Welcome to GDS

Enter a realm of
opportunities. Together, we
can achieve our potential
and make a difference!
EY is a global leader in advisory, assurance, tax, transaction advisory
services and knowledge services. Like all global organizations, EY’s
success depends upon deploying the skills and expertise of its people to
meet the needs of business worldwide.

Global Delivery Services, India plays a vital role in supporting EY’s

various service lines and business operations across the world. Over
the past few years, GDS India has grown exponentially and continues to
scale new heights.

First set up in 2002, GDS India has come a long way. From a single
office in India with 80 employees to three offices in Bangalore, one in
Gurgaon, one in Chennai and several thousand employees, GDS India
has grown from strength to strength.

We, at GDS India, are committed to helping our people, our clients and
our wider communities achieve their potential. Welcome to one of the
Live your dreams, lead by
example, make a difference and experience a great place to work!
 GDS

block

GPN: Male Female

Name

To

To

01
>Yeadq\]lYadk
Khgmk]ÌkfYe]
a^Yhhda[YZd]!
Khgmk]Ìkg[[mhYlagf

Khgmk]Ìk<G: <<'EE'QQ Khgmk]Ìk]ehdgq]j

;`ad\ÌkfYe] )! Male Female <G: <<'EE'QQ

;`ad\ÌkfYe] *! Male Female <G: <<'EE'QQ

>Yl`]jÌkfYe] <G: <<'EE'QQ

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Name

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03
9j]qgmj]dYl]\lgYfqg^gmj]ehdgq]]k7 Yes No

A^q]k$fYe]l`]]ehdgq]]qgmYj]j]dYl]\lg

J]dYlagfk`ah

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@Yn]qgm]n]jZ]]f[gfna[l]\afl`][gmjlg^dYo7 Yes No

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Name G[[mhYlagf

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04
 Global Code of Conduct

The Global Code of Conduct draws on the commitments contained in our shared values.

Our Values

Who we are
People who demonstrate integrity, respect, and teaming.
People with energy, enthusiasm, and the courage to lead.
People who build relationships based on doing the right thing.

To the people of EY

a demanding and complex business environment.

additional support and resources available to all of us.

commitment to abide by it.

meet the expectations of our people, clients and communities.

Sincerely,
Carmine Di Sibio
Chairman and CEO

05
L`]=Q?dgZYd;g\]g^;gf\m[lhjgna\]kl`]]l`a[Yd^jYe]ogjcgfo`a[`o]ZYk]gmj\][akagfkÈYkaf\ana\mYdk
Yf\Yke]eZ]jkg^gmj_dgZYdgj_YfarYlagf&L`];g\]akYf[`gj]\afgmjnYdm]kYf\Z]da]^k$Yf\mf\]jhafkYddl`Yl
we do.

Gmj?dgZYd;g\]g^;gf\m[lakgj_Yfar]\aflgÕn][Yl]_gja]k[gflYafaf__ma\af_hjaf[ahd]kl`Ylk`gmd\Z]mk]\Zq
]n]jqgf]oal`af=Qlg_ma\]gmjZ]`YnagjY[jgkkYddYj]Ykg^gmjY[lanalq2

)&Ogjcaf_oal`gf]Yfgl`]j
*&Ogjcaf_oal`[da]flkYf\gl`]jk
3. Acting with professional integrity
4. Maintaining our objectivity and independence
5. Respecting intellectual capital

We expect everyone who works at EY to behave in accordance with the principles contained in the Global Code
of Conduct. If you do not understand the principles contained within the Code, or are not sure how to apply
l`]e$qgmk`gmd\[gfkmdloal`YfYhhjghjaYl]dq%imYdaÔ]\[gdd]Y_m]lg_]lqgmjim]klagfkYfko]j]\&

Our commitment

L`]?dgZYd;g\]g^;gf\m[lYhhda]klg]n]jqgf]Yl=Q$j]_Yj\d]kkg^l`]ajaf\ana\mYdjgd]$hgkalagfgjhjY[la[]&

 We promote and support the Global Code of Conduct in our day-to-day business activities, through both
personal leadership and business practice.

 Each of us is expected to behave according to the principles contained in the Global Code of Conduct. We
]f[gmjY_][gfkmdlYlagfYf\l`]k]]caf_g^Y\na[]$YkYhhjghjaYl]$^jgel`]j]kgmj[]kYnYadYZd]lgYkkaklaf
application of the Code.

