ONLTNE TRANSFER CLATM FORM [FORM 13 (REV|SED)]

( Tracking lD:10091470052505001 )

Claim Date :1610712019

EMPLOYEES' PROVIDENT FUND SCHEME, 1 952

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(This form has been printed on the basis of Online Transfer Claim Form filled up by the member under Unified portal for submission
to the
employer.)

To,
The Regional P.F. Commissioner,
CHENNAI,
No. 37, Royapettah High Road, Opposite Swagat Hotet, Chennai

Sir,
I request that my Provident Fund balance along with my Pension Service Details may please be transferred to my present
account under intimation to me. My details are as under :

PART A : PERSONAL
/
1. Name Rafique Babumiya Sayyedt

2. Mobile Number 8087687656

3. E-mailid rafiq uesayyed2 1 @ gmail. com

4. Bank Account Number 0427 1020000 1 96

5. Bank IFSC HDFC0000427

PART B : DETAILS OF PREVIOUS PF ACCOUNTS (WHICH IS To BE TRANSFERRED)

1. PF Account No. (with EPFO TN MAS008 460200000 1 37 74

2. Name of the Establishment EQUITAS SMALL FINANCE BANK LIMITED

3. Address of the Establishment PHASE I I,4TH FLOOR,SPENCER PLAZA, NO.769,AN NASALAI CH EN NAI
685
4. PF AiC l.lo. heid by cHEt'iNAl ,l

5. Name of the Trust NOT APPLICABLE

6. PF A/C No. in Trusi NOT APPLICABLE

7. Bank A/C No. of Trust NOT APPLICABLE

B. IFS Code of the Bank Branch of
Trust where account is NOT APPLICABLE

9. Member's Name Rafique Babumiya Sayyed

10. Date of Birth 04/05/1 980

11. Father's/Spouse Name Babumiya Sayyecl

12. Relationship FATHER

13. Date of joining 06t09t2016

14. Date of leaving 05t01t2019

 PART C : DETAILS OF PRESENT PF

1. PF Account No. (with EPFO MH BAN00200 1 900E001 4850

2. Name of ihe Establishment CMS SECURITIES LIMITED

MARSHALL & SONS BUILDING,(BASEMENT) 38, SOORJI VALLABHDAS
3. Address of the Establishment
MARG BALLARD PIER, MUMBAI 599

4. PF tuC No. held bY RO BANDRA(MUMBAI-l)

5" Name of the Trust NOT APPLICABLE

6. PF tuC No. in Trust NOT APPLICABLE

7. Bank A/C No. of Trust NOT APPLICABLE ,t

8. IFS Code of the Bank Branch of
NOT APPLICABLE
Trust where account is

9. Member's Name Rafique Babumiya Sayyed

10. Date of Birth 04t05t1980

1 1. Father's/Spouse Name Babumiya Sayyed

'12. Relationship FATHER

'13.Date of joining 13t05t2019

l, Certify that all the information given above are true to the best'o[my knowledge and I have ensured correctness of
my present and previous account numbers.

the member

Note : Member should take a printout of this form and a signed copy of the same should be submitted to the Present
Establishment i.e. CMS SECURITIES LIMITED

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