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Blank Joint DeclarationForm PDF

This document is a joint declaration by a member and their employer to the Regional Provident Fund Commissioner. It provides corrected personal details of the member such as name, father/husband's name, PF/EPS account number, date of birth, and dates of joining and leaving employment. The employer certifies that the information provided is correct and requests that the changes to the member's records be accepted.

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Arokiaraj
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900 views1 page

Blank Joint DeclarationForm PDF

This document is a joint declaration by a member and their employer to the Regional Provident Fund Commissioner. It provides corrected personal details of the member such as name, father/husband's name, PF/EPS account number, date of birth, and dates of joining and leaving employment. The employer certifies that the information provided is correct and requests that the changes to the member's records be accepted.

Uploaded by

Arokiaraj
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Joint Declaration By the Member and The Employer

Date:

To

The Regional P F Commissioner

Sub: Joint declaration by the member and the employer

Dear Sir,

I, am/ was an employee / ex employee of

furnishing below herewith correct deals with aforesaid establishment :-

UAN Aadhar:

Particulars As in UAN Correct

Name

Father/ Husband Name

PF / EPS Account No.

Date of Birth (DD/MM/YYYY)

Date of joining (DD/MM/YYYY)

Date of leaving EPF (DD/MM/YYYY)

Date of leaving EPS (DD/MM/YYYY)

The reason for variation in Name / DOB is explained in the employer’s forwarding letter dated _____________ . I am also enclosing herewith self-
attested copy of ID Proof ( PAN Card / Aadhar Card – The same is approved in KYC ). The same is attested by the Employer / Ex- Employer.

*Aadhar should be approved in KYC for Member Name & DOB correction. If for any reason Aadhar is not ceded, reason for the same should be
mentioned in the forwarding letter.

An early action in this regard will be highly appreciated.

Yours Faithfully

Name & Signature of Applicant :

Certified that the above information is correct & request as made by the applicant may please be accepted.

Signature With Establishment Seal :

Encl.: As Above

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