ONLINE TRANSFER CLAIM FORM [FORM 13 (REVISED) ]
( Tracking ID: 10157808950705001 )
Claim Date : 18/10/2024
EMPLOYEES' PROVIDENT FUND SCHEME, 1952
(PARA 57)
(This form has been printed on the basis of Online Transfer Claim Form filled up by the member under Unified Portal for submission to the
employer.)
To,
The Regional P.F. Commissioner,
VARANASI,
Bhahvishyanidhi Bhawan, Ashok Vihar-1, Pahariya, Varanasi
Sir,
I request that my Provident Fund balance along with my Pension Service Details may please be transferred to my present
account under intimation to me. My details are as under :
PART A : PERSONAL
1. Name : MUKESH SHAI
2. Mobile Number : 9628043994
3. E-mail id : [email protected]
4. Bank Account Number : 28490100008264
5. Bank IFSC : BARB0RAMNBS
PART B : DETAILS OF PREVIOUS PF ACCOUNTS (WHICH IS TO BE TRANSFERRED)
1. PF Account No. (with EPFO : UPVNS00339810000003761
2. Name of the Establishment : U P POORVA SANIK KALAYAN NIGAM LIMITED,KHAJURI,VARANASI.
3. Address of the Establishment : S-8/114-49,INDRA NAGAR KHAJURI VARANASI 291
4. PF A/C No. held by : VARANASI
5. Name of the Trust : NOT APPLICABLE
6. PF A/C No. in Trust : NOT APPLICABLE
7. Bank A/C No. of Trust : NOT APPLICABLE
8. IFS Code of the Bank Branch of
Trust where account is : NOT APPLICABLE
9. Member's Name : MUKESH SHAI
10. Date of Birth : 15/08/1969
11. Father's/Spouse Name : VIJAY BAHADUR SHAHI
12. Relationship : FATHER
13. Date of joining : 01/12/2014
14. Date of leaving : 31/01/2020
PART C : DETAILS OF PRESENT PF
1. PF Account No. (with EPFO : KDMAL02124720000057019
2. Name of the Establishment : PRINCIPLE SECURITY AND ALLIED SERVICES PRIVATE LIMITED
3. Address of the Establishment : 707, HUBTOWN VIVA, SHANKAR WADI, WESTERN EXPRESS HIGHWAY,
JOGESHWARI EAST MUMBAI SUBURBAN
4. PF A/C No. held by : RO MALAD (KANDIVALI)
5. Name of the Trust : NOT APPLICABLE
6. PF A/C No. in Trust : NOT APPLICABLE
7. Bank A/C No. of Trust : NOT APPLICABLE
8. IFS Code of the Bank Branch of
Trust where account is : NOT APPLICABLE
9. Member's Name : MUKESH SHAI
10. Date of Birth : 15/08/1969
11. Father's/Spouse Name : VIJAY BAHADOOR SHAHI
12. Relationship : FATHER
13. Date of joining : 01/07/2022
I, Certify that all the information given above are true to the best of my knowledge and I have ensured the correctness of
my present and previous account numbers.
Signature of the member
Note : Member should take a printout of this form and a signed copy of the same should be submitted to the Present
Establishment i.e. PRINCIPLE SECURITY AND ALLIED SERVICES PRIVATE LIMITED
