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Composite Declaration Form Form -11
(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

Fathers' Name

2
Spouse's Name

3 Date of Birth (DD/MM/YYYY)

4 Gender: (Male/Female/Transgender)

5 Marital Status(Married/Unmarried/Widow/Widower/Divorcee)

(a) Email Id:

6
(b) Mobile No.:

Present employment details:

7
Date of joining in the current establishment (DD/MM/YYYY)

KYC Details (attach self attested copies of following KYCs)

a) Bank Account No.:

b IFS Code of the branch:

8

c) AADHAAR Number:

d) Permanent Account No. (PAN), if available

Whether earlier a member of Employees' Provident Fund

9
Scheme, 1952 ?
Yes No

Whether earlier a member of Employees' Pension Scheme,

10
1995 ? Yes No
 Previous employment details [if Yes to 9 &/or 10 above] - Un-exempted
Non
Scheme Contri-
Universal PF Date of PPO
Date of exit Certificate butory
Establishment Name & Address Account Account joining Number (if
(DD/MM/YYYY) No. (if Period
Number Number (DD/MM/YYYY) issued)
issued) (NCP)
Days
11

Previous employment details [if Yes to 9 &/or 10 above] - For Exempted Trusts
Non
Scheme Contri-
Universal Date of
PF Account Date of exit Certificate butory
Establishment Name & Address Account joining
Number (DD/MM/YYYY) No. (if Period
Number (DD/MM/YYYY)
issued) (NCP)
Days
12

a) International Worker: Yes No

b) If yes, state country of origin

(India/Name of other country)

13
c) Passport No.

Validity of
passport
d) [(DD/MM/YYYY) From To
to
(DD/MM/YYYY)]

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/eKYC 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.