Entity Chartered Accountants
Function TAX
loww.eufindia.cow.in
Composite Declaratlon Form 11
To be retined by the erployer for fuhre rference)
EMPLOYEES PROVIDENT FUND ORGANTSATION
Employees' Provtdent Fwnds Seheme, 1952 Paragraph 34 &57) &
Empleyee Penrion Seheme, 1995 (Paragraph 2)
(Declaration by a pereon taking p employment in any esthbHehment on whieh EPF Scheme, 1952 md or EP3, 1995 i applieable)
Name of the member
AKASH GUPTA
Fathers Name Father Anand Gupta
Spouse Name
Datc of Birth (DD/MM/1Y) 15/03/1994
4 Gender (MaleFemale Transgender) Male
Marital Status
(MamedUnmarmied/Widow/Widower/Divorcece Unmarried
(a) Email ID guptaakash179@gmail.com
(b) Mobile No
9871295521
Prescnt cmployment dctails:
Date of joining in the currentestablishment(DD/MMYYYY)
KYC Details: (attach self artested copies of following KYC's)
Bank Account No.
245101507338 ICICoO02451
IFS Code of thebranch:
c)AadharNumber 447454834988
d)Permanent Account Number (PAN), if available
BIMPG6548Q
Whether earliera member of Employees' Provident Fund Scheme, 1952 Yes Yes/No
1 0 Whether earlier amember of Employees Pension Scheme, 1952 Yes Yes/No
Previous employment details
Establishment
:[if Yesto 9 AND/OR
Universal Account
10above-Un-exempted
PF Account Number Date of Joining Date of Exit Scheme PPO Non
Name & Address Number (DD/MM/ (DD/MM Ccrtificate Number Contributory
YYYY) YYYY) No. (if Peniod
issued) SSued) (NCP) day
Ernst & young MH/BAN/0043647/00 08/08/2019 31/03/2022
LLP 0/0037451
100553859152
Golf view tower
B sector 42
Gurgaon
122001
Previous employment details { if Yes to 9 AND/OR 10 above)- Exempted Trusts
Name & Address of the UAN Member EPS A/c number Dale of Joining Date of Ext Scheme NOn
I rust (DD/MM/ Certilicatc Conuibutory
(DD/MM/
YYYY) YYYY) No.(it Period (NCP)
ISSued uays
12
a) Intemational Worker: No Yes/No
13 b) Ifyes,state country oforigin (India/Name ofthe Country)
C) Passport No.
d)Validity ofpassport [(DD/MM/YYYY)to (DD/MM/YYYY)]
UNDERTAKING
1) Certified that the particulars are true to the best of my knowledge.
2) Iauthorize EPFO to use my Aadhar for verification/authentication/e-KYC purpose for service delivery
3) Kindly transfer the funds and service details, if applicable, from the previous PF account as declared above to the present P.F. Account as
[ am an Aadhar verified employee in my previous PF Account."
4) In case of changes in above details, the same will be intimated to employer at the earliest.
uc: Jo/o4/22
lace: oAON Signature of Member
DECLARATION BY PRESENT EMPLOYER
A. The member Mr/Ms/Mrs AKASH GUPTA
hasjoined on and has been allotted PF
No and UAN 100553859152
B. In case the person was earlier not a member of EPF Scheme, 1952 and EPS, 199S:
Please tick the Appropriate Option:
The KYC details of the above member in the UAN database
OHave not been uploaded
Have been uploaded but not approved
lHave been uploaded and approved with DSC/-sign.
C. In case the person was earlier member of EPF Scheme, 1952 and EPS, 1995
Please tick the Appropriate Option:
DThe KYC details of the above member in the UAN database have ben approved with E-sign/Digital Signature
Certificate and transfer request has been generated on the portal.
D The previous account of the member is not Aadhar verificd and hence physical transfer form shall be initiated.
Date: Signature of the employer with seal of
Establishment
Auto transter of previous PF acount would be possible in respect of Aadhar verified employees only. Other employees are requested to file
physical clam fom (Fomm-13) for transfer ofaccount from the previous establishment
