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EPF Form-11

Vivek Bhardwaj has started a new job and is filling out a declaration form for his new employer regarding his Employees' Provident Fund and Pension Scheme details. This includes information like his name, father's name, date of birth, gender, marital status, email, mobile number, and whether he was previously enrolled in the provident fund or pension scheme. He is providing his KYC details like bank account, Aadhaar and PAN numbers. He is declaring that he has not previously withdrawn any provident fund or pension amounts. He is authorizing EPFO to use his Aadhaar and is requesting any previous PF amounts be transferred to his new account.

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PulkKit SharMa
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333 views

EPF Form-11

Vivek Bhardwaj has started a new job and is filling out a declaration form for his new employer regarding his Employees' Provident Fund and Pension Scheme details. This includes information like his name, father's name, date of birth, gender, marital status, email, mobile number, and whether he was previously enrolled in the provident fund or pension scheme. He is providing his KYC details like bank account, Aadhaar and PAN numbers. He is declaring that he has not previously withdrawn any provident fund or pension amounts. He is authorizing EPFO to use his Aadhaar and is requesting any previous PF amounts be transferred to his new account.

Uploaded by

PulkKit SharMa
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
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New Form : 11 - Declaration Form

(To be retained by the employer for future reference)

EMPLOYEES' PROVIDENT FUND ORGANISATION


Employees' Provident Fund Scheme, 1952 (Paragraph 34 & 57) and
Employees' Pension Scheme, 1995 (Paragraph 24)
(Declaration by a person taking up Employment in any Establishment on which EPF Scheme, 1952 and for EPS, 1995 is applicable)

1. Name of Member (Aadhar Name) Vivek Bhardwaj


Father's Name Spouse's Name
2. (Please tick whichever applicable) Rajeshwar Dayal
3. Date of Birth (dd/mm/yyyy) 18-01-1996
4. Gender (Male / Female / Transgender) Male
5. Marital Status ? (Single/Married/Widow/Widower/Divorcee) Unmarried
(a) eMail ID [email protected]
6.
(b) Mobile No (Aadhar Registered) 8700464921
Whether earlier member of the Employee's Provident Fund
7. No
Scheme, 1952 ?
Whether earlier member of the Employee's Pension
8. No
Scheme, 1995 ?
Previous Employment details ? (If Yes, 7 & 8 details above)
a) Universal Account Number (UAN)
b) Previous PF Account Number
9.
c) Date of Exit from previous Employment ? (dd/mm/yyyy)
d) Scheme Certificate No (If issued)
e) Pension Payment Order (PPO) (If issued)
a) International Worker Yes / No
b) If Yes, state country of origin (name of other country)
10.
c) Passport No.
d) Validity of passport (dd/mm/yyyy) to (dd/mm/yyyy)
KYC Details : (attach self attested copies of following KYC's) Must Enclose Scan copy for the following documents

a) Bank Account No. & IFS Code A/c No - 36268062625 IFSC- SBIN0016201
11.
b) AADHAR Number 2246-0010-2784
c) Permanent Account Number (PAN), If available CIKPB7807G
After Sep 2014 earned EPS
First EPF Member First Employment EPF Are you EPF Member If Yes, EPF Amount If Yes, EPS (Pension)
(Pension) Amount Withdrawn
Enrolled Date Wages before 01/09/2014 Withdrawn? Amount Withdrawn?
12. before Join current Employer?

No No No No

UNDERTAKING
1) Certified that the particulars are true to the best of my knowledge
2) I authorise EPFO to use my Aadhar for verification / authentication / eKYC purpose for service delivery
3) Kindly transfer the fund and service details, if applicable, from the previous PF account as declared above to the present PF account.
(The transfer would be possible only if the identified KYC details approved by previous employer has been verified by present employer using his Digital Signature
4) In case of changes in above details, the same will be intimated to employer at the earliest.

Date : 11-02-2022
Place : Delhi Signature of Member

DECLARATION BY PRESENT EMPLOYER


A. The member Mr./Ms./Mrs. ……………..…………………….. Has joined on ……………………….and has een alloted PF Number ……….……..

B. In case the person was earlier not a member of EPF Scheme, 1952 and EPS, 1995: ((Post allotment of UAN) The UAN alloted or the member is)
Please Tick the Appropriate Option : The KYC details of the above member in the JAN database
Have not been uploaded Have been uploaded but not approved Have been uploaded and approved with DSC

C. In case the person was earlier a member of EPF Scheme, 1952 and EPS 1995;
The KYC details of the above member in the UAN database have been approved with Digital Signature Certificate and transfer request has
been generated on portal
As the DSC of establishment are not registered with EPFO, the member has been informed to file physical claim (Form-13) for transfer of funds from his previous
establishment.

Date : Signate of Employer with Seal of Establishment

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