JOINT DECLARATION BY THE EMPLOYER & EMPLOYEE
(For correcting Date of Birth & Name of employees)
To, Date-
The Regional PF Commissioner,
EPFO Regional Office, Kukatpally
Sir,
1] Mr/Mrs/Miss _____________________________________ was / is an employee of
M/s __________________________________________ having PF A/c no AP/KKP
_________________ and UAN _________________________.
2] The personal details furnished to the EPFO office earlier vide Form 9 / ECR / Annexure 2 are now
found incorrect. The reason for providing incorrect details was / is
________________________________________________________________________________.
3] Now the employee has requested for correction in Date of birth / Name / Father’s name / Spouse
name on the basis of educational records / Community & Birth certificate / Marriage certificate /
Aadhar / ESIC card / / Passport / Driving License / PAN / SSN slip / Insurance policy / Bank passbook /
Cheque / Any other document _______________________________________ issued by State /
Central government dept. The attested copies of these documents are enclosed herewith.
4] We the authorized officials of establishment have verified the request along with above
documents and find it appropriate to correct / have already corrected these personal details in the
records maintained by the establishment. The attested copies of offer of appointment / identity card
/ job card / pay slip / wage register / superannuation order / termination letter / other record
maintained by the establishment are enclosed herewith.
5] Therefore it is requested to correct the personal details of the employee in the EPFO database
also as under.
PERSONAL AS REPORTED EARLIER VIDE FORM 9 / CORRECTIONS REQUIRED
DETAILS ECR / ANNEXURE 2
Name
Father’s name
Spouse name
Surname
Date of birth
Gender
Date of joining
Date of leaving
6] We understand that in case of any wrong payment / over payment / under payment of EPF and
pensionary benefits to the employee / worker because of the above furnished information, the
establishment / authorized officials along with employee shall be jointly held responsible.
Name & Designation Name of employee -
of Authorized Signatory
Signature Signature of employee –
Establishment Seal
FOR OFFICE USE
Joint declaration in r/o _____________________________________ having PF A/c no AP/KKP
_________________ and UAN _________________________ is received with copies of following
documents :-
Documents furnished by the employee / Documents furnished by the employer /
member establishment
1 Educational records – Clarification dated ………………………………
2 Community & Birth certificate / Marriage Appointment letter
certificate
3 Aadhar / PAN Identity card / job card issued by the
establishment
4 ESIC card / Passport / Driving License Pay slip / wage register
5 Insurance policy / Bank passbook / Cheque Superannuation order / termination letter
6 Any other document issued by State / Any other record maintained by the
Central government dept – establishment -
1) The variation in date of birth is LESS than three years and can be approved as per Aadhar.
2) The variation in date of birth is MORE than three years, above supporting documents along with
Aadhar are verified and found in order, hence DOB can be corrected as requested.
3) The request for correction in date of birth CANNOT be accepted because of following reasons :-
__________________________________________________________________________________
__________________________________________________________________________________
4) The correction in name falls under MINOR / MAJOR category.
5) The clarification given by the establishment is verified and found ACCEPTABLE / NOT ACCEPTABLE
because __________________________________________________________________________
6) The documents in support of correction in the name are verified and found ACCEPTABLE / NOT
ACCEPTABLE because _______________________________________________________________
__________________________________________________________________________________
DEALING ASSISTANT SECTION SUPERVISOR ACCOUNTS OFFICER APFC RPFC I
