Composite Declaration Form ~ 11
(To be retained by the Employer for future refer
EMPLOYEES PROVIDENT FUND ORGANISATION
Employees’ Provident funds Scheme, 1952 (Paragraph 34 & 57) &
Employees’ Pension Scheme 1952 (Paragraph 24)
(@eclaration by 2 person taking up employment in any establishment on which EPF Scheme, 1952. and for
Ps, 1995 is applicable)
Name ofthe member «MS. NUPOOR Gajanan DESHPANDE
Fathers Name
[Spouse Name [Shreyas Devidas Metkute
3 [Date OF Birth: (DD/MM/YYYY) 16-Feb-1995,
ff |Gencer: (Male/Female/Transgender) Female
[5 [Marital status: Married
(Married/Unmarried/Widow/Widower)
5 |(@) Email fa
INUPOOR.DESHPANDE@LNTINFOTECH.CO
iM
(6) Mobile No: lo5s2423045
7 |Present employment details : [00-Sep-2022
| [Date of Joining in the current establishment
| feommrny)
|@ |kvc Details: ( attach self attested copy of
{the following KYCs)
| |(@) Bank Account No 50100428609130
HDFC0005179-BALEWADI
(FSC Code ofthe Branch
| (c) AADHAR Number 1600299384311
| [(@) Permanent Account Number (PAN), if _ |82SPD2474D
| Fevatiabies
P [wether eatier« member of Emaloyees’ — |yes
Provident Fund Scheme,1952