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