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THE EMPLOYEES PROVIDENT FUND SCHEME, 1952(Paragraph

34) and THE EMPLOYEES PENSION SCHEME, 1995(Paragraph 24)

Self-Declaration from employee towards PF Contribution on statutory limit of Basic Wages.

Date:

I,________________________________S/O,D/O,W/O________________________________

do hereby solemnly declare that:-

A) I am employed in M/S RANDSTAD INDIA PRIVATE LIMITED


Affix company address seal

B) My PF A/C number and UAN is

TN/MAS/0035791/000/ UAN –

C) I am unwilling to contribute my PF on Basic wages beyond Rs.15000/- per month.

Hence I request to remit my PF contribution in the above mentioned PF and UAN number
considering the basic wages up to Rs.15000/- only.

Signature or left hand thumb impression of the employee.

Address:

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