1 Name of the member Yeligeru varabasava
2 Father's Name S thippanna
Husband's Name NA
3 Date of Birth: (DD/MM/YYYY) 07-06-1999
4 Gender: (Male/Female/Transgender) MALE
5 Marital Status (Married/Unmarried/Widow/Widower/Divorcee) Unmarried
6 (a) Email ID:
[email protected] (b) Mobile No.: 8106833785
7 Present employment details: 13-04-2024
Date of Joining in the current establishment (DD/MM/YYYY)
8 KYC Details (attach self attested copies of following KYCs) 50100476257311
a) Bank Account No. :
b) IFS Code of the branch: HDFC0000833
c) Aadhaar Number 504380567619
d) Permanent Account Number (PAN), if available BWHPV7233A
9 Whether earlier a member of Employees' Provident Fund YES
Scheme, 1952 (Yes/No)
Whether earlier a member of Employees' Pension Scheme, YES
10
1995 (Yes/No)
11 Previous employment details: (If Yes to 9 AND/OR 10 above] Un-exempted
Establishment Name nobroker
Establishment Address NA
Universal Account Number (UAN) 101472931156
PF Account Number PYBOM13654820000034253
Date of Joining (DD/MM/YYYY)
Date of Exit (DD/MM/YYYY)
Scheme Certificate No. (if issued)
PPO Number (if issued)
Non-Contributory Period (NCP) Days
12 Previous employment details: [if Yes to 9 AND/OR 10 above] - For Exempted Trusts
Name of the Trust
Address of the Trust
Universal Account Number (UAN)
Member EPS A/c Number
Date of Joining (DD/MM/YYYY)
Date of Exit (DD/MM/YYYY)
Scheme Certificate No. (if Issued)
Non-Contributory Period (NCP) Days
13 a) International Worker (Yes/No.)
b) If yes, State Country or Origin (India/Name of other Country)
c) Passport No.
d) Validity of Passport From (DD/MM/YYYY)
To (DD/MM/YYYY)
UNDERTAKING
1) Certified that the particulars are true to the best of my knowledge.
2) I authorise EPFO to use my Aadhaar for verification/authentication/eKYC purpose for service delivery
Kindly transfer the funds and service details, if applicable, from the previous PF account as declared above to the present P.F. Account
3)
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: 13-04-2024 Yeligeru varabasava
Place: holagunda Signature of Member
DECLARATION BY PRESENT EMPLOYER
A The member Mr./Ms./Mrs. has joined on and has been
allotted PF No. 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 no 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.
[ ] he 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 Aadhaar verified employees only. Other
employees are requested to file physical claim (Form - 13) for transfer of account from the previous establishment.
