Author:

UAN*(if Date of
M-Male
Date of
already Member Name* ( As per Aadhaar Birth*( As
F-Female
S No EMP ID joining -
member of data base) per T-Transgender
EPF*
EPF) Aadhaar)
1 2 3 4 5 6

Author:
M-Male F-Female
T-Transgender

UAN*(if Date of
Date of
already Member Name* ( As per Aadhaar Birth*( As
S No EMP ID joining -
member of data base) per
EPF*
EPF) Aadhaar)
1 2 3 4 5 6
910410 101529265427 T Lakshmikara Reddy 9th July 1997 ###
 : Auth
F- or: M-
Matric Author:
F India
M-Married
at n or
h pleas
S- U-
er e
Senior Unmarried
specif
Gender* Secon
Father/Husband y if
W-
le (As any Relation Mobile
dary
ansgender Name*(As per Widow/Wi E- mail ID
per other ship* Number
Aadhaar) natio G- dower
Aadhaar) Gradu D-
nals
S- 7 8 9 Author: 10ate 11
Divorcee
S I-Illetrate L-Literate N-Non Matric
p M-Matric P- S-Senior Secondary G-Graduate
o Post Graduate
P-Post D-Doctrate T-
us Gradu
Technical(Professional)
e ate

D-
Doctr
ate

T-
Techn
ical(P
Author: rofess Author:
Author:
F-Female
F-Father ional) M-Married
Indian or please
Transgender S-Spouse specify if any other U-
nationals Unmarried
W-
Widow/Widower
D-Divorcee

Gender*
Father/Husband
(As Relation Mobile
Name*(As per E- mail ID
per ship* Number
Aadhaar)
Aadhaar)
7 8 9 10 11
M Tamatam Jayanadha Reddy F 7013640823 lakshmikara9009@gmail.com
 Internati
onal
Worker
Marital (If Yes)>> Please provide the below Mandatory Details
Status*
Nationali Gross Qualifica Status* Country
(Yes/No Passport Passport Valid
ty* Wages tion ( As per of
- With Number* from*
Aadhaar) Origin*
COC/Wit
12 13 14 15 16 17 18 19
h out
N-Non Matric
ary G-Graduate COC
te T-

uthor:
M-Married
U-
Unmarried
W-
Widow/Widower
D-Divorcee

Worker
Marital (If Yes)>> Please provide the below Mandatory Details
Status*
Nationali Gross Qualifica Status* Country
(Yes/No Passport Passport Valid
ty* Wages tion ( As per of
- With Number* from*
Aadhaar) Origin*
COC/Wit
12 13 14 15 16 17 18 19
Indian G U No India R4557190 9/11/2017
 Is
below Mandatory Details
Physicall
Locomoti
Passport Valid y Hearing Visual Bank Acc.No IFSC
ve
Upto* Handicap
(Y/N)
20 21 22 23 24 25 26

Is
below Mandatory Details
Physicall
Locomoti
Passport Valid y Hearing Visual Bank Acc.No IFSC
ve
Upto* Handicap
(Y/N)
20 21 22 23 24 25 26
9/10/2027 N N N N 59801559429ICIC0000598
 Name as on Bank PAN Name as on PAN Aadhaar No

27 28 29 30

Name as on Bank PAN Name as on PAN Aadhaar No

27 28 29 30
T LAKSHMIKARA REDDY BCLPT5918A TAMATAM LAKSHMIKARA REDDY774444271405
 Are you already a member of EPF in
Name as on Aadhaar
your Prev. Establishment

31 32

Are you already a member of EPF in

Name as on Aadhaar
your Prev. Establishment

31 32
T LAKSHMIKARA REDDY
 (If Yes)>>Have you ADP End
Pension
Are you already a member of Pension Withdrawn the PF &
PF applicabi
in your Prev. Establishment Pension Amount for Your
wages lity
Prev.EPF Account
33 34 35 36

(If Yes)>>Have you ADP End

Pension
Are you already a member of Pension Withdrawn the PF &
PF applicabi
in your Prev. Establishment Pension Amount for Your
wages lity
Prev.EPF Account
33 34 35 36
No - I am taking
No
Yes- -I First
Iam
havetaking
time
withdrawn
employment
First time
theemployment
amount of my EPF &
he amount of my EPF & Not Pension
S No. Employee ID Name Permanent Address

2-250-56-1-4,RAMI REDDY LAY

OUT,MADANAPALLI,CHITTOOR
dist ANDHRA PRADESH.PIN
910410 T LAKSHMIKARA REDDY CODE-5173325
Father's Name Corresepondence Address Email Id DOJ

PLOT NO : 13,SIRI
RESIDENCY,JV
COLONY,GACHIBOWLI,
HYDERABAD,TELENGANA
TAMATAM JAYANADHA R PIN CODE-500032 lakshmikara9009@gmail.com2/20/2020
DOB Actual Birthday Aadhar Card No PAN No. Mobile No

7/9/1997 7/9/1997 774444271405 BCLPT5918A 7013640823

Landline No Alternate No Personal Email ID Blood Group Marital Status

0 85006309097 lakshmikara9009@gmai.com
A+ SINGLE
 Date of Birth
S. No: Employee ID Name of Insured Age Gender
(dd/mm/yyyy)
1 910410 T LAKSHMIKARA REDDY 9-Jul-97 22 MALE
2 910410 T KALAVATHI
3 910410 T JAYANADHA REDDY
4 910410
5 910410
Relation

Self
Mother
Father
Spouse
Child