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Form 11 (Revised) : Employees Provident Fund Scheme

This 3 sentence summary provides the key details from the Employees Provident Fund Scheme Form 11 document: The document is a declaration form for employees taking up new employment in an establishment where the Employees' Provident Fund and Family Pension Fund schemes are in force, requiring information about their previous employment and fund membership details. It also includes fields for the new employer to provide details of the employee's appointment and admission to the funds. The form is to be filled out by both the new employee and employer with relevant employment and fund contribution information.

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Yuvaraj Singh
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445 views2 pages

Form 11 (Revised) : Employees Provident Fund Scheme

This 3 sentence summary provides the key details from the Employees Provident Fund Scheme Form 11 document: The document is a declaration form for employees taking up new employment in an establishment where the Employees' Provident Fund and Family Pension Fund schemes are in force, requiring information about their previous employment and fund membership details. It also includes fields for the new employer to provide details of the employee's appointment and admission to the funds. The form is to be filled out by both the new employee and employer with relevant employment and fund contribution information.

Uploaded by

Yuvaraj Singh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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Employees Provident Fund Scheme

Form 11 (Revised)
(For unexempted Establishment only)

Paragraph 34 of the Employees’ Provident Funds Scheme, 1952

Declaration by a person taking up employment in an establishment in


which the Employees’ Provident Fund and Family Pension Fund Scheme
are in force :

I ** son/wife/daughter of
Name

hereby solemnly declare that –

(a) I was last employed in


(Name and full address of the establishment)
and left service on (Prior to that I was employee of
from to date

**(b) I was a member of Provident Fund

and also/but not

of the Family Pension Fund from to

and my account number(s) was/were / /

(c) I have /have not withdrawn the amount of any Provident fund/Family Pnsion
Scheme.

(d) I have/have not drawn any superannuation benefits in respect of my past


service from any employer.

(e) I have never been a member of any Provident Fund and/or Family Pension
Scheme.

Date Signature or **right/left hand


thumb impression of the
employee.
(To be filled in by the employer only when the person employed had not already
been a member of the Employees’ Provident Fund)

Shri is appointed as
(Name of the employee) (Designation)
in
(Name of the Factory/Establishment)
with effect from
(Date of appointment)

Date of completion of 120 actual


working days in a period of 6 months or
From to No. of days less or six months* continuous service
worked or date of confirmation whichever is
earliest. Date of admission as member
of Employees’ Provident Fund

Account No.
Signature of the Employer or Manager
or other Authorised Officer.

Date ……………………………

** Strike out whichever is not applicable.


N.B. – The principal employer should have filled it up also in respect of
employees to be employed by or through a contractor.

(For Unexempted Establishment only)

Contract Rest Total

Total No. of Employees

Total No. of Subscribers

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