 We understand that deviations from or violations of the Global Code of Conduct are unacceptable and that we
should feel able to raise them, without fear of retaliation, with an appropriate colleague or to the relevant
]l`a[k`gldaf]&=Q\g]kfglh]jeal\ak[jaeafYlagfgjj]lYdaYlagfg^Yfqcaf\^gj_gg\^Yal`j]hgjlkg^
illegal or unethical behavior.

 O]Y[cfgod]\_]l`YlZj]Y[`]kg^l`]?dgZYd;g\]g^;gf\m[leYqj]kmdlafgmjhjY[la[]klYcaf_\ak[ahdafYjq
action, up to and including termination of employment.

 O]Y^Õjeafojalaf_gmjmf\]jklYf\af_g^l`]hjaf[ahd]k[gflYaf]\afl`]?dgZYd;g\]g^;gf\m[lYf\
our commitment to abide by them.

Ogjcaf_oal`gf]Yfgl`]j

O]Zmad\j]dYlagfk`ahkoal`]Y[`gl`]jZYk]\gfYk`Yj]\ljmklYf\[gfÕ\]f[]l`Yl]Y[`g^mk`YkYh]jkgfYdYf\
professional commitment to do the right thing.

We are committed to communicating openly and honestly.

O]Yj][geeall]\lgogjcaf_af\an]jk]l]YekYf\Yj]h]jkgfYddqY[[gmflYZd]lggl`]jl]Yee]eZ]jk^gjl`]
[gfljaZmlagfo]eYc]&

We rely upon each other to deliver quality service to our clients and for our individual development.

We nurture integrity, respect and teaming.

06
We consult with each other and value the perspectives of those who are different from us, as well as those who
challenge our own point of view.

O]]eZjY[]emdla[mdlmjYd]ph]ja]f[]Yf\\an]jkalqYkklj]f_l`kg^gmj_dgZYdgj_YfarYlagf&9kkm[`$o]j]kh][l
one another and strive for an inclusive environment free from discrimination, intimidation and harassment.

We encourage and support the professional development of our colleagues and promote individual achievement
and continuous learning.

O]]ph][lYf\\]dan]j^]]\ZY[cj]_mdYjdq$[Yf\a\dqYf\[gfkljm[lan]dq$Yf\hgkalan]dqj][g_far]km[[]kk&

Ogjcaf_oal`[da]flkYf\gl`]jk

Fg[da]flgj]pl]jfYdj]dYlagfk`ahakegj]aehgjlYfll`Yfl`]]l`a[k$afl]_jalqYf\j]hmlYlagfg^=Q&

œ Ogjcaf_oal`[da]flkÀ
We commit ourselves, as professionals, to uphold the trust placed in us by others.

O]Yj][geeall]\lg\]dan]jaf_imYdalqk]jna[]kl`Ylj]Ö][lgmjhjg^]kkagfYd[YhYZadala]kYf\Yj]YhhjghjaYl]lg
l`]kh][aÕ[akkm]kYf\f]]\kg^gmj[da]flk&

We are robust and courageous in our challenge to clients and are not afraid to deliver unwelcome information to them.

O]kmhhgjlgmjh]ghd]Yf\oaddoal`\jYo^jgeogjcaf_^gjYfq[da]flkl`Ylhmlgmjh]ghd]mf\]jmf\m]hj]kkmj]
or threaten them in exercising their professional duties.

œ Ogjcaf_oal`j]_mdYlgjkÀ
O]mh`gd\l`]hjg^]kkagfYdklYf\Yj\kYf\jmd]kYhhda[YZd]lgmk$Yf\gmjÕjekY[lan]dqogjcoal`l`]j]_mdYlgjk
who oversee our professional conduct to ensure that these rules and standards meet the continuously changing
f]]\kg^l`]eYjc]l&

œ Ogjcaf_oal`gl`]jkÀ
We reject unethical or illegal business practices in all circumstances.

O]Ynga\ogjcaf_oal`[da]flkYf\gl`]jko`gk]klYf\Yj\kYj]af[gehYlaZd]oal`gmj?dgZYd;g\]g^;gf\m[l&

We coordinate, as appropriate, with other members of our profession in matters of public interest.

