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    Form 2 PDF

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    Satish Sati
    This document is a nomination and declaration form for employees' provident fund and pension schemes. It contains fields for an employee to provide their personal details like name, date of birth, account number, and addresses. It also allows the employee to nominate individuals to receive the funds standing to their credit in the provident fund in the event of their death. Additionally, it requests information about family members who would be eligible for widow or children's pension upon the employee's death. The form must be signed by the employee and certified by an authorized employer representative.

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    Download as PDF, TXT or read online from Scribd

    Form 2 PDF

    Uploaded by

    Satish Sati
    70 views2 pages
    This document is a nomination and declaration form for employees' provident fund and pension schemes. It contains fields for an employee to provide their personal details like name, date of birth, account number, and addresses. It also allows the employee to nominate individuals to receive the funds standing to their credit in the provident fund in the event of their death. Additionally, it requests information about family members who would be eligible for widow or children's pension upon the employee's death. The form must be signed by the employee and certified by an authorized employer representative.

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    Form 2.pdf

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    This document is a nomination and declaration form for employees' provident fund and pension schemes. It contains fields for an employee to provide their personal details like name, date of birth, account number, and addresses. It also allows the employee to nominate individuals to receive the funds standing to their credit in the provident fund in the event of their death. Additionally, it requests information about family members who would be eligible for widow or children's pension upon the employee's death. The form must be signed by the employee and certified by an authorized employer representative.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    70 views2 pages

    Form 2 PDF

    Uploaded by

    Satish Sati
    This document is a nomination and declaration form for employees' provident fund and pension schemes. It contains fields for an employee to provide their personal details like name, date of birth, account number, and addresses. It also allows the employee to nominate individuals to receive the funds standing to their credit in the provident fund in the event of their death. Additionally, it requests information about family members who would be eligible for widow or children's pension upon the employee's death. The form must be signed by the employee and certified by an authorized employer representative.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    FIRSTSOURCE SOLUTIONS LIMITED

    NOMINATION AND DECLARATION FORM FOR UNEXEMPTED / EXEMPTED ESTABLISHMENTS

    Declaration and Nomination Form under the Employees’ Provident Fund


    Date of Appointment : (Paragraph 33 and 61 (1) of the Employees’ Provident Fund Scheme, 1952 and
    paragraph 18 of the Employees’ Pension Scheme, 1995) and Employee’
    FORM 2 (REVISED)
    Pension Scheme

    1. Name : Father/Husbands name Surname: .

    2. Date of Birth: 3. Account NO: MH/46430

    4. Sex: 5. Marital Status:

    6. Permanent Address:

    7. Temporary Address:

    PART - A (EPF)
    I hereby nominate the person (s) / cancel the nomination made by me previously and nominate the person (s), mentioned below to
    receive the amount standing to my credit in the Employees’ Provident Fund, in the event of my death.

    Total amount or Share if the nominee is minor, name


    Nominee’s
    Name & address of the Nominee of accumulations in P.F relationship & address of the guardian
    relationship with the Date of Birth
    (s) To be paid to each who may receive the amount during the
    member
    nominee minority of nominee

    1. * Certified that I have no family as defined in Para 2 (g) of the Employees’ Provident Funds scheme, 1952 and should I
    acquire a family hereafter the above nomination should be deemed as cancel.

    2. * Certified that my father / mother / is / are dependent upon me.

    *Strike out which is not applicable.

    EMP. NO.
    Signature or thumb impression of the subscriber
    PART - B (EPF)
    I hereby Furnish below particulars of the members of my family who would be eligible to receive Widow/ Children Pension in the
    event of my death.

    Sr. No Name & address of the Family Member/s Date of Birth Relationship with Member

    ** Certified that I have no family as defined in Para 2 (vil) of the Employees’ Pension Scheme, 1995 and should I acquire a family
    hereafter I shall furnish particulars thereon in the above form.
    I hereby nominate the following person for receiving the monthly widow pension (admissible under para 16 (2) (a) (I)& (ii) in the
    event of my death Without leaving any eligible family member/s for receiving pension.

    Sr. No Name & address of the Family Member/s Date of Birth Relationship with Member

    Date :

    ** Strike out which is not applicable.


    Signature of the employee of the subscriber

    CERTIFICATE BY EMPLOYER
    Certified that the above declaration and nomination had been signed / thumb impressed before me by
    ___________________________________. employed in my establishment after he/she has read the entries / the entries have
    been read over to him/her by me and got confirmed by him/her.

    for FIRSTSOURCE SOLUTIONS LIMITED

    Authorised Signatory
    Place:
    Date:
    for FIRSTSOURCE SOLUTIONS LIMITED
    5th Floor, Paradigm'B' wing, Mindspace, Link
    Road, Malad (West), Mumbai 400 064.

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