ANNEXURE-B

On Non-Judicial Stamp Paper

of appropriate value

AFFIDAVIT-CUM-UNDERTAKING

To,

i) The Regional Provident Fund Commissioner,

Employees’ Provident Fund Organization,
_______________________________
_______________________________
_______________________________

ii) Bharat Electronics Limited,

(Address of the Unit / Office where the employee is currently working / has exited)
______________________
_____________________

AND

BEL PF Trust Bangalore/Ghaziabad

1.0 Particulars of the Employee / Ex-Employee* executing the Undertaking, are as under:

i) Name

ii) BEL Staff No.

BEL Department / Unit / Office
iii)
& Location
iv) Date of Joining BEL
Full Postal Address with Pin
v)
Code

Additional information in respect of serving Employees (who have attained 58 years of age
but not 60 years) /Ex-Employees who are drawing Pension under EPS, 1995 are as under:

PPO Number and issuing

RPFC Office in case of
vi)
Employees who are already
drawing pension
Date of attaining the age of 58
vii) years (eligible for Pension
under EPS 1995)
Date of actual Superannuation /
viii)
Cessation of Service
Name of Pension disbursing
ix)
Bank and Branch

2.0 I …………………………………… (name), Son/Daughter/Wife * of …………………

hereby declare and undertake as follows:
a) I have read and understood the terms of Employees’ Pension Scheme, 1995 (EPS’95) as
amended from time-to-time including as it was before the amendment of 2014 and the
Judgment dated 04.11.2022 of the Hon’ble Supreme Court in SLP(C) Nos. 8658-8659 of
2019;

b) This Joint Option under the provision of the erstwhile Para 11(3) and Para 11(4) of the
EPS’95 is exercised by me in the online / digital mode pursuant to the aforesaid Judgment
dated 04.11.2022;

c) I understand that the Joint Option Form submitted by me shall be subject to acceptance of
EPFO and is also subject to EPFO instructions / guidelines / directives / Court directions, etc.
that may be issued from time-to-time. I further understand that the Option exercised is
irrevocable at any stage, unless otherwise specifically permitted by the EPFO or the
applicable Law; and no claim for change of Option shall be entertained or considered under
any circumstances;

d) I undertake and agree to make single tranche payment of due contribution along with interest
(which will be as worked out /demanded by EPFO ) upto the date of payment to BEL PF
Trust/EPFO (as applicable)within the prescribed time limit as may be intimated by EPFO or
BEL or BEL PF Trust and without any delay and demur. I hereby authorize /agree
- that the amount may be transferred from my accumulated PF balance with BEL PF
Trust(s)
- and in case as on the date of payment if my accumulated PF balance is NIL/falls short
of the actual amount I shall pay the difference in single tranche

e) I indemnify BEL / BEL PF Trust(s) for any act, commission or omission on the part of BEL
or BEL PF Trust(s) exercised in pursuance of EPFO instructions in relation to exercise of my
Joint Option under EPS’95;

f) I hereby agree that I shall not hold the BEL / BEL PF Trust(s) liable for any delay or non –
deposit of the aforesaid amount to the EPFO and for any other liability which may be
determined by EPFO and the concerned authorities for reasons not directly attributable to
BEL / BEL PF Trust(s).

g) I agree that BEL / BEL PF Trust(s) shall be entitled to initiate appropriate proceedings in case
of any false declaration / information, if any, made by me while submitting the Joint Option
or for non-remittance of funds as required.

h) I agree to receive the pension amount as determined by EPFO.

Place: ---------------------------
Date: (Signature)

Witness:

1. Signature : ……………………………
Name : ……………………………
Mobile No: ……………………………
E-mail ID : ……………………………
Address : ……………………………
……………………………
 ……………………………

2. Signature : ……………………………
Name : ……………………………
Mobile No: ……………………………
E-mail ID : ……………………………
Address : ……………………………
……………………………
……………………………

Note: Non-Judicial Stamp paper for executing the undertaking in States where BEL Units /
Offices are located is as follows:

Karnataka – Rs. 200/-, Maharashtra – Rs. 100/-, Telangana – Rs. 100/-, Uttar Pradesh – Rs. 100/-,
West Bengal – Rs. 100/-, Delhi – Rs. 100/-, Andhra Pradesh – Rs. 100/-, Tamil Nadu – Rs. 20/-,
Haryana – Rs.100/- and Uttarakhand – Rs.10/-

However, in case if Ex-Employees settled in any other State, the Affidavit-cum-Undertaking may
be executed in Non-Judicial Stamp Paper of appropriate value, as applicable in the respective
State, in consultation with Advocate / Notary.

Instruction to fill the form:

No changes shall be made to the content of the Affidavit-cum-Undertaking except for filling up
the following details as per applicability:

i) Serving Employees to mention the RPFC address based on Current Trust membership and
Exit employees to mention the Trust through whom they had submitted the Pension
application.

BEL PF TRUST, Bangalore:

The PF Commissioner,
Regional Provident Fund Commission,
No.62, 3rd Cross, Industrial Suburb, Near MEI Bus stop,
Yeshwanthpur – 2nd stage,
Bangalore-560022

BEL PF TRUST, Ghaziabad:

The PF Commissioner,
Regional Provident Fund Commission,
Nidhi Bhawan, Opp. Medical College,
Jagriti Vihar, Sector-5, Meerut - 250006

ii) Serving employees to choose the Trust in which they are currently member. Exited employees
to choose the Trust through whom pension application was submitted.

Duly notarised original Affidavit-cum-Undertaking has to be sent to respective PF Trust, failing

which the Joint Option form will not be taken up for processing.