AFFIDAVIT TO BE SIGNED BY EMPLOYER

This is to cortify that Sh. ..s/o Sh.

..
is/was an cmployce of our establishment M/s Bcaring PF Code no.

It is certificd that Sh. has credentiais as mentioned be.ow and

are requircd to bc corrcctcd as: -

Details Wrong Details Correct Details

(Present Details) (Proposcd Dctails)

Name as per
Aadhaar
Father's Name
Aadhaar
Date of Birth
Date of joining
Date of lcaving
Address

It is certificd that Sh... has worked in our cstablishment (rom

to .Aill date (whichever is applicable).
It is certified that due to some clerical mistake, certain wrong details of employcc like
Name, Father's Name, Date of Birth, Date of Joining/Leaving etc. have been entercd into the
member profile by the establishment.
It is certified that in order to get it rectificd the establishment is also cnclosing and
forwarding the Joint Declaration Form alongwith all the necessary documents for onward
submission and necessary action by the EPFO.
It is certified that I, s/o Sh. r/o
.....bcing the
employer i.e. Proprictor/Director/Owner of the said establishment (as defincd in Section 2 of
the EPF & MP Act, 1952) take fulland complete responsibility for the corrctions mentioned
in the said Form and if any error/fraud occurs in future due to the said córrcctions madc,
shall be responsible for the same.
Further, it is also assurcd that such acts of negligcncc on the part of cstablishment
while submitting details of cmployces shall not occur in future.

Sh.

(Signature and Name of the Proprietor/Director/Owner)