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  • Sr. No. Name Date of Birth Relationship With Member Guardian Name Guardian's Relationship With Member

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    noor basha
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    This document is an application for monthly pension under the Employees' Pension Scheme of 1995 submitted by Gurrala Sreenivasamma. Some key details provided in the application include: - The applicant is claiming superannuation pension as a member of the scheme. - She was last employed with the DRDA, Kurnool and retired from service on November 30, 2021 after joining in January 1998. - Her pension is to be credited to her State Bank of India account and she has a son named Pasem Madhu Kiran. - She is opting to defer her pension until age 60 and contribute to the deferred pension. - Documents including photo, family details and cancelled cheque are enclosed with

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    10014760244703001

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    This document is an application for monthly pension under the Employees' Pension Scheme of 1995 submitted by Gurrala Sreenivasamma. Some key details provided in the application include: - The applicant is claiming superannuation pension as a member of the scheme. - She was last employed with the DRDA, Kurnool and retired from service on November 30, 2021 after joining in January 1998. - Her pension is to be credited to her State Bank of India account and she has a son named Pasem Madhu Kiran. - She is opting to defer her pension until age 60 and contribute to the deferred pension. - Documents including photo, family details and cancelled cheque are enclosed with

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    6 views2 pages

    Sr. No. Name Date of Birth Relationship With Member Guardian Name Guardian's Relationship With Member

    Uploaded by

    noor basha
    This document is an application for monthly pension under the Employees' Pension Scheme of 1995 submitted by Gurrala Sreenivasamma. Some key details provided in the application include: - The applicant is claiming superannuation pension as a member of the scheme. - She was last employed with the DRDA, Kurnool and retired from service on November 30, 2021 after joining in January 1998. - Her pension is to be credited to her State Bank of India account and she has a son named Pasem Madhu Kiran. - She is opting to defer her pension until age 60 and contribute to the deferred pension. - Documents including photo, family details and cancelled cheque are enclosed with

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 2

    UAN : 100147602447

    Mobile Number : 9618901725


    Tracking Id : 10014760244703001
    IP Address :103.159.248.115

    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) : GURRALA SREENIVASAMMA

    b) Sex : Female

    c) Marital Status : Married

    d) Date of Birth (dd/mm/yyyy) : 01-12-1963

    4. E.P.F. Account Number : GRCDP00255690000000024

    Name of the Establishment in which


    5. : DRDA, KURNOOL
    the member was last Employed

    6. Date of Joining in current Establishment : 01-01-1998

    7. Date of Leaving Service : 30-11-2021

    8. Reason of Leaving Service : RETIREMENT

    50-760-D3 2nd Floor,Birla Quarters Deva Nagar,Kurnool -


    9. Address for communication
    518002

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

    11a Deferred Pension : Yes

    11b. Deferred Pension age : 60

    11c. Deferred Pension Contribution : With Contribution

    12. Particulars of Family

    Sr. Guardian's Relationship with


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

    1 25/10/1991 Son --NA-- --NA--

    PASEM MADHU KIRAN

    13. Details of Bank Accounts Opened :

    Page 1 of 2
    1. Account Number 10937225552
    2. Name of the Bank STATE BANK OF INDIA
    3. Name of the Branch TREASURY BRANCH, KURNOOL (IFSC : SBIN0006305)

    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 : 27-Dec-2023 12:06:42


    Place :

    Page 2 of 2

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