$} Chola
To
Human Resources Deparment
‘Cholamandalam Investment and Finance Company Limited
Chennai
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Designation Bxach. Awdikmamegen.
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(iss, we Rochon, am
of on ce Signature
Signa fhe Superior Signatur ofthe Employee
Ylome: Feaykumar Ganesan
Eotole! RIBI2
(@& Scanned with OKEN ScannerPF Nomination Form
FORM — 2 (REVISED)
NOMINATION & DECLARATION FORM.
FOR UNEXEMPTED / EXEMPTED ESTABLISHMENTS
Declaration & Nomination Form Under the Employees' Provident Funds & Employees Pension Scheme
Paragraph 33 & 61 (11) of the Employees’ Provident Fund Scheme, 1962 & Paragraph 18 of the
Employees’ Pension Scheme 1905
{Name (inBiock eters) PETC mUTHO a:
2. Famers /Hesbands Ve Py yA ne sVneen.
wv .
3, Date of Birth Ql Ob Bk 4Sex Male/Female
5. Marital Status Manvisd
| 8. Account No. ™ 1o1\ gob 7gaTl
7.Address Permanent: Ya pelerSSn Temporany:
Nena, Vedea slot : -
| 8. Date of Joining EPF su Aled ae
PART A(EPF)
I hereby nominate the person(sVeancel the nomination made by me previously and nominate the person(s)
mentioned below to receive the amount standing to my credit in the Employees’ Provident Fund, in the
event of my death.
Name & Address of Nominee’s” DateofBirth’ Total amount | If the nominee is a minor, name &
the nominee | relationship ‘or share of relationship & address of the guardian
nominees with the ‘accumulations who may receive the amount during
member in Provident the minority of nominee
Fund to be
paid to each
nominee
1 2 3 4 5
B Bhanrale sh ,
Dewi ute do. N49 {00
1." Gerifed that have no family as defined in para 2 (g) of the Employee's Provident Fund Scheme
+1952 and should | acquire a family hereafter the above nomination should be deemed cancelled.
2. * Certified that my father mother is/are dependent upon me
3. * Unmarried members in the absence of dependent parents may nominate any other person to
receive the shares.
* Svike out whichever not applicable.
Note“ fresh nominaion shall be made by the di
member on hie mertage and any nomination mad Be ee
POON msc ie
‘
x 3. Religion : IW OHO
an tale 3 Saat: 84 738
6. Postheid Borarch BueltL 7 Permanent address Yes, Kk o§ SNatee oy
Mamader: 4 %,
piace: Pdauchanry. Recent.
Date: 3g Jslan. 3 ‘Signature of the Employee
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PART B (EPS) Para ~ 18
Thereby furnish below particulars of the members of my family who would be eligible to receive widow/children
pension in the event of my death.
["SNo. Name of the Family ‘Address Date of Relationship with the
Members Birth member
1S. Shosrmtle: Pout fps kU :SS+N-nlagur Bow lI wee.
3 Ps. Sugiv thom yg tess -S.nage 29.71. Bodo Son
4
5
“Cerified that | have no family, as defined In para 2 (vil of Employee's Pension Scheme. 1995" and should | acquire
a family hereafter | shall furnish particulars thereon in the above form.
hereby nominate the following person for receiving the monthly widow pension (admissible under para 16(2) (9) (i) &(i)in
the event of my death without leaving any eligible family member for receiving pension
‘Name & Address of the nominee Date of Birth Relationship with the member
s. Dharrmlo, Poss Bo Le 199 whe.
I
vate: 24.3. Qh, hue.
4 je ‘Signature -3
“Strike out whichoveris not applicable Signature orleft thumb impression of the Subscriber
CERTIFICATE BY EMPLOYER
Crified that the above declaration and nomination has been signed / thumb impressed before me by
‘ShriSmKum ‘employed in my establishment after helshe read the
entries/entries have been read over to him/her by me and got confirmed by himvher.
