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18 views2 pages

indus

Uploaded by

Rajesh Gupta
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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ONLINE TRANSFER CLAIM FORM [FORM 13 (REVISED) ]

( Tracking ID: 10114591613005008 )


Claim Date : 18/07/2024
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,
BANDRA(MUMBAI-I),
341, Bhavishya Nidhi Bhawan Bandra (East), Mumbai

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 : RAJESH KUMAR GUPTA

2. Mobile Number : 9576712494

3. E-mail id : [email protected]

4. Bank Account Number : 0142000102690528

5. Bank IFSC : PUNB0014200

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

1. PF Account No. (with EPFO : MHBAN00451180000192096

2. Name of the Establishment : INDUSIND BANK LIMITED

3. Address of the Establishment : 425,DADASAHEB BHADKA MKAR MARG LAMINGTON ROAD MUMBAI 599

4. PF A/C No. held by : BANDRA(MUMBAI-I)

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 : RAJESH KUMAR GUPTA

10. Date of Birth : 26/01/1988

11. Father's/Spouse Name : SHANKAR PRASAD

12. Relationship : FATHER

13. Date of joining : 28/06/2017

14. Date of leaving : 17/08/2017


PART C : DETAILS OF PRESENT PF

1. PF Account No. (with EPFO : THVSH01185850000031274

2. Name of the Establishment : STAR UNION DAI-ICHI LIFE INSURANCE COMPANY LIMITED

3. Address of the Establishment : 11TH FLR. VISHWAROOP IT PARK,OPP. VASHI RLY STN. NAVI MUMBAI
VASHI MUMBAI SUBURBAN
4. PF A/C No. held by : SRO VASHI

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 : RAJESH KUMAR GUPTA

10. Date of Birth : 26/01/1988

11. Father's/Spouse Name : SHANKAR PRASAD

12. Relationship : FATHER

13. Date of joining : 23/08/2021

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 Previous
Establishment i.e. INDUSIND BANK LIMITED

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