O]j][g_far]gmjj]khgfkaZadalqYkYfgj_YfarYlagfafhdYqaf_YfY[lan]Yf\hgkalan]jgd]afkmhhgjlaf_Y
successful and sustainable society.

9[laf_oal`hjg^]kkagfYdafl]_jalq

œ Gmjhjg^]kkagfYdafl]_jalqÀ
We comply with laws, regulations and standards that apply to us in our professional conduct.

O]mh`gd\l`]=QfYe]&O]\gfgleakj]hj]k]fll`]hgkalagfl`Yl=QlYc]kafhjg^]kkagfYdYf\gl`]jeYll]jk&

We promote a culture of consultation. We address questions of ethics and consult appropriately to help resolve
them. We do not hide from or ignore issues.

We provide ethics hotlines to deal with sensitive ethical issues.

O]mf\]jklYf\Yf\[gehdqoal`=Qhgda[a]kYf\hjg[]\mj]k&

07
œ Gmj[geh]lalan]YhhjgY[`À
O]j][g_far]l`Ylgmj[geh]lalan]Y\nYflY_]akY[`a]n]\l`jgm_`l`]]p[]dd]f[]g^gmjhjg^]kkagfYdY\na[]Yf\
the quality of our service delivery.

O][geh]l]]f]j_]la[YddqYf\na_gjgmkdq$Yf\j][g_far]l`]f]]\lgZ]`gf]klafgmj[geh]lalan]Z]`Ynagj&

O]\gfglg^^]jh]jkgfYdaf\m[]e]fllgk][mj]ogjc&

œ <g[me]flaf_gmjogjcÀ
O]hjgh]jdq\g[me]flgmj[da]fl]f_Y_]e]flkYf\Zmkaf]kkgh]jYlagfkafY[[gj\Yf[]oal`=Qhgda[a]kYf\
relevant legal and professional requirements.

We never destroy or alter documents, or recommend their destruction or alteration, for any illegal or improper
reason.

œ Gmj^]]kÀ
We charge appropriate fees for our services in accordance with our engagement terms and our professional rules.

œ Lae]Yf\]ph]fk]kÀ
O]j]imaj]Y[lmYd`gmjkogjc]\Yf\]ph]fk]kaf[mjj]\lgZ]j]hgjl]\&

O]af[mj]ph]fk]kafY[[gj\Yf[]oal`=Qhgda[a]kgj$o`]j]Y_j]]\$gmj[da]flkÌ]ph]fk]hgda[a]k&

EYaflYafaf_gmjgZb][lanalqYf\af\]h]f\]f[]

œ Our objectivity
O]eYaflYafYf\Y^ÕjegmjgZb][lanalqYf\af\]h]f\]f[]$j][g_faraf_l`Yll`]k]Yj][jala[Ydlggmj
professional responsibilities.

O]]ehdgqhjg^]kkagfYdkc]hla[ake&

We reject inappropriate pressure from clients or others.

O]Yj]Yd]jl^gjh]jkgfYdYf\hjg^]kkagfYd[gfÖa[lkg^afl]j]klYf\lYc]aee]\aYl]Yf\YhhjghjaYl]kl]hklg
resolve or manage any that may arise.

O]\gfglY[[]hlhYqe]flkgjal]ekg^nYdm]a^l`ak[gmd\j]YkgfYZdqZ]na]o]\YkafÖm]f[af_gmj[gf[dmkagfkgj
advice.

œ Our independence
O][gehdqoal`=QÌkaf\]h]f\]f[]jmd]k$af[dm\af_l`]j]klja[lagfkYhhda[YZd]lggmj^Yeada]k&O]mf\]jklYf\l`Yl
these may sometimes be more rigorous than applicable professional and legal requirements.

O]Ynga\j]dYlagfk`ahkl`YlaehYajÈgjeYqYhh]YjlgaehYajÈgmjgZb][lanalqYf\af\]h]f\]f[]&

We continuously monitor our independence.

08
 J]kh][laf_afl]dd][lmYd[YhalYd

O]j]kh][lYf\hjgl][l[gfÕ\]flaYdaf^gjeYlagfgZlYaf]\^jge$gjj]dYlaf_lg$gmj[da]flkgjl`aj\hYjla]k$Yko]dd
as personal information about our people, in accordance with local law and professional standards.

