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EPF FORM 11

This document is a declaration form for an employee, Mr. Kanneboina Raju, joining an establishment under the Employees' Provident Fund Scheme, 1952 and Employees' Pension Scheme, 1995. It includes personal details, KYC information, and an undertaking for fund transfer from a previous PF account. The employer is also required to confirm the member's employment details and KYC status for the EPF and EPS schemes.

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Rakeshdontha Srp
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20 views

EPF FORM 11

This document is a declaration form for an employee, Mr. Kanneboina Raju, joining an establishment under the Employees' Provident Fund Scheme, 1952 and Employees' Pension Scheme, 1995. It includes personal details, KYC information, and an undertaking for fund transfer from a previous PF account. The employer is also required to confirm the member's employment details and KYC status for the EPF and EPS schemes.

Uploaded by

Rakeshdontha Srp
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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(To be retained by the Employer for future reference)

EMPLOYEES' PROVIDENT FUND ORGANIZATION


Employees' Provident Funds Scheme, 1952 (Paragraph 34 & 57) &
Employees' Pension Scheme, 1995 (Paragraph 24)
(Declaration by a person taking up employment in an establishment on which EPFS 1952 and/or EPS 1995 is applicable)

1 Name of the Member Mr. Kanneboina Raju

Fathers' Name
2
Spouse's Name Rajaiah

3 Date of Birth (DD/MM/YYYY) 26-06-1992


4 Gender: (Male/Female/Transgender) Male
5 Marital Status(Married/Unmarried/Widow/Widower/Divorcee) Single
(a) Email Id: [email protected]
6
(b) Mobile No.: 9701086911
Present employment details: 10-02-2025
7
Date of joining in the current establishment (DD/MM/YYYY)
KYC Details (attach self attested copies of following KYCs)

a) Bank Account No.: 32509346784


8 b IFS Code of the branch: SBIN0020143
c) AADHAAR Number: 998055295555
d) Permanent Account No. (PAN), if available EGUPK0195L
Whether earlier a member of Employees' Provident Fund Scheme,
9
1952?
Yes/No
10 Whether earlier a member of Employees' Pension Scheme, 1995? Yes/No
Previous employment details [if Yes to 9 &/or 10 above] - Un-exempted
Scheme
Establishment Name & Universal PF Account Date of joining Date of exit PPO Number (if Non Contributory
Certificate No. (if
Address Account Number Number (DD/MM/YYYY) (DD/MM/YYYY) issued) Period (NCP) Days
issued)

11

Previous employment details [if Yes to 9 &/or 10 above] - For Exempted Trusts

Universal Account Member EPS A/c Date of joining Date of exit Scheme Certificate Non Contributory
Name and Address of the Trust
Number Number (DD/MM/YYYY) (DD/MM/YYYY) No. (if issued) Period (NCP) Days

12

a) International Worker: Yes/No


b) If yes, state country of origin
13 (India/Name of other country)
c) Passport No.
d) Validity of passport [(DD/MM/YYYY) to (DD/MM/YYY)]
UNDERTAKING

1. Certified that the particulars are true to the best of my knowledge.


2. I authorize EPFO to use my Aadhaar for verification/authentication/e-KYC purpose for service delivery.
3. Kindly transfer the funds and service details, if applicable, from the previous PF account as declared above to the present PF Account as I
am an Aadhaar verified employee in my previous PF Account *
4. In case of changes in above details, the same will be intimated to employer at the earliest.

Date:
Place: Signature of the Member

DECLARATION BY PRESENT EMPLOYER

A. The member Mr./Ms./Mrs. _________________________________________________________ has joined on ____________________


and has been allotted PF Number ___________________ and UAN ___________________________.

B. In case the person was earlier not a member of EPF Scheme, 1952 and EPS, 1995:

Please Tick the Appropriate Option:

The KYC details of the above member in the UAN database

Have not been uploaded

Have been uploaded but not approved

Have been uploaded and approved with DSC. e-sign

C. In case the person was earlier a member of EPF Scheme, 1952 and EPS, 1995:

Please Tick the Appropriate Option:

The KYC details of the above member in the UAN database have been approved with E-sign/Digital Signature
Certificate and transfer request has been generated on portal.

The previous Account of the member is not Aadhaar verified and hence physical transfer form shall be initiated.

Date: Signature of Employer with Seal of Establishment

* Auto transfer of previous PF account would be possible in respect of Addhaar verified employees only. Other employees to fill physical claim
(Form-13) for transfer of account from pervious establishment.

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