NON EMPLOYMENT CERTIFICATE

Date:

To,

ITD CEMENTATION INDIA LIMITED WORKMEN PROVIDENT FUND

NATIONAL PLASTIC BUILDING,
VILE PARLE (EAST),
Mumbai - 400057

I __________________________S/o,W/o,H/o, _____________________declare and state that I

was an employee of M/s. ITD Cementation Limited and covered under The E.P.F. & M.P. Act
-1952 bearing PF A/c No. MH/20241/ _____________and left the Service on
dt._______________.

And state that I had not been employed in any other Establishment which is covered under the
EPF Scheme, 1952, after 2 months of date of leaving the service of ITD Cementation India
Limited

In case if my said declaration is found to be false and incorrect, I am liable for suitable action as
may deemed by the Company and Employees Provident Fund organization, Mumbai.

Employee Code :
Name :
Contact Number :
Personal Email Id:

Signature of Employee