Scribd
Upload
47 views1 page

Joint Declaration Form

The document is a Joint Declaration Form submitted by PATTU M to update incorrect personal details in the EPFO member profile. The corrections include changes to Aadhaar, name, date of birth, gender, and other personal information. A.VARADAPITCHAIRAJ, the authorized signatory of M/S Raja Engineering Works, has verified the request and attached supporting documents.

Uploaded by

Bala Suresh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
47 views1 page

Joint Declaration Form

The document is a Joint Declaration Form submitted by PATTU M to update incorrect personal details in the EPFO member profile. The corrections include changes to Aadhaar, name, date of birth, gender, and other personal information. A.VARADAPITCHAIRAJ, the authorized signatory of M/S Raja Engineering Works, has verified the request and attached supporting documents.

Uploaded by

Bala Suresh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 1

Joint Declaration Form

I PATTU M having UAN 1006 5908 5126 PF account TN/AMB/48734/10581 and


Aadhaar 4145 0872 2210 was with establishment M/S Raja Engineering Works.
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.

S. Details/particulars Incorrect details Correct details


No.
1 Aadhaar 4145 0872 2210
2 Name PATTU PATTU M
3 DOB 08/08/1979
4 Gender FEMALE
5 Fathers/Mothers MURUGAN
6 Relationship HUSBAND
7 DOJ 12.05.2020
8 DOL 07.07.2022
9 Reason of leaving CESSATION
10 Marital Status MARRIED
11 Nationality INDIAN

I A.VARADAPITCHAIRAJ s/o P.ARUNACHALAM, 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 Aadhar card, PAN card and Bank Passbook in support of the request of the
employee mentioned above.

We PATTU M(Employee) and A.VARADAPITCHAIRAJ (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/over payment/under payment
because of the above furnished information shall be jointly held responsible.

Authorized signatory Name of the member

You might also like