To,

The Assistant P.F. Commissioner (Pension)

Employees’ Provident Fund Organisation
Regional Office, Keonjhar

(Through the Branch Manager of Bank through which pension was drawn by member)

Sub: Intimation regarding death of member pensioner and request for release of Widow
&/or Children Pension.

Ref: Name of member pensioner…………………………………………

PPO No. OR/KJR/………………………………
Bank Account No……………………………….

Sir,
This is to inform that the above-mentioned member pensioner has expired on dated
………………………… I/We have opened Bank Accounts(s) in the same branch where the
member was receiving pension i.e., …………………………………………. Branch. The
photocopies of Death Certificate of member pensioner and bank passbook(s), Aadhaar Card (s)
of Widow &/ or children duly attested by Bank Branch Manager are enclosed herewith for your
kind reference.

SL. Name of Spouse/Children Bank A/c No. Aadhaar Number

No.

Therefore, it is requested to kindly release the Widow &/or Children pension along with due
arrears pensions.

Enclosures: All documents be attested by Banker

1. Death Certificate of member pensioner

2. Bank passbooks of Spouse &/or children
3. Aadhaar Cards of Spouse &/or children
4. Physical Life Certificate
Yours faithfully,

Signature of applicant…………………………………
Name of the applicant…………………………………
Full postal address…………………………………
…………………………………………..
Official Seal & signature of Banker Mobile No…………………………………
Name……………………….
Designation……………………….
of the bank authority