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  • PF 1 .Form.2

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    sjsundarji
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    This document contains details about nominating a family member or other person to receive the subscriber's monthly pension benefits in the event of their death. It includes spaces to provide the name, address, date of birth, and relationship of eligible family members. It also allows the subscriber to nominate a person other than a family member to receive the pension. The subscriber must sign or provide a thumbprint to confirm the declarations and nominations.

    Original Description:

    Original Title

    PF_1_.FORM.2

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    © Attribution Non-Commercial (BY-NC)

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    This document contains details about nominating a family member or other person to receive the subscriber's monthly pension benefits in the event of their death. It includes spaces to provide the name, address, date of birth, and relationship of eligible family members. It also allows the subscriber to nominate a person other than a family member to receive the pension. The subscriber must sign or provide a thumbprint to confirm the declarations and nominations.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    10 views1 page

    PF 1 .Form.2

    Uploaded by

    sjsundarji
    This document contains details about nominating a family member or other person to receive the subscriber's monthly pension benefits in the event of their death. It includes spaces to provide the name, address, date of birth, and relationship of eligible family members. It also allows the subscriber to nominate a person other than a family member to receive the pension. The subscriber must sign or provide a thumbprint to confirm the declarations and nominations.

    Copyright:

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

    As

    L7ifl6z, -
    (ow
    .
    1 ) u 18 PART II (E.PS.) Para 18
    T)6T)LUJ iL(4( TO5111 floli 9UJUJLb / tOm5fa.4T OLtLb 2
    tJ)L tfkq*btan rot i9ü
    aiubmbwun1ebr eiet. ‘3p tohm&
    hereby furmsh below part!cuiar5 of the members of m farnii* who would he ehgbte o c eo widow cntdrn pOOOfl the erect ci c deith

    T tbu a
    O
    1 smbwonfehr uriir 2I
    SL No Name of the family Members. — Addrecs Date of I3trth Reiatmnsltip mOlt the member
    (II 2) (4) (St

    t995- aTi Tiserrsn6 utui LLdD u 2 (Vii) uq noj 5.tburL /4m.m


    saf utZide LDqrTaiTsn ujsi. ax
    0
    atjshwsas saajrin
    Certified that! have no family, as defined in para 2 (viiofEmployees Pension Scheme. i995 and should I acquire
    a family hereafter I shall fumish particulars thereon in the ahoe form.
    sTain tSinaarrrorc wrrmr eaawaj aujth stair t/u4eh oiftu ,u’b asti
    uit A aaair ausmrr i5tsc u tesartir wuC& u 16 2)g)(i rcjrb tii)--ic uu.
    I hereby nominate the following person for receiv:ng the monthly widow pension admissible under pars Tb t 2H
    ti & (ii) in the event of my death without leaving any eligible family member for receis ing pension.
    auieunib uuwf air ‘iuajtb. )feu’fli[)i5. t 35 a.giuLsnr.i sit we
    Name and Address of the Nominee. Date of Birth Relationship with the member.
    ,

    iiit / Place:
    Q1 J Date

    *0
    abaurra4saiTu aTLai)Lb. iSGaTrfigir satujrrtjuds sbsuj soya GiuQbaSsTsu rea.
    Strike out whichever is not applicable. Signature or Thumb impression of the Subscriber
    ieiasr gi wturrsrrrt’air sa,rsiir57 / CERTIFICATE BY EMPLOYER
    6T5OTJ J€ij5sr6’O u6oaflL)rfitttb./4l/Gkasbsd1_______________________________
    jsusiflair eii)aagoaair jib /
    1
    jt5l ptuLtb/ Slain sornah (urr l:5 LItS ieirjib
    STaiTSOrTrSJ st5Tsnr4gb
    lQwrrT uyjjg.b arij awa ujrriiutit / saw usa1rsir CReaw ymisswndo /aiTsTrnd 5ThOTU
    ilaa arrs.

    Certified that the above declaration and nomination has been signed thumb impressed before me by
    Shn Smt. Kumari___________________________________________________ employed in my establishment after —

    he she has read the entries entries have been read over to him her by me and got confirmed by him her.

    IL1y Place: jstisaT


    5 ajPsrruujn rPsin emw’ oirruuLc

    yarsir wtrrtb ubp iscrfshr smujotiiiiir


    /fF,g) Date
    Signature oft/to Enipir
    Authoriced Officer of (ho E.c(rtI’Iih’ityi[

    uss:
    Designation

    55• oUuJw cwssrnuuz 355.sTOy .t TLLJI 4a -trttt4

    .\ame and .4ddrr c. of rlu’ Fsctor, E,stabttxhou..ni or Ru/+er 5


    ran
    Supplied by C. Säaramon £ lIte,. ‘3 3. Ro:ape’tah High Rcad. Prapeitab. 11-if’sNAt - 1-1 4 201 3.10
    CS B
    46. Slowe Street. Basement of Regina Mansion, Opp High Courti. C HFN\A: 1. 2534 2° —
    Brancheuai .

    94 ,
    Astad Colon, Anna Nagar WeOt. Near Thrrsmangalam Signal, i HFNNAI - S 01 261 °2S 73

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