JOINT DECLARATION FOR, To ‘The Regional PF Commissioner, Employees PF Organisation, RO, Bengaluru (Central/Malleswaram). Sub: Request for correction in the details of the employee / member. Sir, Resneeecenieene an employee/ex-employee of the establishment M/s.. (BG/BNG/_ wish to inform that the following information is/are not correctly mentioned in the PF records and hence request you to correct the same as furnished hereunder. PARTICULARS AS PER PF RECORDS TO BE CORRECTED AS Name Father/Husband Name PF/EPS Account No. UAN Date of birth (oo/mm/vvvy) Date of Joining (Q0/MM/YYYY) Date of Leaving (D0/Muyyvvy) Gender Aadhar Number PAN | am enclosing herewith attested copy of Proof (PAN Card / Election ID Card / School Certificate / Birth Certificate / Pass Port / Driving License / Aadhar Card / UAN Card / ES! Card / Medical Certificate from District Civil Surgeon authorised by the competent authority concerned / Wage register atthe time of joining / Employer office record, etc.) which is approved in KYC for your ready reference. The documents are enclosed as per the Annexure — A. “Ihereby give my consent to share my Aadhar detalls/ Aadhar based authentication for the Purpose of establishing my identity and seeding it with UAN", Allthe documents (Xerox) enclosed are signed by me and attested by the employer, Yours faithfully, NAME AND SIGNATURE OF THE APPLICANT Mobile No, : Certified that the above information is corr accepted and necessary changes in your caused, if any, in this regard, ect and request as made by the applicant may please be records may be made. We regret for the inconvenience Enel: As above Authorised Signatory Seal and SignatureANNEXURE - A LIST OF DOCUMENTS TO BE SUBMITTED FOR CHANGE IN DOB A. Birth Certificate issued by the Registrar of Births and Deaths. B. Any school/education related certificate ¢.PassPort D. Any other reliable document issued by a government department E. Inthe absence of proof of date of birth as above, Medical certificate issued by District ‘the member medically and support with an affidavit on oath by the member duly Civil surgeon after examining authenticated by a_ competent court. F. Employer certifying the genuineness of the request LIST OF DOCUMENTS TO BE SUBMITTED FOR CHANGE IN NAME (MINOR CHANGE) A. Aadhar D. Election 1D E. Employer certifying the genuineness of the request LIST OF DOCUMENTS TO BE SUBMITTED FOR CHANGE IN NAME (COMPLETE CHANGE ) ‘A. Original records of the establishment such as wage register, increment Orders, Pay slips, Appointment Order, ESIC return for joining month 8. Advertisement published in the leading Newspaper for said changes Affidavit D. Employer certifying the genuineness of the request E, Form 11 copy which was submitted by the member at the time of Joining. LUST OF DOCUMENTS TO BE SUBMITTED FOR CHANGE IN DATE OF JOINING A. Form No.5 filed by the employer with due attestation B, Details of ECR copies from the date of joining of the member C. Wage register for the time of joining D. Employer certifying the genuineness of the request E. Form 11 copy which was submitted by the member at the time of Joining. UST OF DOCUMENTS TO BE SUBMITTED FOR CHANGE IN DATE OF LEAVING A. Form No.10 issued by the employer with due attestation B, Details of ECR paid tll date of leaving C. Wage register at the time of leaving D, Employer certifying the genuineness of the request E, Form 11 copy which was submitted by the member at the time of Joining.