UAN : 100303924506

Mobile Number : 9922930759

Tracking Id : 10030392450603001

APPLICATION FOR MONTHLY PENSION FORM-10D (E.P.S.)

(EMPLOYEES' PENSION SCHEME, 1995)

1. By whom the Pension is claimed? : Member

2. Type of Pension Claimed : Superannuation

3. a) Member's Name (In Block Letters) : RAMCHANDRA APPAJI SALGUDE

b) Sex : Male

c) Marital Status : Married

d) Date of Birth (dd/mm/yyyy) : 02-01-1959

4. E.P.F. Account Number : PUKOL01017840000000040

Name of the Establishment in which

5. : MAGNA INDUSTRIES
the member was last Employed

6. Date of Joining in current Establishment : 10-04-2007

7. Date of Leaving Service : 01-01-2017

8. Reason of Leaving Service : SUPERNNUATION

Near asther adhar hospital,Parthibhanager,Kolhapur -

9. Address for communication
416012

10a. Opted for reduced pension : --NA--

11. Particulars of Family

Sr. Guardian's Relationship with

Name Date of Birth Relationship with Member Guardian Name
no. Member

1 15/10/1969 Wife --NA-- --NA--

JANAKI RAMACHANDRA
SALAGUDE

12. Details of Bank Accounts Opened :

1. Account Number 39512476504

2. Name of the Bank STATE BANK OF INDIA
3. Name of the Branch PBB RAJARAMPURI, KOLHAPUR (IFSC : SBIN0004257)

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 Full Postal Address
4. MAHARASHTRA
Pin Code

Detail of Scheme Certificate already in Posession

13. : No

Sl No Scheme Certificate Control No Authority who issued the Scheme Certificate

-- --NA-- --NA--

14. Documents enclosed

1. Photo 3. Cancelled Cheque

2. Family Details 4. ---

Certified that:

(1) I am not drawing Pension under Employee's Pension Scheme,1995

(2) The particulars given in this application are true and correct

Cancelled Cheque :

Date : 04-Aug-2020 17:07:11

Place :

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