Joint Declaration By the Member and The Employer To : Date: ‘The Regional PF Commissioner, t YEARS OF CELEBRATING ‘THE MANATMA Sir, Subject: Joint Declaration by the Member and the Employer Itis found that there is an error in the basic details of the employees Mr/Mrs./Kum as PF Account No./UAN 5 in the Employees Provident Fund Organisation Establishment Master ‘The ero occured due to wrong ats upload Itis certified that the above person is / was an employee of our establishment and his/her correct particulars are given below. To be Corrected as Particulars: ‘As per EPF Data Base (Please enter exactly as in Aadhar) Name Father's Namo ‘Spouse Name Gender Details Date of Birth (DD/MMIYYYY) Date of Joining (DDIMM/YYYY) Date of Leaving (DD/MMIYYYY) Important : Without uploading at least one KYC and enclosing copy of Aadhar request will not be considered. Its also certified that the following KYC has been seeded to the above member's UAN and uploaded to EPFO through the Digital Signature of the Authorized Signatory KYC Uploaded 1. Aadhar 2.PAN 3, Bank Alc No. and IFSC Code 4, Passport / Driving License, Birth Certificate, etc. 5. Any other Govt. issued Photo Identity Card. Imp : A copy / copies of the above document(s) is/are attached/enclosed We hereby deciare that the particulars given above are correct, We further give an undertaking that if any wrong payment occurs out of information / declaration submitted above. | / We will solely / jointly responsible for the same. Yours Faithfully Name and Signature of Applicant / Member Encl. As above Name and Signature of Authorised Signature with Establishment seal FOR OFFICE USE ONLY ‘ACCEPTED. 2 SSASSSA ss a0 APFC “RPFC(F&A)