JOINT OPTION FORM UNDER ERSTWHILE PARA 11(3) & PARA 11(4) OF EMPLOYEES’ PENSION SCHEME 1995

Date:___________________
To

The Regional Provident Fund Commissioner,

Employees Provident Fund Organization,

___________________________________

___________________________________

___________________________________

Sub.: Submission of Joint option under Para 11(3) and Para 11(4) of Employees’ Pension Scheme, 1995 based upon the
Hon’ble Supreme Court’s Judgement in C.A. No. 008143 - 008144 / 2022 titled “EPFO vs. SUNIL KUMAR”
pronounced on 04-11-2022.

Sir,

Your kind attention is invited towards Para 43 and Para 44 (iv) of the aforesaid judgement dated 04-11-2022 of
Hon’ble Supreme Court of India, in the above cited Civil Appeal wherein the eligible employee and his /her employer are
required to submit a joint option under erstwhile Para 11(3) & para 11(4) of the EPS’95 within a period of 4 months from the
date of judgement.

Since no format for the Joint Option has yet been provided by EPFO (also not available on EPFO’s website), based on
similar formats issued by various ROs/EPFO in the years 2017 & 2018 while implementing the RC Gupta judgement; in order
to comply with the above requirement, we (employee and employer) are, hereby submitting the joint option form as required
under erstwhile Para 11(3) & Para 11(4) of Employees’ Pension Scheme-1995 for claiming pension on actual salary/wages
instead of ceiling salary limit of Rs. 15,000/-.

My particulars (retired employee) are as under:

1. Name & designation of Retired

employee
2. Father’s name / Spouse’s Name
3. Date of Birth

4. EPF A/C No.

5. PPO No.

6. UAN Number (if applicable)

7. Aadhaar No.
8. Mobile No.
9. Date of retirement (on attaining 58 /60
years) /Date of Voluntary retirement
(at the age of _______years)
10. E-mail address

11. Residential Address

Contd…………2
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DECLARATION BY RETIREE

It is certified that immediately after joining ________________________________________________________, I

had been contributing towards the Provident Fund on my actual salary/wages and an equal amount used to be contributed
in my PF by the employer also as provided under Para 26(6) of EPF Scheme, 1952. It is to further certify that an amount
@8.33% of the statutory ceiling limit i.e. (earlier Rs. 5,000 / 6,500 and Rs.15,000/- w.e.f. 01.09.2014) out of the Employer’s
contribution had been remitted by my employer every month towards Employees’ Pension Scheme, 1995 since 16-11-1995
onwards.

Since I have already withdrawn the entire amount of Provident Fund on my retirement on attaining the age of
superannuation / voluntary retirement, I undertake to return the due differential amount that I had withdrawn after my
retirement/voluntary retirement /exit i.e., the difference between the amount @8.33% of my actual salary/wages out of
employer’s contribution towards Pension Fund and the amount already remitted by the employer in EPS’95 on ceiling
salary/wages from the date of joining the EPS’95 till my attaining the age of 58 /60 / _____ years with due interest for claiming
my eligibility for drawing Pension on the basis of actual salary/wages instead of on ceiling salary/wages in accordance with
the aforesaid judgement.

I retired on attaining age of 58 years for the purpose of EPS-1995 / 60 years (on my opting for deferred pension) /
______years (on my taking voluntary retirement), after 01-09-2014 i.e., on _______________. In case there is any different
format for submission of joint option, a copy of the same may be provided to me and I am ready to submit the same once
again.

Place: ________________ Signature: __________________________

Date: ________________ Name: _____________________________
Employee No._____________________
Address: __________________________________
__________________________________
__________________________________

UNDERTAKING BY THE EMPLOYER

I,________________________________________________________________________________________
(Name and Designation) being the authorized signatory on behalf of ______________________________________________,
do hereby certify that Shri/Mrs./Miss________________________________________________ was working with us as
______________________________________ and has retired / voluntarily retired on attaining age of 58 /60 years
/______years on ________________. His/her EPF A/c No. was ____________________________________. He/she had been
contributing towards Provident Fund on his/her actual salary/wages, as per the terms of Para 26(6) of the EPF Scheme 1952.
Equal share had been contributed by this establishment too. This establishment has no objection if he/she deposits/returns
the due differential amount @ 8.33% of the employer’s share w.e.f. 16-11-1995 i.e. from the date of commencement of the
Scheme or when his/her salary/wages exceeded the statutory limit, along with due interest as declared under EPF Scheme,
1952 from time to time, thus making him/her eligible for drawing pension on the basis of Pensionable salary based on his/her
actual salary/wages, instead of on the statutory limit as per erstwhile Para 11(3) & Para 11(4) of the EPS’95 Scheme as
permitted to do so by the aforesaid judgement of Supreme Court dated 04-11-2022.

I certify that the particulars furnished above are correct as per the available record.

Place: __________________

Date: ___________________

(Signature of authorized signatory with official seal)