Joint Declaration By the Member and The Employer

Date:---------------------
To
The Regional P F Commissioner,
EPFO, RO, PUNE-II
AKURDI, PUNE

Subject: Correction in Name of Member/Father/Spouse/Date of Birth/Date of Joining/Date of Leaving of Member

bearing PF Code No. PU/PUN/0033543/000/ regarding.

Sir,
I Prashant Umap am / was an employee / ex-employee of M/s Birlasoft Limited furnishing below herewith
correct details during my service with aforesaid establishment: -

PARTICULARS CORRECT WRONG

Name of Member
Father/Husband Name
PF/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.

Name of Authorized Signatory

Signature with establishment seal

Encl: As above