NON EMPLOYMENT CERTIFICATE SELF DECLARATION BY THE MEMBER / CLAIMANT Slo, Wio. Hie N Residing at dohereby sloamnly affirm and sincerely state as here under a aca Slo, Wio. Hi, ‘declare that my husbandiwife was an employee of Ms bearing PF Account No, and eft the job on, ‘and that limy husbaha/wife had nat been employed in any other establishment covered under the EPF Scheme, 1952, Prior to the date of joining the establishment /atter the date of Leaving service ‘rom the above establishment. ‘And that | dectare that | am notin receipt of any pensionary benefits under Employees Family ensien 197//Employees Pension Scheme, 1995 That what's stated aboveis true and correct to the best of my Knowledge. Incase, my above dectaration is found to be false, | undertake to returm the Pension in full with, interest as declared by EPF Organisation and | am lable for any action that may be initiated by EPFO inthis regard. Solomnly affirmed at ‘Signature ofthe memberkslaimant ‘Onthisday the NOTE: Stike whicheveris not applicable, Authorised Signatory