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List of Attachments with claim application form

(Please tick against the documents enclosed)

UAN No. _____________________________ Member ID GJ/AHD/ ______________________________

Form 19 & Form 10 C/SC

Bank Passbook xerox or cancelled cheque with name printed of bearer

Photo ID Proof (Please mention)

Pan card copy (If PF is more than Rs. 30,000/- and service is less than 5 years)

Form 5/10

15 G/15H/Declaration

Age proof of Member & Family members

Self affidavit

Member Sign ____________________________ DA Sign ____________________________

Date ____________________