NON EMPLOYMENT CERTIFICATE ‘SELF DECLARATION BY THE MEMBER / CLAIMANT pe! kuung Slo. Wio. Ho N Residingat NO 81,9" won , KAMALA NEMeL ExT. 0 Bangarer— — séo0a2 dohereby sioemnly affirm and sincerely state as here under _KTRaN wene . n Slo. Wio. Hlo, declare that limy hussandiwife was an employee of Mis, bearing PF. Accoun: No.®y [ic \aai4\ vaayee, and left the job on_4 | ‘and that Iimy husbandiwife had not been employed in any other establishmert covered under the EPF Scheme, 1952, Priorto the date of oining the establishment/ after the dats of Leaving service from the above establishment ‘And that | declare that | am not in receipt of any pensionary benefits under Employees Family Pension 197//Employees Pension Scheme, 1995 That whatis stated above is true and correc to, the best of my Knowldge. Incase, my above dectaration is found to be false, undertake toretutn the Pension in fllwth « interest as déclared by EPF Organisation and | am lable for any action that may be initiated by EPFO inthis regard Solornny armed at user ‘Signature the membericlaimant ‘Onthis day the NOTE: Strke whichever is not applicable, Authorised Signatory