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EPF Online Transfer Claim Form

This document is an Online Transfer Claim Form for the Provident Fund balance of Debasis Sahu, requesting the transfer of funds from a previous account at ETV Bharat to a current account at ICICI Bank. It includes personal details, previous and current PF account information, and certifies the accuracy of the provided information. The form must be printed and submitted to the current employer, ICICI Bank.

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22 views2 pages

EPF Online Transfer Claim Form

This document is an Online Transfer Claim Form for the Provident Fund balance of Debasis Sahu, requesting the transfer of funds from a previous account at ETV Bharat to a current account at ICICI Bank. It includes personal details, previous and current PF account information, and certifies the accuracy of the provided information. The form must be printed and submitted to the current employer, ICICI Bank.

Uploaded by

sajida.begum.sahir
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

ONLINE TRANSFER CLAIM FORM [FORM 13 (REVISED) ]

( Tracking ID: 10144397040805001 )


Claim Date : 26/09/2022
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,
HYDERABAD,
Bhavishyanidhi Bhawan, No. 3-4-763, Barkatpura Chaman, Hyderabad

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 : DEBASIS SAHU

2. Mobile Number : 7735566129

3. E-mail id : [email protected]

4. Bank Account Number : 19120110017456

5. Bank IFSC : UCBA0001912

PART B : DETAILS OF PREVIOUS PF ACCOUNTS (WHICH IS TO BE TRANSFERRED)

1. PF Account No. (with EPFO : APHYD16364660000012600

2. Name of the Establishment : ETV BHARAT (A DIVISION OF USHODAYA ENTERPRISES PRIVATE LIMITED)

3. Address of the Establishment : SP2 BUILDING , 4TH FLOOR, RAMOJI FILM CITY, ANAJPUR HYDERABAD
618
4. PF A/C No. held by : HYDERABAD

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 : DEBASIS SAHU

10. Date of Birth : 05/04/1996

11. Father's/Spouse Name : DASARATHI SAHU

12. Relationship : FATHER

13. Date of joining : 01/04/2019

14. Date of leaving : 21/05/2022


PART C : DETAILS OF PRESENT PF

1. PF Account No. (with EPFO : MHBAN00187960005521232

2. Name of the Establishment : ICICI BANK

3. Address of the Establishment : ICICI TOWER BANDRA KURLA COMPLEX BANDRA EAST, MUMBAI 598

4. PF A/C No. held by : TRUST

5. Name of the Trust : ICICI BANK LTD. PROVIDENT FUND

6. PF A/C No. in Trust : 101443970408

7. Bank A/C No. of Trust : 000401121201


8. IFS Code of the Bank Branch of
Trust where account is : ICIC0000004

9. Member's Name : DEBASIS SAHU

10. Date of Birth : 05/04/1996

11. Father's/Spouse Name : DASARATHI SAHU

12. Relationship : FATHER

13. Date of joining : 09/05/2022

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. ICICI BANK

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