www.epfindia.gov.
in
Composite Declaration Form-11
(To be retained by the employer for future reference)
EMPLOYEES’ PROVIDENT FUND ORGANISATION
Employees’ Provident Funds Scheme, 1952 (Paragraph 34 & 57) &
Employees’ Pension Scheme, 1995 (Paragraph 24)
(Declaration by a person taking up employment in any establishment on which EPF Scheme, 1952 and / or EPS, 1995 is applicable)
1 Name Bhattala Dilip Reddy
Father's Name B Venkata reddy
2
Spouse's Name L Mounika Reddy
3 Date of Birth :(DD/MM/YYYY) 10/06/1997
4 Gender :(Male/Female/Transgender) Male
Marital married
5 Status :(Married/Unmarried/Widow/Divorcee)
(a) Email ID :
[email protected]6
(b) Mobile No : 8095994933
Present employment details: 13/02/2023
7 Date of joining in the current
establishment(DD/MM/YYYY) Itilite technologies pvt ltd
KYC Details: (attach self-attested copies of following KYC's)
a) Bank Account No. : 023201517462
b) IFSC Code of the branch : ICIC0000232
8 Employee Name as per Bank : Bhattala Dilip Reddy
c) AADHAR Number 236870125130
Employee Name as per Aadhar : Bhattala Dilip Reddy
d) Permanent Account Number (PAN), if available CLRPD6391M
Employee Name as per PAN : B DILIP REDDY
Whether earlier a member of Employee’s Provident yes Yes/No
9
Fund Scheme, 1952
Whether earlier a member of employee’s Pension yes Yes/No
10
Scheme, 1995
Previous employment details: [if Yes to 9 AND/OR 10 above] -- Un-exempted
Establishment Universal EPF Date of Joining : Date of Scheme PPO N
Name & Account Account (DD/MM/YYYY) Exit :(DD/MM/YYYY) Certificate Number Contr
Address Number Number No. (if (if Pe
issued) issued) (NCP
11
Itilite 101343160 BGBNG 13/02/2023 10/05/2024
technologies pvt 445 17404420
ltd, bangalore 00
Previous employment details: [if Yes to 9 AND/OR 10 above] – For Exempted Trusts
Name & Member Date of Joining Date of Exit Scheme Non
Address of UAN EPS A/c (DD/MM/YYYY) (DD/MM/YYYY) Certificate Contributory
the Trust Number No. (if Period (NCP)
issued) Days
12
13 a) International Worker Yes / No
b) If Yes, state country of origin (India / Name of the Country
c) Passport No.
d) Validity of Passport [(DD/MM/YYYY) to (DD/MM/YYYY)]
14 Qualification
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 not approved
Have been uploaded and approved with DSC/e-Sign
C. 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 been approved with E-
Sign/Digital Signature Certificate and tranfer request has been genereated on portal.
The previous Account of the member is not Aadhar Verified and hence physical trasnfer form
shall be intiatied.
Date : Signature of Employer with Seal of the
Establishment
*Auto transfer of previous PF account would be possible in respect of Aadhar verified employees only. Other employees
are requested to file physical claim (Form-13) for transfer of account from the previous establishment.