O]lYc]hjgY[lan]e]Ykmj]klgkY^]_mYj\gmj\g[me]flk$[gehml]jkYf\gl`]j\YlY\]na[]kl`Yl[gflYaf
h]jkgfYdgj[gfÕ\]flaYdaf^gjeYlagf&

O]\gfglmk][gfÕ\]flaYdaf^gjeYlagf^gjh]jkgfYd_Yaf&

We obtain, develop and protect intellectual property in an appropriate manner. We respect the restrictions on its
use and reproduction.

O]mk]Yf\k`Yj]afl]jfYdYf\]pl]jfYdcfgod]\_]afY[[gj\Yf[]oal`=Qhgda[a]kYf\gmjd]_YdYf\hjg^]kkagfYd
obligations.

O]Y[cfgod]\_]l`Yl]Y[`g^mkakj]khgfkaZd]^gjc]]haf_gmjhjg^]kkagfYdcfgod]\_]mh%lg%\Yl]Yf\^gjk`Yjaf_
best practices.

O`]j]lgÔf\kmhhgjl

Af\]n]dghaf_l`ak?dgZYd;g\]g^;gf\m[l$l`]d]Y\]jk`ahg^=Qj][g_far]kl`Ylfg[g\][Yf[gn]j]n]jq
]n]flmYdalqÈYf\l`Yl^jgelae]lglae]o]eYqj]imaj]l`]Y\na[]Yf\kmhhgjlg^gl`]jkafY\\j]kkaf_kge]g^
the situations that arise during the normal course of daily business life.

O]`Yn]dgf_hjgegl]\Y[gfkmdlYlan][mdlmj]Yl=Q&AfY\\alagflg]klYZdak`]\afl]jfYdj]dYlagfk`ahk$o]`Yn]
[j]Yl]\Ykmhhgjlf]logjcl`YlakYnYadYZd]^gj[gfkmdlYlagfYf\Y\na[]$lg`]dh]Y[`g^mkdan]mhlggmj
commitments under the Code.

œ @]j]Yj]kge]g^l`]hdY[]ko`]j]qgm[Yf_g^gjY\na[]Yf\_ma\Yf[]2

ImYdalqYf\JakcEYfY_]e]flD]Y\]jk$o`g`Yn]Z]]fYhhgafl]\Yll`]?dgZYd$K]jna[]Daf]$9j]Y$Yf\dg[Ydd]n]d

L`]LYd]flL]YeYlYddd]n]dkoal`afl`]_dgZYdgj_YfarYlagf

L`]G^Õ[]g^l`]?]f]jYd;gmfk]dgjD]_Yd;gmfk]dafqgmj9j]Ygjdg[Yddq

Professional Practice Directors

Global, Area, and local policies and procedures, including online resources and databases

Ethics hotlines and ethics oversight teams

09
 Hmllaf_alaflgY[lagf

L`ak?dgZYd;g\]g^;gf\m[l_an]k]n]jqgf]Yl=QYf]l`a[Yd^jYe]ogjclg`]dheYc]l`]ja_`l
decisions. The principles contained in the Code provide us with a clear set of standards, grounded in our values,
on which to base our behavior across all areas of our professional activity.

@go\go]hmll`];g\]aflgY[lagf7@go[Yf]Y[`g^mkeYc]kmj]l`Ylo]Yj]danaf_mhlggmj[geeale]flk
under the Code?

A^qgmYj]mfkmj]g^l`]ja_`l[gmjk]g^Y[lagf$gjYj]^Y[]\oal`Y\a^Õ[mdlakkm]$Ykcaf_qgmjk]d^l`]^gddgoaf_
im]klagfkeYq`]dhqgm\]l]jeaf]l`]YhhjghjaYl]oYqlgY[l2

)&@Yn]A[gfkmdl]\YhhjghjaYl]dqoal`[gdd]Y_m]k7

2. Are my actions legal and in compliance with the standards of our profession?

+&9eA[gehjgeakaf_eqafl]_jalqgjl`]afl]_jalqg^=Qgjgmj[da]flk7

,&9eAmh`gd\af_l`]nYdm]kg^=Q7

-&9eAlj]Ylaf_gl`]jkl`]oYqA]ph][lgl`]jklglj]Yle]7

.&Akeq[`ga[]g^Y[lagfl`]egkl]l`a[YdYegf_l`]hgkkaZd]Ydl]jfYlan]k7<gA^]]d_gg\YZgmleq[`ga[]7

