Joint Declaration By the Member and The Employer

Date:-------------------

To

The Regional P F Commissioner,EPFO, RO, PUNE-IIAKURDI, PUNE

Subject: Correction in Name of Member/Father/Spouse/Date of

Birth/Date of Joining/Date of Leaving of Memberbearing PF
Code No. PU/PUN/0033543/000/ regarding.

Sir, I sacan anvekar am / was an employee / ex-employee of

M/s Birlasoft Limited furnishing below herewithcorrect details
during my service with aforesaid establishment
: -PARTICULARS CORRECT WRONGName of
MemberFather/Husband NamePF/EPS Number Date of Birth
(DD/MM/YYYY)Date of joining (DD/MM/YYYY) Date of leaving
(DD/MM/YYYY)

I am also enclosing herewith duly attested by employer copy of

ID proof (Any One – PAN Card / Voters Identity Card / Passport /
Driving License / Aadhar Card and for major change in date of
birth must enclosed other documents i.e. School Leaving
Certificate, Birth Certificate, Certificate issued by any institution
or department etc.) for your ready reference. Therefore, you are
requested to make necessary changes in your records (if
required) under intimation to me. An early action in this regard
will be highly appreciated. Yours Faithfully Name & Signature of
Applicant Above mentioned information in this letter is correct
and as per our office record and correct and wrong both person
name is same. If any wrong/over/excess/short payment done at
the time of settlement of PF/EPS/F-13 any other claim of after
doing necessary correction by the EPFO Office, our
establishment /company will be fully responsible and liable to
refund the withdrawal amount.
PARTCULARS CORRECT WRONG

flame of Member

FaTete4gsbant3 Name
Os Egg '...-aer

-
D:i; z • z - -; 0011,111/TYYT)

Fatelly

Name Ce ALCM:MOO Signatory

Sent are wI T est ab lish men t seal

EnegAs chow