Application Form for Seeking Information under RTI Act 2005

To ,
Central Public Information Officer
Employees' Provident Fund Organisation,
Office of the Addl. Central Provident Fund Commissioner
(Karnataka & Goa),
Bhavishyanidhi Bhavan,
No. 13, Raja Ram Mohan Roy Road,
Bangalore – 560 025 (KN)

Applicant Name <First Name Last Name>

Applicant Address <Communication Address>
Applicant Email <E-Mail Address>
Application Phone <Phone Number>
PF Account No. <Your EPF Number>

Information Sought

I have an EPF account with my previous employer XYZ company based in Bangalore. I applied for withdrawal of
my EPF account on dd/mm/yy, but I have been waiting for 2 yrs now. I would like to know the following things.

1. Have you received my application for transfer of PF Account from city (PF A/C Number) to City (PF A/C
Number) ? If answer is yes, please mention date of receipt of application(s) and its current status.

2. Please let me know the current balance in my account and if the interest is accruing or not.

3. To know the status of a PF account in Noida, please mention the contact details of concerned
person/office with addresses, phone numbers and email addresses. Please also mention the office
timings; a contact/inquiry may be initiated.

4. Please provide details of First Appellate Authority under RTI Act 2005 with detailed postal and email
address etc. for this RTI application.

"I do hereby declare that I am a citizen of India. I request you to ensure that the information is provided before
the expiry of the 30 day period after you have received the application"

Proof of payment of application fee : Attached Indian Postal Order for Rs. 10 /- dated . dd/mm/yyyy favoring
“Accounts Officer of EPFO” as application fee.

Date : dd/mm/yy Name :

Place : Bangalore Signature:

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