/&A^A\g[me]fleq\][akagf$ogmd\Yj]na]o]jY_j]]oal`l`]Y[lagfA`Yn]lYc]f7

0&Ogmd\eqY[lagfk\YeY_]l`]j]hmlYlagfg^=Q7

AY_j]]lgYZa\]Zql`]YZgn]l]jekYf\[gf\alagfk&

Name

* *
GPN Date Signature

(*) EYf\YlgjqÕ]d\

10
Arbitration procedures

*
17
 Previous Employment Data Confidentiality Declaration

UNDERTAKING

I ______________________________(name of the employee) S/O,D/O Mr………………………………………………………..,

undertake and confirm that, I have not carried nor am I in possession of any asset/s, documents or other
confidential or proprietary information in any format or media (printed, digital, audio, video) including but
not limited to devices, records, notes, reports, proposals, correspondence, email communications,
specifications, drawing, notebooks, flowcharts, materials, equipment, other documents or property and
copies or reproductions of any of the aforesaid items belonging to my previous organisation/s where I was
earlier employed or of any of their clients in any manner whatsoever which would constitute any breach
of the confidentiality obligations under my contract or any other law.
I further undertake that I shall not share the information of my previous employer as well as the client/s
of my previous employer, which are confidential in nature and is prohibited from sharing under any
contract or law, with any one in _________________________________________________________ (Complete
name of the entity concerned). I fully understand that if I am found to be in breach of this, I shall be
subjected to appropriate disciplinary action, including termination of my services, without any further
notice or compensation thereof. I also understand that this shall be without prejudice to any other legal
rights that Firm may have.

 (Only check if you are a fresher) I confirm that this is my first Employment; hence the above section is not
applicable to me.

I also confirm that I have read and understood the Confidentiality Global Policy as well as Global Code of
Conduct and undertake to abide by the same.

_________________
(Name of Employee with Sign)
Date :-

1
 FORM – F

[See Sub-Rule (1) of Rule 6]

NOMINATION
To
M/s.

I Shri/smt./Kumari..............................................whose particulars are given in the statement

below, hereby nominate the person(s) mentioned below to receive the gratuity payable after my
death as also the gratuity standing to my credit in the event of my death before that amount has
become payable, or having become payable has not been paid and direct that the said amount of
gratuity shall be paid in proportion indicated against the name(s) of the nominee(s).

2. I hereby certify that the person(s) mentioned is a/are member(s) of my family within the
meaning of clause (h) of Section 2 of the Payment of gratuity Act, 1972.

3. I hereby declare that I have no family within the meaning of clause (h) of section 2 of the said
act.

4. (a) My father/mother/parents is/are not dependent on me.

(b) My husband's father/mother/parents is/are not dependent on my husband.

5. I have excluded my husband from my family by a notice dated the ________________ to the
Controlling Authority in terms of the proviso to clause (h) of Section 2 of the said Act.

6. Nomination made herein invalidates my previous nomination.

Nominee(s)
Name in full with full Relationship with Age of Proportion by which the
address of nominee(s) the employee Nominee gratuity will be shared
1.

2.

3.

4.

So On
Statement

1. Name of employee in full :

2. Sex :

3. Religion :

4. Whether unmarried/married/widow/widower :

5. Department/Branch/Section where employed :

6. Post held with Ticket or Serial No., if any :

7. Date of appointment :
8. Permanent address :

Village _____________________ Thana _____________ Sub-division ______________

Post office __________________ District ____________ State ___________________

*
Place : Signature / Thumb-impression
Date : of the employee.

Declaration by witnesses
Nomination signed/thumb-impressed before me.

Name in full and full Signature of witnesses

address of witnesses

1. 1.

2. 2.

Place:
Date :

Certificate by the employer

Certified that the particulars of the above nomination have been verified and recorded in this
establishment.
Employer’s reference No., if any. for

Authorised Signatory
Signature of the employer/
officer authorised
Designation
M/s.

Name & Address of the establishment or

Rubber-stamp thereof
Acknowledgment by the employee

Received the duplicate copy of nomination in Form `F’ filed by me and duly certified by the
employer.

Date : * Signature of the employee

Note : Strike out the words/paragraphs not applicable.

