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EPF and EPS Nomination Form Guide

This document contains Alima Elyas Shaikh's declaration and nomination forms under the Employees' Provident Fund Scheme and Employees' Pension Scheme. [1] She nominates her sister Raziya Khaja Kamarshah to receive the full amount standing in her EPF account in the event of her death. [2] Under the EPS, she certifies having no eligible family members for a pension and nominates her sister to receive any widow pension. [3] The forms are submitted digitally without a physical signature on August 31, 2021.

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shubham chutke
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235 views2 pages

EPF and EPS Nomination Form Guide

This document contains Alima Elyas Shaikh's declaration and nomination forms under the Employees' Provident Fund Scheme and Employees' Pension Scheme. [1] She nominates her sister Raziya Khaja Kamarshah to receive the full amount standing in her EPF account in the event of her death. [2] Under the EPS, she certifies having no eligible family members for a pension and nominates her sister to receive any widow pension. [3] The forms are submitted digitally without a physical signature on August 31, 2021.

Uploaded by

shubham chutke
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

The Employees' Pension Scheme,

FORM 2
EMPLOYEES' PROVIDENT FUNDS SCHEME, 1952
[Paragraphs 33 AND 61(1)]
EMPLOYEES' PENSION SCHEME, 1995
[Paragraphs 18]

DECLARATION AND NOMINATION FORM UNDER THE EMPLOYEES' PROVIDENT FUNDS


SCHEME AND EMPLOYEES' PENSION SCHEME

1. UAN : 101373929657
2. Name (in block letters) : ALIMA ELYAS SHAIKH
3. Father's / Husband's Name : ELYAS SHAIKH
4. Date of Birth : 21/04/1986
5. Gender : FEMALE
6. Marital Status : MARRIED

7. Address (Permanent) : b/701 STAR TOWER, NEAR SITARA BAKERY, NALASOPARA, PALGHAR,
MAHARASHTRA, 401209
8. Address (Temporary) : b/701 STAR TOWER, NEAR SITARA BAKERY, NALASOPARA, PALGHAR,
MAHARASHTRA, 401209
9. (A) Date of Joining of EPF Scheme, : 01/10/2018
(B) Date of Joining of EPF Scheme, : --
(C) Date of Joining of EPF Scheme, : 01/10/2018

PART A (EPF)
I hereby nominate person(s) / cancel the nomination made by me previously and nominate the person
(s) mentioned below to receive the amount standing to my credit in the Employees' Provident Fund, in the

If the Nominee is
Total amount or minor, name and
Nominees's share of relationship and
Name of the
relationship with accumulations in address of the
Nominee / Nominees Address Date of Birth
the Member Provident Fund to guardian who may
be paid to each receive the amont
nominee during the minority of
nominee
(1) (2) (3) (4) (5) (6)

B/101 SAI PRERNA SISTER 27/10/1984 100% --


APT, NEAR LAXMI
RAZIYA KHAJA
NAGAR, NALASOPARA,
KAMARSHAH
THANE,
AADHAAR: XXXX
MAHARASHTRA,
XXXX 9288
401209
Bank A/c:
01710010002XXXX
IFSC:
BACB0000017

1. *Certified that I have no family as defined in Para 2(g) of the Employees' Provident Funds Scheme, 1952 and should I
acquire a family hereafter the above nomination should be deemed as cancelled.

2. *Certified that my father/mother is/are dependant upon me.

(Signature is not required as the document is to be digitally signed)


The Employees' Pension Scheme,

PART B (EPS)
(Para 18)

I hereby furnish below particulars of the members of my family who would be eligible to receive
widow / children pension in the event of my death:

Relationship with
Sl. No. Name of the Family members Address Date of Birth
the member
(1) (2) (3) (4) (5)

1 -- -- --
--

*Certified that I have no family as defined in Para 2(vii) of the Employees' Pension Scheme, 1995 and
should I acquire a family hereafter I shall furnish particulars thereon in the above form.

I hereby nominate the following person for receiving the monthly widow pension admissible under
para 16(2)(a)(i) and (ii) in the event of my death without leaving any eligible family member for receiving

Relationship with the member


Name and Address of the Nominee Date of Birth

RAZIYA KHAJA KAMARSHAH 27/10/1984 SISTER


AADHAAR: XXXX XXXX 9288
Bank A/c: 01710010002XXXX
IFSC: BACB0000017

Date : 31-Aug-2021

(Signature is not required as the document is to be digitally signed)

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