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  • Epfo

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    Hari S Subramanian
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    The document is a declaration and nomination form under the Employees' Provident Fund Scheme and Employees' Pension Scheme. It provides personal details of the employee such as name, date of birth, gender, address, UAN number, and dates of joining the various pension schemes. It nominates the employee's mother to receive the full amount standing in his provident fund account in the event of his death. It also nominates his mother to receive any widow pension benefits under the Employees' Pension Scheme in the absence of any other eligible family members.

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    epfo

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    The document is a declaration and nomination form under the Employees' Provident Fund Scheme and Employees' Pension Scheme. It provides personal details of the employee such as name, date of birth, gender, address, UAN number, and dates of joining the various pension schemes. It nominates the employee's mother to receive the full amount standing in his provident fund account in the event of his death. It also nominates his mother to receive any widow pension benefits under the Employees' Pension Scheme in the absence of any other eligible family members.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    5 views2 pages

    Epfo

    Uploaded by

    Hari S Subramanian
    The document is a declaration and nomination form under the Employees' Provident Fund Scheme and Employees' Pension Scheme. It provides personal details of the employee such as name, date of birth, gender, address, UAN number, and dates of joining the various pension schemes. It nominates the employee's mother to receive the full amount standing in his provident fund account in the event of his death. It also nominates his mother to receive any widow pension benefits under the Employees' Pension Scheme in the absence of any other eligible family members.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    The Employees' Pension Scheme,

    FORM 2
    EMPLOYEES' PROVIDENT FUNDS SCHEME, 1952
    [Paragraphs 33 AND 61(1)]
    EMPLOYEES' PENSION SCHEME, 1995
    [Paragraphs 18]

    DECLARATION AND NOMINATION FORM UNDER THE EMPLOYEES' PROVIDENT FUNDS


    SCHEME AND EMPLOYEES' PENSION SCHEME

    1. UAN : 100929012255
    2. Name (in block letters) : HARIHARA SUBRAMANIAN S
    3. Father's / Husband's Name : Shanmuga Sundaram
    4. Date of Birth : 24/03/1995
    5. Gender : MALE
    6. Marital Status : UN-MARRIED

    7. Address (Permanent) : G1 FLAT PLOT NO 24 SHIVA FLATS, MANICK ENCLAVE


    SEMMANCHERY, CHENNAI, CHENNAI, TAMIL NADU, 600119
    8. Address (Temporary) : G1 FLAT PLOT NO 24 SHIVA FLATS, MANICK ENCLAVE
    SEMMANCHERY, CHENNAI, CHENNAI, TAMIL NADU, 600119
    9. (A) Date of Joining of EPF Scheme, : 20/10/2016
    (B) Date of Joining of FPS Scheme, : --
    (C) Date of Joining of EPS Scheme, : 20/10/2016

    PART A (EPF)
    I hereby nominate person(s) / cancel the nomination made by me previously and nominate the person
    (s) mentioned below to receive the amount standing to my credit in the Employees' Provident Fund, in the

    If the Nominee is
    Total amount or minor, name and
    Nominees's share of relationship and
    Name of the
    relationship with accumulations in address of the
    Nominee / Nominees Address Date of Birth
    the Member Provident Fund to guardian who may
    be paid to each receive the amont
    nominee during the minority of
    nominee
    (1) (2) (3) (4) (5) (6)

    G1 FLAT PLOT NO 24 Dependent 06/06/1967 100% --


    SHIVA FLATS, MANICK Mother
    THANGESWARI
    ENCLAVE
    AADHAAR: XXXX
    SEMMANCHERY,
    XXXX 0585
    CHENNAI, CHENNAI,
    Bank A/c: NOT
    TAMIL NADU, 600119
    AVAILABLE

    1. *Certified that I have no family as defined in Para 2(g) of the Employees' Provident Funds Scheme, 1952 and should I
    acquire a family hereafter the above nomination should be deemed as cancelled.

    2. *Certified that my father/mother is/are dependant upon me.

    (Signature is not required as the document is to be digitally signed)


    The Employees' Pension Scheme,

    PART B (EPS)
    (Para 18)

    I hereby furnish below particulars of the members of my family who would be eligible to receive
    widow / children pension in the event of my death:

    Relationship with
    Sl. No. Name of the Family members Address Date of Birth
    the member
    (1) (2) (3) (4) (5)

    1 -- -- --
    --

    *Certified that I have no family as defined in Para 2(vii) of the Employees' Pension Scheme, 1995 and
    should I acquire a family hereafter I shall furnish particulars thereon in the above form.

    I hereby nominate the following person for receiving the monthly widow pension admissible under
    para 16(2)(a)(i) and (ii) in the event of my death without leaving any eligible family member for receiving

    Relationship with the member


    Name and Address of the Nominee Date of Birth

    THANGESWARI 06/06/1967 MOTHER


    AADHAAR: XXXX XXXX 0585
    Bank A/c: NOT AVAILABLE

    Date : 17-Nov-2022

    (Signature is not required as the document is to be digitally signed)

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