EY | Assurance | Tax | Transactions | Advisory

About EY
EY is a global leader in assurance, tax, transaction and
advisory services. The insights and quality services we
deliver help build trust and confidence in the capital markets
and in economies the world over. We develop outstanding
leaders who team to deliver on our promises to all of our
stakeholders. In so doing, we play a critical role in building a
better working world for our people, for our clients and for
our communities.

EY refers to the global organization, and may refer to one or

more, of the member firms of Ernst & Young Global Limited,
each of which is a separate legal entity. Ernst & Young
Global Limited, a UK company limited by guarantee, does
not provide services to clients. For more information about
our organization, please visit ey.com.

© 2016 EYGM Limited.

All Rights Reserved.
ED None

purposes only and is not intended to be relied upon as accounting,

 Declaration Form
(To be retained by the Employer for future reference)

Employees’ Provident Fund Organization

THE EMPLOYEES’ PROVIDENT FUNDS SCHEME, 1952 (PARAGRAPH-34 & 57)
&
THE EMPLOYEES’ PENSION SCHEME, 1995 (PARAGRAPH-24)

DECLARATION BY A PERSON TAKING UP EMPLOYMENT IN AN ESTABLISHMENT ON WHICH EMPLOYEES’ PROVIDENT FUND SCHEME,
1952 AND/OR EMPLOYEES’ PENSION SCHEME, 1995 IS APPLICABLE.
(PLEASE GO THROUGH THE INSTRUCTIONS)

1) NAME (TITLE)
MR . MS. MRS.
(PLEASE TICK)

2) DATE OF BIRTH D D M M Y Y Y Y

3) FATHER’S/ MR .
HUSBAND’S NAME

4) RELATIONSHIP IN RESPECT OF (3) ABOVE FATHER HUSBAND

(PLEASE TICK)

5) GENDER MALE FEMALE TRANSGENDER

(PLEASE TICK)

6) MOBILE NUMBER
(IF ANY)

7) EMAIL ID (IF ANY)

8) WHETHER EARLIER A MEMBER OF THE EMPLOYEES’ PROVIDENT FUND SCHEME, 1952 ?

(PLEASE TICK) YES NO
9) WHETHER EARLIER A MEMBER OF THE EMPLOYEES’ PENSION SCHEME, 1995?
(PLEASE TICK) YES NO
IF RESPONSE TO ANY OR BOTH OF (8) & (9) ABOVE IS YES, THEN MANDATORILY FILL UP THE PREVIOUS EMPLOYMENT DETAILS
AT (10,11&12):
Page 1 of 3
 A. PREVIOUS EMPLOYMENT DETAILS
10)THE DETAILS OF THE UNIVERSAL ACCOUNT NUMBER (UAN) OR PREVIOUS PF MEMBER ID:

UAN
OR
PREVIOUS PF MEMBER ID REGION CODE OFFICE CODE ESTABLISHMENT ID EXTENSION ACCOUNT NUMBER

11) DATE OF EXIT FOR PREVIOUS D D M M Y Y Y Y

MEMBER ID (DD/MM/YYYY)

12) (A) IF SCHEME CERTIFICATE ISSUED FOR PREVIOUS EMPLOYMENT, THEN SCHEME CERTIFICATE NUMBER:___________
(B) IF PENSION PAYMENT ORDER (PPO) ISSUED FOR PREVIOUS EMPLOYMENT, THEN PPO NUMBER:______________

B. OTHER DETAILS

13) INTERNATIONAL WORKER YES NO

(PLEASE TICK)

IF THE REPLY TO (13) ABOVE IS YES, THEN ENTER THE DETAILS IN 13(A), 13(B) & 13(C):
13(A) COUNTRY OF ORIGIN (Please Tick)
INDIA OTHER THAN INDIA (IF YES, PLEASE
MENTION NAME OF THE COUNTRY)

13(B) PASSPORT NUMBER ______________________________

13(C) PASSPORT VALID FROM

D D M M Y Y Y Y

To D D M M Y Y Y Y

14) EDUCATIONAL ILLITERATE

NON-
MATRIC
SENIOR
GRADUATE
POST
DOCTOR
TECHNICAL/
QUALIFICATION MATRIC SECONDARY GRADUATE PROFESSIONAL
(PLEASE TICK)

15) MARITAL STATUS MARRIED UNMARRIED WIDOW/ WIDOWER DIVORCEE

(PLEASE TICK)

