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Form19 Revised

Form 19 is good project work

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slv.susuday
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1K views1 page

Form19 Revised

Form 19 is good project work

Uploaded by

slv.susuday
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

Date:

The Trustees,
Infosys Limited Employees’ Provident Fund Trust,
C/o. Infosys Limited
Plot No. 44, Electronics City, Hosur Road,
Bangalore - 560 100.

Dear Sir,

I would like to withdraw the amount in my Provident Fund Account with you.

I hereby declare that I have not been employed in any establishment which is covered under the EPF
Scheme. The brief particulars of my employment with Infosys Limited are given below:

1. Employee Number :
2. Name in full :
3. Father’s Name :
4. Permanent Address :

5. Date of joining :
6. Date of Leaving :
7. Provident Fund A/c No. :
8. Reason for Leaving : □ Moved out of India
□ Taken Break for studies
□ Having own business
□ Any other reason (specify below)

9. Savings Bank A/c No. :


10. IFSC Code :
11. Name of the Bank & Branch address :

Signature of the employee

Certificate by Employer

The above particulars are correct. Please settle the Provident Fund Account.

Date: Authorised Signatory

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