UAN : 101945155539

Mobile Number : 9952844491

Tracking Id : 10194515553903001
IP Address :157.46.86.22

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) : SEKAR

b) Sex : Male

c) Marital Status : Married

d) Date of Birth (dd/mm/yyyy) : 22-04-1968

4. E.P.F. Account Number : MDMDU00010920000000714

Name of the Establishment in which

5. : SRI NACHAMMAI COTTON MILLS LIMITED,
the member was last Employed

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

7. Date of Leaving Service : 10-06-2004

8. Reason of Leaving Service : CESSATION (SHORT SERVICE) - Any other reason

9. Address for communication kanchipuram,Thiruvalluvar street,kancheepuram - 600044

10a. Opted for reduced pension : Yes

10b. In case of Reduced Pension (opted date for : 22-04-2018

commencement of pension)

11a Deferred Pension : --NA--

12. Particulars of Family

Sr. Guardian's Relationship with

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

1 17/04/1974 Wife --NA-- --NA--

CHITRA SEKAR

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 Sr. Guardian's Relationship with
Name Date of Birth Relationship with Member Guardian Name
no. Member

2 01/12/2003 Son --NA-- --NA--

SHAKTHI SEKAR

3 30/10/1997 Son --NA-- --NA--

RAHUL SEKAR

13. Details of Bank Accounts Opened :

1. Account Number 214910100008294

2. Name of the Bank UNION BANK OF INDIA
3. Name of the Branch HASTHINAPURAM (IFSC : UBIN0821497)

Full Postal Address

4. TAMIL NADU
Pin Code

Detail of Scheme Certificate already in Posession

14. : Yes

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

1 MDMDU00024026 --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 :

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Date : 06-Jun-2023 17:22:09
Place :

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