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Part A: Personal

This document is an Online Transfer Claim Form for transferring Provident Fund balance from a previous account to a current one, submitted by Sambath Joshi S. It includes personal details, previous and present PF account information, and a certification of accuracy by the member. The form must be printed and submitted to the current employer, Thaya Constructions.

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8 views2 pages

Part A: Personal

This document is an Online Transfer Claim Form for transferring Provident Fund balance from a previous account to a current one, submitted by Sambath Joshi S. It includes personal details, previous and present PF account information, and a certification of accuracy by the member. The form must be printed and submitted to the current employer, Thaya Constructions.

Uploaded by

karthiinfo1990
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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ONLINE TRANSFER CLAIM FORM [FORM 13 (REVISED) ]

( Tracking ID: 10135265540805001 )


Claim Date : 29/06/2023
EMPLOYEES' PROVIDENT FUND SCHEME, 1952
(PARA 57)

(This form has been printed on the basis of Online Transfer Claim Form filled up by the member under Unified Portal for submission to the
employer.)

To,
The Regional P.F. Commissioner,
PEENYA,
NO. 62,1ST MAIN(MEI ROAD),3RD CROSS INDL. SUBURB,YESHWANTPUR 2ND STAGE Bangaluru

Sir,
I request that my Provident Fund balance along with my Pension Service Details may please be transferred to my present
account under intimation to me. My details are as under :

PART A : PERSONAL

1. Name : SAMBATH JOSHI S

2. Mobile Number : 9940868502

3. E-mail id : srjjoshi1234@gmail.com

4. Bank Account Number : 65001000015864

5. Bank IFSC : IOBA0000650

PART B : DETAILS OF PREVIOUS PF ACCOUNTS (WHICH IS TO BE TRANSFERRED)

1. PF Account No. (with EPFO : PYPNY00298050000010112

2. Name of the Establishment : RAMAKRISHNA CONSTRUCTIONS

3. Address of the Establishment : NO 1030/1, SRINIVASA NILAYA, 3RD CROSS, M.J.NAGAR, HOSPET
BELLARY DIST 648
4. PF A/C No. held by : PEENYA

5. Name of the Trust : NOT APPLICABLE

6. PF A/C No. in Trust : NOT APPLICABLE

7. Bank A/C No. of Trust : NOT APPLICABLE


8. IFS Code of the Bank Branch of
Trust where account is : NOT APPLICABLE

9. Member's Name : SAMBATH JOSHI S

10. Date of Birth : 04/10/1996

11. Father's/Spouse Name : SELVARAJ

12. Relationship : FATHER

13. Date of joining : 14/09/2018

14. Date of leaving : 31/08/2019


PART C : DETAILS OF PRESENT PF

1. PF Account No. (with EPFO : CBSLM24677160000010010

2. Name of the Establishment : THAYA CONSTRUCTIONS

3. Address of the Establishment : 102, Ilnd Floor, Sheik Dawood Street Erode ERODE

4. PF A/C No. held by : SRO SALEM

5. Name of the Trust : NOT APPLICABLE

6. PF A/C No. in Trust : NOT APPLICABLE

7. Bank A/C No. of Trust : NOT APPLICABLE


8. IFS Code of the Bank Branch of
Trust where account is : NOT APPLICABLE

9. Member's Name : SAMBATH JOSHI S

10. Date of Birth : 04/10/1996

11. Father's/Spouse Name : SELVARAJ

12. Relationship : FATHER

13. Date of joining : 15/08/2021

I, Certify that all the information given above are true to the best of my knowledge and I have ensured the correctness of
my present and previous account numbers.

Signature of the member

Note : Member should take a printout of this form and a signed copy of the same should be submitted to the Present
Establishment i.e. THAYA CONSTRUCTIONS

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