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Monthly Pension Application Form 10D

This document is an application for a monthly pension under the Employees' Pension Scheme of 1995. It provides details about the applicant such as name, date of birth, employment history including joining and leaving dates, pension details including type of pension claimed, family details, bank account information, and documents enclosed with the application. The applicant, Teki Venkata Suryanarayana, is applying for a superannuation pension after leaving employment at Vishakhapatnam Steel Project on February 8, 2021 due to retirement.

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504 views2 pages

Monthly Pension Application Form 10D

This document is an application for a monthly pension under the Employees' Pension Scheme of 1995. It provides details about the applicant such as name, date of birth, employment history including joining and leaving dates, pension details including type of pension claimed, family details, bank account information, and documents enclosed with the application. The applicant, Teki Venkata Suryanarayana, is applying for a superannuation pension after leaving employment at Vishakhapatnam Steel Project on February 8, 2021 due to retirement.

Uploaded by

sagarpnb
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

UAN : 100375430842

Mobile Number : 9676864747


Tracking Id : 10037543084203001
IP Address :[Link]

APPLICATION FOR MONTHLY PENSION FORM-10D (E.P.S.)


(EMPLOYEES' PENSION SCHEME, 1995)

1. By whom the Pension is claimed? : Member

2. Type of Pension Claimed : Superannuation

3. a) Member's Name (In Block Letters) : TEKI VENKATA SURYANARAYANA

b) Sex : Male

c) Marital Status : Married

d) Date of Birth (dd/mm/yyyy) : 09-02-1963

4. E.P.F. Account Number : GRVSP00069860000105882

Name of the Establishment in which


5. : VISHAKHAPATNAM STEEL PROJECT,
the member was last Employed

6. Date of Joining in current Establishment : 16-11-1995

7. Date of Leaving Service : 08-02-2021

8. Reason of Leaving Service : SUPERNNUATION

9. Address for communication Q NO 414B,SECTOR 6,UKKUNAGARAM - 530032

10a. Opted for reduced pension : --NA--

11a Deferred Pension : No

12. Particulars of Family

Sr. Guardian's Relationship with


Name Date of Birth Relationship with Member Guardian Name
no. Member

1 01/07/1968 Wife --NA-- --NA--


TEKI VEERA VENKATA
SATYAVATI

13. Details of Bank Accounts Opened :

1. Account Number 095510021050820


2. Name of the Bank UNION BANK OF INDIA

Page 1 of 2
3. Name of the Branch STEELPLANT TOWNSHIP (IFSC : UBIN0809551)

Full Postal Address


4. ANDHRA PRADESH
Pin Code

Detail of Scheme Certificate already in Posession


14. : No

Sl No Scheme Certificate Control No Authority who issued the Scheme Certificate

-- --NA-- --NA--

15. Documents enclosed

1. Photo 3. Cancelled Cheque


2. Family Details 4. ---

Certified that:

(1) I am not drawing Pension under Employee's Pension Scheme,1995

(2) The particulars given in this application are true and correct
(3) In consideration of your having, at my request agreed to make payment of pension due to me everymonth by credit
to my account (as refer in 13.1) with bank (as refer in 13.2), I the undersigned, agree and undertake to refund or
make good any amount to which I am not entitled.I also irrevocably authorize the bank to recover any such amount
credited to my account to which I am not entitled by debiting my said account or any other account/deposits
belonging to me in the possession of the bank against any claim made by RPFC in this regard.I further hereby
undertake and agree to bind myself and my heirs, successors, executors and administrators to indemnify the RPFC
against any amount credited to my account to which I am not entitled.

Cancelled Cheque :

Date : 28-Jan-2023 [Link]


Place :

Page 2 of 2

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