16) SPECIALLY ABLED YES NO IF YES, TICK THE CATEGORY

(PLEASE TICK) LOCOMOTIVE VISUAL HEARING

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17) KYC DETAILS KYC DOCUMENT TYPE NAME AS ON KYC DOCUMENT NUMBER REMARKS, IF ANY
BANK ACCOUNT-1* IFSC CODE*
NPR/AADHAAR
PERMANENT ACCOUNT
NUMBER (PAN)
PASSPORT EXPIRY DATE
DRIVING LICENCE EXPIRY DATE
ELECTION CARD
RATION CARD
ESIC CARD
* Mandatory Field (NOTE: BANK ACCOUNT NUMBER (ALONG WITH IFSC CODE) IS MANDATORY. YOU
ARE HOWEVER ADVISED TO PROVIDE ALL KYC DOCUMENTS AVAILABLE WITH YOU IN ADDITION TO MANDATORY KYCS TO
AVAIL BETTER SERVICES. SELF-ATTESTED PHOTOCOPIES OF THE DOCUMENTS MUST BE ATTACHED WITH THIS FORM.

C. UNDERTAKING:
A. I CERTIFY THAT ALL THE INFORMATION GIVEN ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF.
B. IN CASE, EARLIER A MEMBER OF EPF SCHEME, 1952 AND/OR EPS, 1995,
(I) I HAVE ENSURED THE CORRECTNESS OF MY UAN/ PREVIOUS PF MEMBER ID.
(II) THIS MAY ALSO BE TREATED AS MY REQUEST FOR TRANSFER OF FUNDS AND SERVICE DETAILS IF APPLICABLE FROM
THE PREVIOUS ACCOUNT AS DECLARED ABOVE TO THE PRESENT P.F. ACCOUNT. (THE TRANSFER WOULD BE POSSIBLE
ONLY IF THE IDENTIFIED KYC DETAILS APPROVED BY PREVIOUS EMPLOYER HAS BEEN VERIFIED BY PRESENT
EMPLOYER USING HIS DIGITAL SIGNATURE CERTIFICATE).
(III) I AM AWARE THAT I CAN SUBMIT MY NOMINATION FORM THROUGH UAN BASED MEMBER PORTAL.

DATE:
PLACE: SIGNATURE OF MEMBER
DECLARATION BY PRESENT EMPLOYER
A. THE MEMBER Mr./Ms./Mrs. ………………………….. HAS JOINED ON ………………….. AND HAS BEEN ALLOTTED PF MEMBER ID
…………………………………………...
B. IN CASE THE PERSON WAS EARLIER NOT A MEMBER OF EPF SCHEME, 1952 AND EPS, 1995:
 (POST ALLOTMENT OF UAN) THE UAN ALLOTTED FOR THE MEMBER IS …………………………
 PLEASE TICK THE APPROPRIATE OPTION:
THE KYC DETAILS OF THE ABOVE MEMBER IN THE UAN DATABASE
□ HAVE NOT BEEN UPLOADED
□ HAVE BEEN UPLOADED BUT NOT APPROVED
□ HAVE BEEN UPLOADED AND APPROVED WITH DSC
C. IN CASE THE PERSON WAS EARLIER A MEMBER OF EPF SCHEME, 1952 AND EPS, 1995:
 THE ABOVE MEMBER ID OF THE MEMBER AS MENTIONED IN (A) ABOVE HAS BEEN TAGGED WITH HIS/HER UAN/PREVIOUS
MEMBER ID AS DECLARED BY MEMBER.
 PLEASE TICK THE APPROPRIATE OPTION:-
□ THE KYC DETAILS OF THE ABOVE MEMBER IN THE UAN DATABASE HAVE BEEN APPROVED WITH DIGITAL
SIGNATURE CERTIFICATE AND TRANSFER REQUEST HAS BEEN GENERATED ON PORTAL.
□ AS THE DSC OF ESTABLISHMENT ARE NOT REGISTERED WITH EPFO, THE MEMBER HAS BEEN INFORMED TO FILE
PHYSICAL CLAIM (FORM-13) FOR TRANSFER OF FUNDS FROM HIS PREVIOUS ESTABLISHMENT.

DATE: SIGNATURE OF EMPLOYER WITH SEAL OF ESTABLISHMENT

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