Date :

From :

To
The Trustees
EIT Services India Private Limted.,
Employees' Provident Fund Trust
Bangalore – 560 100.

Dear Sir,

I would like to withdraw the amount in my Provident Fund Account with you.

I hereby declare that, I have not been employed in any establishment which is covered under the EPF Scheme. The
brief particulars of my employment with EIT Services India Private Limted. Ltd are given below:

1. Name in Full : _______________________________________________________

2. Father’s Name : _______________________________________________________

3. Address for
Correspondence : _______________________________________________________

_______________________________________________________

4. Present Address : _______________________________________________________

_______________________________________________________

5. Date of Joining : _______________________________________________________

6. Date of Leaving : _______________________________________________________

7. Badge No. : _______________________________________________________

8. P.F. Number : ______________________________________________________

9. Reason for leaving : ______________________________________________________

10. PAN : ______________________________________________________

11. Personal Mail ID : ______________________________________________________

12. Contact No. : _______________________________________________________

13. Bank Account No. : ________________________________________________________

14. Bank Name : ________________________________________________________

15. IFSC Code : ________________________________________________________

16. MICR Code : ________________________________________________________

( Two cancelled Cheque leaf of the bank to be attached )

Signature

Certificate by the Employer

The above particulars are correct. You can settle the PF Account.