UAN : 100187667877

Mobile Number : 8446787239

Tracking Id : 10018766787703002
IP Address :106.193.80.74

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) : MILIND YASHWANT KAMBLE

b) Sex : Male

c) Marital Status : Married

d) Date of Birth (dd/mm/yyyy) : 01-06-1964

4. E.P.F. Account Number : PUKOL00292650000000385

Name of the Establishment in which

5. : HINDUSTAN UNILEVER LTD
the member was last Employed

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

7. Date of Leaving Service : 31-05-2022

8. Reason of Leaving Service : SUPERNNUATION

9. Address for communication AT FANSAT,POST SANGAVE,SANGMESHWAR - 415611

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

11a Deferred Pension : No

12. Particulars of Family

Sr. Guardian's Relationship with

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

1 29/11/1967 Wife --NA-- --NA--

MINAKSHI MILIND
KAMBALE

13. Details of Bank Accounts Opened :

1. Account Number 11285529708

2. Name of the Bank STATE BANK OF INDIA

Page 1 of 2
 3. Name of the Branch CHIPLUN (IFSC : SBIN0000350)

Full Postal Address

4. MAHARASHTRA
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 : 17-Nov-2022 10:20:01

Place :

Page 2 of 2