UNITED TECHNICAL CONSULTANTS PROVIDENT FUND 6, Community Centre, Saket, New Delhi-110017 ( Employees Provident Fund Scheeme

, 1952 ) 1 Name of the member (In Block Letters) 2 Father's Name or(husband's name in the case of married woman) 3 Name and Address of the Factory/Establishment in which the member was last employed) 4 Provident Fund Account No. 5 Date of Leaving Service 6 Reason for Leaving 7 Date of Joining the Establishment 8 Date of Birth 9 Full Postal Address (In Block Letters) :

: UNITECH LIMITED : 6, COMMUNITY CENTRE, SAKET , NEW DELHI-110017 : DL/4937/ : : : : : ,Last Place of Posting

, E.Code:-

Pin Code :-__________________________ 10 Mode of Remittance (By account payee cheque sent direct for credit to my savings bank account under intimation to me) (a) Bank Account No. (b) Name of Bank ( c ) Full address of the Branch (In Block Letters) :

: : :

Date ( Signature or left/right hand thumb impression of the member ) Note:- In the case of submission of application for settlement under clause (s) of sub-paragraph(i) and in clause (b) of sub paragraph(2) of paragraph 69 of the EPF scheeme, 1952 the calim should be submitted after two months from the date of leaving service provided the member continues to remain un-employed in an establishment to which the Act applies. Date ( Signature or left/right hand thumb impression of the member ) ( ADVANCE STAMPED RECIEPT ) Received sum of *Rs.___________(Rupees____________________________________________________________________) from UNITED TECHNICAL CONSULTANTS PROVIDENT FUND by deposit in my Saving Bank account towards the settlement of my Provident Fund Account. Affix 1/Rupee Revenue Stamp ( Signature or left/right hand thumb impression of the member ) ( For the use of UNITED TECHNICAL CONSULTANTS PROVIDENT FUND )

* The space should be left blank which shall be filled in by the United Technical Consultants Provident fund)

Accounts Officer

Trustee

Paid by Cheque No._________________ Dated _____________________ Bank Voucher No.______________________________

REMARKS

E. (b) Name of Bank ( c ) Full address of the Branch (In Block Letters) : : : : Date ( Signature or left/right hand thumb impression of the member ) Note:. NEW DELHI-110017 : DL/4937/ : : : : : .______________________________ REMARKS . COMMUNITY CENTRE. 1952 ) 1 Name of the member (In Block Letters) 2 Father's Name or(husband's name in the case of married woman) 3 Name and Address of the Factory/Establishment in which the member was last employed) 4 Provident Fund Account No. Saket.Code:- Pin Code :-__________________________ 10 Mode of Remittance (By account payee cheque sent direct for credit to my savings bank account under intimation to me) (a) Bank Account No. Date ( Signature or left/right hand thumb impression of the member ) ( ADVANCE STAMPED RECIEPT ) Received sum of *Rs.Last Place of Posting . Affix 1/Rupee Revenue Stamp ( Signature or left/right hand thumb impression of the member ) ( For the use of UNITED TECHNICAL CONSULTANTS PROVIDENT FUND ) * The space should be left blank which shall be filled in by the United Technical Consultants Provident fund) Accounts Officer Trustee Paid by Cheque No. 5 Date of Leaving Service 6 Reason for Leaving 7 Date of Joining the Establishment 8 Date of Birth 9 Full Postal Address (In Block Letters) : : UNITECH LIMITED : 6.UNITED TECHNICAL CONSULTANTS PROVIDENT FUND 6. New Delhi-110017 ( Employees Provident Fund Scheeme. 1952 the calim should be submitted after two months from the date of leaving service provided the member continues to remain un-employed in an establishment to which the Act applies.___________(Rupees____________________________________________________________________) from UNITED TECHNICAL CONSULTANTS PROVIDENT FUND by deposit in my Saving Bank account towards the settlement of my Provident Fund Account. Community Centre. SAKET ._________________ Dated _____________________ Bank Voucher No.In the case of submission of application for settlement under clause (s) of sub-paragraph(i) and in clause (b) of sub paragraph(2) of paragraph 69 of the EPF scheeme.

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