FORMAT-B

( For the Retired Employees )

( Time Period for submission of the option between
the period from 04.11.2022 to 03.03.2023 to the
concerned RPFC/APFC)
(Designed by S K Gupta , Advocate , Supreme Court , for his client
only ), Email:skpfdelhi@gmail.com,Mobile:9891170907,
www.makeinindialawfirm.com
………………………………………Cut………………………Cut……………………………….
Regional Provident Fund Commissioner , Date : …./12/2022
Employees’ Provident Fund Organisation,
…………...…..

Subject : Application/Option under paragraph 11 (3) of the Employees’

Pension Scheme,1995, as well as under paragraph 11(4) of the
Employees’ Pension Scheme, 2014 in view of the judicial directions of the
Hon’ble Supreme Court and compliance as per paragraph 44 (ix) and 44(x)
thereof. The reference of the Supreme Court’s judgments are as under:

1. The EPFO & Anr. Etc. Vs. Sunil Kumar B . & Ors. , SLP ( C ) Nos.
8658-8659 of 2019
2. R.C. Gupta and others vs. Regional P.F. Commissioner and
others,in Civil Appeal No(s) 10013- 10014 of 2016 arising
out of SLP NO 33032-33033 of 2015 , 2017 LLR 86 (SC)

1 Name of Employees

2 UAN No.
PPO No.
3
Monthly Pension Amt.
Name of Establishment
4
PF Code No

Name of Bank &

5
Account No.
Mobile No.
6
Email :

Aadhaar No.
7
PAN No.
 --2--
Declaration by the Employee
I, …………………………………………………………………, being an employee of the establishment (
unexampled establishment / exempted establishment) as well as member of the
EPFS,1952 & EPS,1995, hereby say that I had already been contributed the Pension Fund
on higher /actual basic wages , and exercised option as per paragraph 11(3) of the
Employees’ Pension Scheme,1995 during my services period.

I further hereby say that as per the latest Supreme Court’s judgment (supra) , I am entitled
to get a higher pension. Therefore , kindly do adjustment between the Account No.01 and
Account No.10 by debit /credit system. Accordingly , please send a calculation for
remitting the PF amount in account No.10, if any , for getting higher pension as per the
latest verdict of the Hon’ble Supreme Court (supra)

I further say that I am getting pension Rs……………….per month, and the same
may kindly be adjusted while making a higher pension/arrear as per the verdict
of the Hon'ble Supreme Court judgments (supra), particularly directed in
paragraph 44 (ix) and 44(x) , and compliance thereof failing which the Learned
CPFC as well as the concerned RPFC will be liable to face contempt . However ,
the RPFC/APFC, being statutory authority , is liable to response this letter after
due application of mind , and the same has been decided by the Hon’ble Supreme
Court in the matter of of Salem Advocate Bar Association V/s Union of India , AIR,
2005 Supreme Court, 3353, Case No. WP(C) 496 of 2002.

If PF authorities fail to consider the present application for higher pension option, and
calculation of arrear along with interest thereof, then the employee may approach to
the Hon’ble Supreme Court for non-compliance of the latest judgment dated
04.11.2022 (supra) without issuing statutory legal notice.

Place
Date:
Signature of Employee
Undertaking by the Employer

I, ...................................... (Name and Designation) being the authorized

signatory as per Form 5A of M/s ........ …………………………… do hereby certify
that Mr / Mrs .....................................................................................................
was an employee of this establishment with PF A/c No. ……………………… .......
During his/her service, we, being an Employer , I had deducted his/her EPF on
actual salary i.e. more than statutory limit every months during his services
period, and remitted the same as per paragraph 38 of the EPFS ,1952 along with
administrative charges in compliance of the paragraph 26(6) of the EPFS,1952
in the member’s account every months.

I hereby certify that the particulars furnished are correct as per the records of
the personal file, and the documents presented by the employees for verification.

Place
Date:

(Signature with official seal)

Encl:AadharCard Bank
Pass Book details

Copy of the PPO certificate

NB: This application forthwith to be submitted to concerned RPFC/APFC
through email , speed post and physically.