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    Beneficiary Nomination-Provident Fund

    Uploaded by

    BharatSubramony
    This document is a nomination and declaration form for an employee's provident fund and pension scheme. It contains the employee's personal details like name, date of birth, PF and EPS account numbers. It allows the employee to nominate individuals to receive the PF and pension funds in the event of the employee's death. The employee also provides family details if any to receive widow or children's pension. The form is signed by the employee and certified by the employer to confirm the details provided.

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

    Beneficiary Nomination-Provident Fund

    Uploaded by

    BharatSubramony
    98 views2 pages
    This document is a nomination and declaration form for an employee's provident fund and pension scheme. It contains the employee's personal details like name, date of birth, PF and EPS account numbers. It allows the employee to nominate individuals to receive the PF and pension funds in the event of the employee's death. The employee also provides family details if any to receive widow or children's pension. The form is signed by the employee and certified by the employer to confirm the details provided.

    Original Title

    Beneficiary_nomination-Provident_Fund

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    This document is a nomination and declaration form for an employee's provident fund and pension scheme. It contains the employee's personal details like name, date of birth, PF and EPS account numbers. It allows the employee to nominate individuals to receive the PF and pension funds in the event of the employee's death. The employee also provides family details if any to receive widow or children's pension. The form is signed by the employee and certified by the employer to confirm the details provided.

    Copyright:

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

    Beneficiary Nomination-Provident Fund

    Uploaded by

    BharatSubramony
    This document is a nomination and declaration form for an employee's provident fund and pension scheme. It contains the employee's personal details like name, date of birth, PF and EPS account numbers. It allows the employee to nominate individuals to receive the PF and pension funds in the event of the employee's death. The employee also provides family details if any to receive widow or children's pension. The form is signed by the employee and certified by the employer to confirm the details provided.

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    © All Rights Reserved
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    Date of Appointment :

    FORM 2 (REVISED)
    NOMINATION AND DECLARATION FORM
    FOR UNEXEMPTED / EXEMPTED ESTABLISHMENTS
    Declaration and Nomination Form under the Employees’ Provident Funds
    and Employees’ Pension Scheme
    ( Paragraph 33 and 61 (1) of the Employees’ Provident Fund Scheme, 1952 and Paragraph 18
    of the Employees’ Pension Scheme, 1995).
    1. Name : ___________________ __________________________ __________________
    ( IN BLOCK NAME FATHER’S/ HUSBAND’S NAME SURNAME
    LETTERS)

    2. Date of Birth______________________ 3. PF Account No.MH/BAN/48736/


    4. EPS Account No :MH/BAN/48736/ 5. Sex : Male / Female :______________________

    6.Marital Status: Married/ Unmarried/ Widow/Widower 7. Permanent Address: ________________


    _________________________________________________________________________________
    ________________________________________________________________________________
    8.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
    “................................................................” in the event of my death.
    Name & Address of the Nominee’s Date of Birth Total amount If the nominee is minor,
    Nominee (s) relationship or Share of name relationship & address
    with the accumulations of the guardian who may
    member in P.F. to be receive the amount during
    paid to each the minority of nominee
    nominee
    1 2 3 4 5

    1.Certified that I have no family as defined in the Rules of the


    “................................................................................” 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.

    X Signature or thumb impression of the subscriber


    EMP NO :
    P.T.O.
    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.
    Sr. Name and Address of the Family member/s Date of Birth Relationship with the
    No. member
    (1) (2) (3) (4)

    ** Certified that I have no family, as defined para 2 (vii) of the Employees’ Pension
    Scheme,1995 and should I acquire a family hereafter I shall furnish particulars there on in the above
    form.
    I hereby nominate the following person for receiving the monthly widow pension [ admissable under
    para 16 (2) (a) (i) & (ii) in the event of my death without leaving any eligible family member / s for
    receiving pension.
    Sr. Name & Address of the Nominee Date of Birth Relationship with the
    NO. member
    (1) (2) (3) (4)

    Date : _____________
    ** Strike out which is not applicable

    X Signature or thumb impression of the subscriber


    CERTIFICATE BY EMPLOYER
    Certified that the above declaration and nomination has been signed / thumb impressed before me by
    Shri. / Smt /Miss__________________________________________ 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 The Boston Consulting Group (India) Pvt. Ltd

    Authorised Signatory

    Place : Mumbai For The Boston Consulting Group (India) Pvt. Ltd

    Date : ____________ Nariman Bhavan, 14 th Floor, 227, Nariman Point,


    Mumbai -400 021

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