ONLINE TRANSFER CLAIM FORM [FORM 13 (REVISED) ]
( Tracking ID: 10074273279205007 )
Claim Date : 05/02/2024
EMPLOYEES' PROVIDENT FUND SCHEME, 1952
(PARA 57)
(This form has been printed on the basis of Online Transfer Claim Form filled up by the member under Unified Portal for submission to the
employer.)
To,
The Regional P.F. Commissioner,
DELHI (NORTH),
28, Community Centre, Wazirpur Industrial Area, Delhi
Sir,
I request that my Provident Fund balance along with my Pension Service Details may please be transferred to my present
account under intimation to me. My details are as under :
PART A : PERSONAL
1. Name : AVINASH KUMAR PANDEY
2. Mobile Number : 8745821360
3. E-mail id : AVINASHPANDEY474@GMAIL.COM
4. Bank Account Number : 12130100030148
5. Bank IFSC : BARB0GONDAX
PART B : DETAILS OF PREVIOUS PF ACCOUNTS (WHICH IS TO BE TRANSFERRED)
1. PF Account No. (with EPFO : DLCPM16250210000010876
2. Name of the Establishment : BLUE JAY FINLEASE LIMITED
3. Address of the Establishment : FLAT NO. 1201-C, ANTRIKSH BHAWAN, 22, KASTURBA GANDHI MARG,
DELHI 187
4. PF A/C No. held by : DELHI (NORTH)
5. Name of the Trust : NOT APPLICABLE
6. PF A/C No. in Trust : NOT APPLICABLE
7. Bank A/C No. of Trust : NOT APPLICABLE
8. IFS Code of the Bank Branch of
Trust where account is : NOT APPLICABLE
9. Member's Name : AVINASH KUMAR PANDEY
10. Date of Birth : 19/10/1995
11. Father's/Spouse Name : RADHEYSHYAM
12. Relationship : FATHER
13. Date of joining : 21/02/2022
14. Date of leaving : 10/06/2022
PART C : DETAILS OF PRESENT PF
1. PF Account No. (with EPFO : GNGGN14613030000010833
2. Name of the Establishment : SOUNDRISE HEARING SOLUTIONS PRIVATE LIMITED
3. Address of the Establishment : UNIT NO.206, 2ND FLOOR IRIS TECH PARK, SECTOR-48, SOHNA
ROAD,GURGAON GURGAON 179
4. PF A/C No. held by : RO GURGAON
5. Name of the Trust : NOT APPLICABLE
6. PF A/C No. in Trust : NOT APPLICABLE
7. Bank A/C No. of Trust : NOT APPLICABLE
8. IFS Code of the Bank Branch of
Trust where account is : NOT APPLICABLE
9. Member's Name : AVINASH KUMAR PANDEY
10. Date of Birth : 19/10/1995
11. Father's/Spouse Name : RADHEYSHYAM
12. Relationship : FATHER
13. Date of joining : 04/09/2023
I, Certify that all the information given above are true to the best of my knowledge and I have ensured the correctness of
my present and previous account numbers.
Signature of the member
Note : Member should take a printout of this form and a signed copy of the same should be submitted to the Present
Establishment i.e. SOUNDRISE HEARING SOLUTIONS PRIVATE LIMITED