Place: ‘Signature ofthe employer or authorized officers of the establishment
Name: For Cholamandalam Investment & Finance
CompanyLtd
Date Designation: Authorised Signatory/ies
Name & Address of the factory / Establishment or Rubber Stamp thereon
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Membership ~ Family Relief Scheme
Kindly arrange to deduct a sum of Rs.5I- (Rupees Five only), on monthly basis, from my salary, towards
the Management Staff Family Relief Scheme.
Employee Name Percurmurhyr &
o
Nominee’s Name & Relationship : S. Shaw eile. Dowt - whe
Employee's Signature Rese Chum << Signature -6
Date a9 3} ah,
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Chola
Declaration by Witnesses
Nomination signedithumb impressed before me.
‘Name in full and full address of witnesses. Signature of witnesses.
1 1
2 2
Place
Date
Cortificate by the Employer
Ceried that the paricars of the above nomination have been veried and recorded in tis
aumanuoe For Cholamandalam Investment & Finance
- Company Ltd
Employer's Reference No., itany.
‘Signature of the employer and Designation _ Authorised Signatoryiies
‘Acknowledgement by the Employee
Received he dupicat copy ofromination Fo fled by me and dy geld by the emir. p
Date deck of the Employee Signature -5
NOTES : (1) Strike out the words not applicable
(2) Clause(h) of Section2 — Family in relation to an employee, be deemed to consist of
le employee, himself, his wife, his children, whether married or
(Inthe case of a mal
Unmarried, his dependent parents and the widow and children or his predeceased, if
any.
{i) Inthe case of female employee, himself, her husband, her children, whether married
‘or unmarried his dependent parents and the depended parent of her husband and the
\widow children of her predeceased son if any.
Provided that if a female employee by a notice in writing to the controling authority, express her desire to
prelude her husband from her family, the husband and his dependent parents shall no longer be deemed,
for the purposes of this Act, to be included in the family of such female employee unless the said notice is
subsequently withdrawn by such female employee.
Explanation: Whether the personal law of an employee permits the adoption by him of a child any child
‘lawfully adopted by him shall be deemed to be included in his family, and where a child of an employee
has been adopted by another person and such adoption is, under the personal law of the person making
such adoption, lawful, such child shall be deemed to be excluded from the family of the employee.
© scanned with OKEN ScannerFrom:
Freoyee name: Pe Chumakbur, P
joyce Cod ;
Emotes benaton: Byamch Bustle wemaier. u Decah Rabbi
fates: Yon WK +S: S+ V NOQar, Panola Noor
7
Cholamandelam Investment and Finance Company Limited,
“Chola Crest”, 54-55 & Super B-4, Thiru-Vi-ka Industrial Estate,
Guindy, Chennai - 600032
Sir/Madam,
Sub:
indertaking to employer
1am presently employed with Cholamandalam Investment and Finance Company Limited.
I declare/undertake to the Company on my individual capacity tha
1. 1 am entrusted with the work of collecting instalments and other amounts payable by the customers of the
Company in their respective loan account/s
2. Lwill either remit the collected cash into Company's bank account or hand it over to cashier or branch manager
of the respective branch of Company on daily basis. I will be more cautious while collecting cash from customers
and will not negligent in handling the collected cash.
3. Lull not:
3a) Collectitransfer any amount from the customers of Company into my personal account, which includes Google
pay, Phone pe, Paytm and any other online payment modes:
'b) deposit any cheques of my relatve's/friends into customer's account;
collect cash from customers without receipt; *
4) upload fake challan without deposition;
@) issue receipt and cancel it frequently;
f). fund my personal amount into customers account;
4g) remit instalment and/or other amounts payable by customer/s by using my personal debit
or credit card/s;
1) involve in teeming and lading practices;
j) violate the process/es laid down by the Company and RBI guidelines/ notifications;
3). repossess vehicle/asset without proper approval of the concemed authority.
5) Ill ensure that the repossessed/surrendered vehicles are not moved to 3rd party/ies and such vehides are
parked only at the authorised parking yard of Company.
IFT fal to comply with my undertaking/s, the Company may take any appropriate legal/other action against me
as per their policies.
Recbumuiae,
piace: FUDUC H emg,