5. No revenue stamp (Re.1/-) is required to be affixed by member. 6. Kindly sign in place of member signature.

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1 INSTRUCTIONS FOR FILLING COMPOSITE PF FORM (AADHAAR) PF/EPS WITHDRAWAL 1. Please note this claim form is applicable only if member's complete details as per the new Form 11, Aadhaar number and bank account number details have been made available in UAN portal and the UAN account is also active. 2. Employer attestation is required in this form. 3. Please refer to point 1 and put a tick on the type of withdrawal you are applying (PF/PENSION/PARTIAL WITHDRAWAL). 4. If you are withdrawing your PF and EPS please fill in point 8 with your PAN card number and attach Form 15G/Form 15H if applicable. 5. Please fill in your full postal address in point Kindly sign in place of member signature. 7. No revenue stamp (Re.1/-) is required to be affixed by member. 8. Income Tax (TDS) is deducted if the service is less than 5 years (60 months). No Income Tax (TDS) is deducted in case the total balance is less than Rs. 50,000/-. However, TDS is if the member submits PAN in such cases. In case PAN is not submitted, then is deducted. 9. The total service in the present establishment as well as previous establishment is counted and, therefore, it is advisable to merge all PF accounts. 10. Pension Withdrawal benefits can be availed only if the service is less than 10 years. INSTRUCTIONS FOR FILLING COMPOSITE PF FORM (AADHAAR) PARTIAL WITHDRAWAL 1. Please note this claim form is applicable only if member's complete details as per the new Form 11, Aadhaar number and bank account number details have been made available in UAN portal and the UAN account is also active. 2. Employer attestation is not required in this form. 3. Please refer to point 1 and put a tick on the type of withdrawal you are applying (PF/PENSION/PARTIAL WITHDRAWAL). 4. Purpose of advance documents required: (The purpose may be one of the following): i) Housing Loan/Purchase of site/house/flat or for construction/addition alteration in existing house/repayment of Housing loan: No document is required. New Declaration Form/Utilization Certificate required earlier has been discontinued. ii) Illness of member/family: i) Certificate of doctor and ii ) Certificate by employer that ESIC facility is not available to the member may be submitted by the member. iii) Marriage of self/son/daughter/brother/sister: No document/marriage Card is required. iv) Post Matriculation education of children: No document is required. v) Lockout or closure of factory/cut in supply of electricity: No document is required vi) Natural calamity: No document is required. vii) Purchasing equipment by physically handicapped: Medical certificate is required. viii) One year before retirement: 90% of total PF balance can be withdrawn. No document is required ix) Investment in Varistha Pension Bima Yojana: 90% of total PF balance can be transferred to LIC. No document is required. 5. No revenue stamp (Re.1/-) is required to be affixed by member. 6. Kindly sign in place of member signature.

2 CHECKLIST FOR PF AND EPS To be submitted by a member to withdraw his Provident Fund dues on leaving service/retirement/termination. Sl. No. Particulars Yes/ No 1. Name of the Member as per cancel cheque 2. Match the Name in the Form & on the cheque Cancelled cheque has member's printed Name 3. Date of Leaving Service (should not be default Date) 4. Date of Leaving Service (should not be default Date) Xerox copy of Bank passbook atached 5. Cancelled cheque should be of single A/c 6. 1 Employee Signature on the Form 7. DOB (Certfcate of Children below 25 years) 8. Family partculars (Spouse/ children below 25 years) 9. Copy of PAN 10. Copy of Aadhaar 11. Data Correcton leter

3 CHECKLIST FOR PARTIAL WITHDRAWAL For the use of Provident Fund members to avail advances / withdrawals as provided in the scheme. Sl. No. Particulars Yes/ No 1. Name of the Member 2. Date of Birth 3. Match the Name in the Form & on the cheque Cancelled cheque has member's printed Name 4. Cancelled cheque should be of single A/c 5. One signature of Employee 6. Copy of PAN 7. Copy of Aadhaar 8. Data Correcton leter

4 Joint Declaration By the Member and The Employer Date : To The Regional Provident Fund Commissioner Sub: Joint declaration by the member and the employer for Correction of member details Dear Sir, I, am an employee of furnishing below herewith correct details with aforesaid establishment :- Particulars Already Furnished To be Corrected Name Father/ Husband Name PF / EPS Account No. Date of Birth (DD/MM/YYYY). Date of joining (DD/MM/YYYY) Date of leaving (DD/MM/YYYY) I am also enclosing herewith self-attested copy of ID proof (Pan Card) for your ready reference. Therefore, you are requested to make necessary changes in your records (if required) under intimation to me. An early action in this regard will be highly appreciated. Yours Faithfully Name & Signature of Applicant : Name of Authorized Signatory : Signature With Establishment Seal :

5 EMPLOYEES' PROVIDENT FUND ORGANISATION COMPOSITE CLAIM FORM (NON-AADHAAR) Mobile No. [FORM NO. 19(PF FINAL SETTLEMENT) / 10C(PENSION WITHDRAWAL BENIFITS) / 31(PF PART WITHDRAWAL)] 1. Claim applied for: i) Final PF Settlement ii) Pension Withdrawal Benifits iii) PF PART WITHDRAWALS (Tick Whichever is/are applicable) 2. Name of the member :(IN CAPITAL LETTERS) 3. (a) Universal Account No (UAN) (b) PF Account No.(In case of UAN not avilable) 4. (a) Father's Name (b) Husband's Name 5. Aadhaar Number:(For Seeding) 6. Date of Birth: Date of Joining the establishment: (a) Purpose of PF PART Withdrawals: (Tick whichever applicable) (b) Amount (in Rs.) : /- (c) For purpose of site/house/flat or construction through 'agency' or repayment of Housing loan or LIC, indicate cheque to be drawn 'in favour off' and payee's address SN Purpose of Part Withdrawals Tick I Housing loan/purchase of site/house/flat or for construction/addition,alteration in existing house /Repayment of housing Loan(Para 68B/ 68BB/68BC) II Lockout or closure of factory(para 68H) III Illness of member/family (Para 68J) IV Marrige of self/son/daughter/brother/sister (Para68K) V Post Matriculation Education of children (Para68K) VI Natural Calamity(Para 68L) VII Cut in Electricity in Establishment(Para 68M) VIII Purchasing Equipment by physically handicaped (Para 68N) IX One year before retirement(para 68NN) X Investment in Varistha Pension Bima Yojona (Para 68NNN) 9. Date of Leaving Service:(Not required if applying for PF part withdrawal) 10. (a) Permanent Account No(PAN): (Only in case of service less than 5 years) (Please enclose 2 copies of Form no 15G/15H,if applicable) (b) Reason of Leaving Service: - Service terminated on account of (a) ill health of member (b) Contraction/Discontinuation of employer's buisness or (c) other cause beyond the control of member. - Personal Reasons 11. Full Postal Address 12. Bank Account Details for Payment Saving Bank Account no. : Please attach a copy of cancelled cheque/attested copy of first page of pass book Name & Address of the Bank: IFS Code : -The number hereby declares that he has not been employed for two months ( Yes/No.) -Certified that the particulars are to the best of my knowldge. -In case the amount is used for any purpose other than stated in column (10) above, I am liable to return the entire amount with penal interest. Member's Signature Employer's signature Designation & Seal of Employer