DEATH CLAIM SCRUTINY

DOJ Marital Status Age of member at the time of

1. Member Name: Death
2. EPF A/c:OR/KJR/ UAN: Married Total service period
3. Task ID: Un-married
Establishment is Un-Exempted PF PENSION EDLI Additional information
LIVE CLOSED Exempted PF PENSION EDLI DOB
Date of Leaving in Date of leaving in Date of Death Contribution received Adhaar of member
ledger claim in DC upto in ledger DSC of employer
Form – 5/10
Claim submitted after ………. Year of Death
Claim History (if any)
Reason As per claim Died while in service Updated in System
of leaving As per ledger Died away from service Not updated in System
Member’s name in Ledger, Claims & DC Tallied

Sl. Beneficiary as per Eligibility

BANK PASS BK
DOB Certificate

Descriptive Roll
No.

LEGAL HEIR
BANK NAME
Un- Married

E-NOMINATION
RELATION

SFMC

ATTESTED
AGE As on

PENSION
SFMC ADHAAR DOB

Signed by
Married

member
death of

CLAIM
PHOTO
Legal Heir

EDLI
PF
1
2
3
4
5
6
7
Parents died before member died: Yes NO Status Not Mentioned
REMARKS  SFMC/LEGAL HEIR not submitted  Photographs not attested by employer.
 Date of leaving in claim NOT mentioned  DOL/Reason of leaving not updated in system
 Contribution not received up to the date of Death.
 Father Mother status not mentioned in SFMC