Joint Declaration Form
I …………………………………………………………………………………………………..Having UAN……………………………………………….
PF account………………………………………….and Aadhar……………………………………………is/was with establishment
M/s……………………………………………………………………………………………………………………………………………………………………
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.No. Details/particulars Incorrect details Correct Details
1 Aadhar
2 Name
3 DOB
4 Gender
5 Father/Mother
6 Relationship
7 DOJ
8 DOL
9 Reason of leaving
10 Marital Status
11 Nationality
I………………………………………………………………………...S/o………………………………………,authorized signatory of the
establishment have verified the request, document attached and the records of the establishment and certify
that the facts mentioned above the correct. I am also enclosing …………………...……………....……………….
and ………………………………..(documents of Establishment) in support of the request of the employee
mentioned above.
We………………………………………………………….(Employee) and …………………………………………………………….
(Authorized Signatory) hereby declare we have not concealed any facts and the above mentioned facts are
correct. We also Indemnity 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
