ANNEXURE - II
(On the letter pad of Establishment)
Joint Declaration Form
I….….................................................having UAN………………....................…………….
PF account………………………….. andAadhaar.....…………………………. is/was with
establishment M/S…………………………….......................................…. The personal
details furnished to EPFO earlier were found to be incorrect/blank, and therefore request
for change/updation in the member profile as follows.
क्रं.सं. वििरण / ब्यौरा गलत वििरण सही वििरण
S.No. Details / Particulars Incorrect details Correct Details
01 आधार / Aadhaar
02 नाम / Name
03 जन्मतिति / DOB
04 त िंग / Gender
05 तििा / मािा / Father/
Mother
06 सिंबिंध/Relationship
07 तनयुक्ति की तिति/ DOJ
08 छोड़ने की तिति/ DOL
09 सेवा छोडने का कारण /
Reason of Leaving
10 वैवातिक क्तथिति /
Marital Status
11 नागररकिा / Nationality
I……………...................................….s/o……………......................…………………,
authorized signatory of the establishment, have verified the request, document attached,
and the records of the establishment and certify that the facts mentioned above are correct.
I am also enclosing ………….....………………, …………………………………..……
……………....……………… and ……………......………………………. (documents of
Establishment) in support of the request of the employee mentioned above.
We…………………………...........(Employee) and..……………………………………….
(Authorized Signatory) hereby declare we have not concealed any facts and the above-
mentioned facts are correct. We also indemnify that in case of wrong
payment/overpayment/underpayment because of the above furnished information shall be
jointly held responsible
Authorized Signatory Member Name and Signature
