier years)
Visa Copy (In case of going abroad)
Death Certificate (In case of death)
Doctor Certificate (In case of medical unfitness)
Final Settlement Computation Sheet
Any other document (Please specify)