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    FORM 2 (Revised) ::::::: PY/BOM/10088/ (Leave This Blank)

    Uploaded by

    Abhilash
    This document contains nomination forms for employee provident fund (EPF) and pension scheme (EPS) benefits. In Part A (EPF), the employee provides details of nominee(s) to receive the PF balance accrued in the event of the employee's death. In Part B (EPS), the employee lists family members eligible for pension benefits and can also nominate others to receive widow pension if no family exists. The employer certifies that the employee declarations were signed/thumb impressed in their presence and the entries were read and confirmed. Contact information for the employer establishment is also provided.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    FORM 2 (Revised) ::::::: PY/BOM/10088/ (Leave This Blank)

    Uploaded by

    Abhilash
    1K views3 pages
    This document contains nomination forms for employee provident fund (EPF) and pension scheme (EPS) benefits. In Part A (EPF), the employee provides details of nominee(s) to receive the PF balance accrued in the event of the employee's death. In Part B (EPS), the employee lists family members eligible for pension benefits and can also nominate others to receive widow pension if no family exists. The employer certifies that the employee declarations were signed/thumb impressed in their presence and the entries were read and confirmed. Contact information for the employer establishment is also provided.

    Original Title

    PF Nomination Form 2

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    This document contains nomination forms for employee provident fund (EPF) and pension scheme (EPS) benefits. In Part A (EPF), the employee provides details of nominee(s) to receive the PF balance accrued in the event of the employee's death. In Part B (EPS), the employee lists family members eligible for pension benefits and can also nominate others to receive widow pension if no family exists. The employer certifies that the employee declarations were signed/thumb impressed in their presence and the entries were read and confirmed. Contact information for the employer establishment is also provided.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    1K views3 pages

    FORM 2 (Revised) ::::::: PY/BOM/10088/ (Leave This Blank)

    Uploaded by

    Abhilash
    This document contains nomination forms for employee provident fund (EPF) and pension scheme (EPS) benefits. In Part A (EPF), the employee provides details of nominee(s) to receive the PF balance accrued in the event of the employee's death. In Part B (EPS), the employee lists family members eligible for pension benefits and can also nominate others to receive widow pension if no family exists. The employer certifies that the employee declarations were signed/thumb impressed in their presence and the entries were read and confirmed. Contact information for the employer establishment is also provided.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
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    Employee No.

    ___mandatory____________
    FORM 2 (Revised) (Mandatory)

    NOMINATION AND DECLARATION FORM FOR UNEXEMPTED/


    EXEMPTED ESTABLISHMENTS
    Declaration and Nomination Form under the Employees’ Provident Funds and Employees’ Pension Scheme
    (Paragraphs 33 & 61 (1) of the Employees’ Provident Funds Scheme, 1952 and paragraph 18 of the Employees’ Pension Scheme, 1995)

    1 Name (in Block Letters) :


    2 Father’s/Husband’s Name :
    3 Date of Birth :
    4 Sex (Male/Female) :
    5 Marital Status :
    6 Account No. (PF/EPS Number) : PY/BOM/10088/ (leave this blank)

    7 Address (Residential) : Permanent:

    Temporary:

    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:

    Name of Address Nominee’s relation- Date of Total amount of Share of If the nominee is a minor,
    nominee/ ship with the member Birth Accumulations in Provi- name & relationship & address
    Nominees dent Fund to be paid to of the guardian who may
    Each nominee receive the amount during
    The minority of nominee

    1 2 3 4 5 6

    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 cancelled.
    2 * Certified that my father/mother is/are dependent upon me.
    3. * Strike out whichever is not applicable.

    < Employee Signature >


    Signature or thumb impression of the subscriber

    **Strike out whichever is not applicable.

    Part B (EPS) (Para 18)


    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.

    Sl. No. Name of the family Address Date of Birth Relationship with the member
    member

    1 2 3 4 5

    ** Certified that I have no family, as defined in para 2(vii) of 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 persons for receiving the monthly widow pension (admissible under para 16 2(a) (i) and (ii)
    in the event of my death without leaving any eligible family member for receiving Pension.

    Name and Address of the Nominee Date of Birth Relationship with the member

    1 2 3
    1.

    2.

    3.

    4.

    Date:

    Employee signature
    Signature or thumb impression of the subscriber
    **Strike out whichever is not applicable.
    CERTIFICATE BY EMPLOYER

    Certified that the above declaration and nomination has been signed/thumb impressed before me by
    Shri/Smt./Kumari________________________________________________________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.

    Place: ___________________
    Date __________________
    Signature of the Employer or other authorised
    Officer of the establishment

    Designation……………………………………….
    Name and address of the Factory/Establishment

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