Ack No.

230511113420014340230

Application Form for validation of Joint Options

[£.L~npJoyecs who had retired before 01 .09.2014 and exorcised JQUJLQP.illl.n
JIDtlllr Pare 1113) of eps Scheme prJor to 01.09.2014 J

To be exercised by eligible members of EPS-1995 on or before 26th June, 2023 with reference to Para 44(1,) read with
Para 44(vt) of order dated 4.11 .2022 of lhe Hon 'ble Supreme Courl In SLP No. 8058-8659 ol 2019

CIS!::LAIMEB
1have gone t11rough Supreme Court Judgement dated 04 .11 .2022 in SLP (c) No . 8658-8659 o f
2019 and I am re gis teri n g th e app li ca tion in terms of directions con tained in th e said judgement. I
undertake tha t the pension will be calculat e d subject to formula determined under the Scheme .

Place : KI\ZIPET

Date 11 /0512023

SI .No Details

1 PPO Number GRCDP000 351 31

2 PPO Dale 03-NOV-20 10
G.R.T ESWARA fl EDD Y
3 Name of Member (as per PPO)

4 Gender MALE
5 UAN No. NA
6 Date of Birth of Member 01-JUL-1951
G.MAH ANAN DI RE DDY
7 Father's I Spouse Name (as per PPO)

8 Office by which PPO was issued KADAPA

9 Service Details

PF Account Number Dale of joining Date of leavmg Date of 101ning Date of leaving
Establishment Name
FPS FPS EPS EPS
TNMAS00518000000114 FOOD
9 .1 01-SEP-1976 15-NOV-1995 16-NOV-1995 30-JUN-2009
143 CORPORATION OF
Date of Superannuation
10 30-JUN-2009
(applicable only if date of filing joint option is before 01-09-2014)

Date from which employer's contribution was received on wages

exceeding statutory wage ceiling of Rs 5000 in EPF prior to
01 .06 .2001 from the day his salal)' e,ceeded Rs 5000?
11 16-NOV-1995
(applicable only if date of joining is prior to 01 .06 .2001)

Whether Employer's contribution was received on wages

exceeding statutory wage ceiling of Rs 6500 in EPF prior to
01 .09 .2014 from the day his salary exceeded Rs 6500?
12 N.A.
(applicable on ly if date of exit is on or after 01 .06 .2001)

Date of filing joint option under the proviso to Para 11(3) of

EPS Scheme?
13 Please attach the copy of joint option form. 09-MAR-2006

(applicable only if date of filing joint option is before 01-09-2014)

14 Date of rejection of joint option by EPFO. 19-JUN-2006

Office by which rejected
15 RPFC NEW DELHI
Please attach the copy of the order of rejection .

16 Aadhaar No. of Member xxxx xxxx 2167

17 Aadhaar linked Mobile No. of member 9490639396
• GRTREDDY@ GMAI L.COM
18 Ema il ID of member

19 Aadhar linked Bank Accoun t no. 068801000001

20 IFS Code ICIC0000688
Whether m ember wants to use accumula tion available in
21 No
his I her PF account for payment of due contribution for this option?

22 How much is the PF accounl balance on lhe ~ale of filing option? N.A
Whether member is giving undertaking to deposit th e contributions
23 along with inlerest due till date of payment lh rough his last
Yes
employer [only when PF account has no/ insufficient balance )?

Page 1 o l 2
 Ack No. 230511113420014340230

Poc laratloni

l hereby declare thal I have read and understood the Suprom~ Cou_rt Judgement In SLP (c) no.8658-
8659 of 2019.of the Hon'blo supreme Court and I em regi stering thrs application In terms of lhe
directions contained In the said judgement.
2, 1understand and agree that as a member or tho Employees' Pension Scheme, my rights to clalm
pension are Umlted to the scope of judgement and within tho EPF & MP Act, 1952 end the Schemes
framed thereunder.

3. I further understand that the central government is empowered lo amend the scale of benefits,
commensurate with the con trlbuUons made, ellher prospectlvoly or relrospoctively, on which the
pension payable to me shall be computed .

4. I do hereby agree that the details of contribution and interest given by my employers are essenUal for
the computation of dues payable for this applica llon, and lhls Is the full and final submission,

5. I hereby certify that the services details in the above form are correct and no material fact has been
mis-represented or hidden by me.

6. I hereby agree to pay due contribution in a single tranche as specified by EPFO, along with in terest at
rates declared under Para 60 of EPF Scheme 1952 or at the rate declared by the concerned trust of
such establishment, from time to time , whichever is higher.if any.

7, I hereby }oinUy apply along with my employer to pay full amount of contribution on salary exceeding
wage ceiling under erstwhile para 11(3) (since deleted) of EPS 95 along with interest upto the last
date of the month in which payment Is made, in accordance with the judgemen t dated 04 .11 .2022 of
the Hon'ble Supreme Court through my last employer within such Period as directed bv EPEQ
after validation of my application- If the full amount payable is not deposited by my last employer
within such Period as directed by EPFO after validation of my aoolication- lhis application
shall be treated as Null and Void.

8. I undertake that all the facts are true. If the details submitted by me or my employer are found to be
incorrect at any point of time, this application shall be treated as Null and Void .

9. I am aware that in case of false declaration and willful mis-representation, appropriate penal action
may be taken by EPFO against me.

Place : KAZlPET G.R.T.ESWARA RE DDY

Date : 11/05/2023
llilllllnlill!IIDUlllllll~lllllll illll~IIIIHIIIIIIIUlll l:llllill

Pago 2 of 2
-- I

~ll'~ I Enrollment No. : 1093/22070/01744

To
Guddell Rama Tulasl Eawara Reddy
11,a!l o-:'.>:> &o:O 11t•jt'> '66
S/0 G Mahanandl Raddy 0

29-3430
NEAR RAO'S DEGREE COLLEGE
PADMAVATHI NAGAR
Nandyal
Nandyal,Kumool,
Andhra Pradesh • 518501
9490639396

IIIIIIIIIIIU~II IIIIII IIR

UF1222464761N
12224647

[!is,
!:b <!:!lo/O ~oq,g / Your Aadh~ar No. :

2520 47102167
~Q"o - ~~er
I ~
..........,.-w _:;:.-
------------------------------------------·
G:&4¥ilbiS6_-; - >cg -·.
K>i!!l c,,:'.,, &o:, llt~j!l'M

l
Guddetl Rama Tulaal e:wara Reddy

'1,oM:fldY- of Blr1h: 1951

~/Male

2s20 4110 21s1 m

~
IUQ""O - ~~6-

Mob:\e... l'.ro'. · rt4- 3~3q""

 ) '-"":.!/,j ~
'\

EMP LOYEES ' PROVIDENT FUND DRGANI S~

REG I ONAL /SUB- REGIONAL OFF I CE
SUB REGIONAL m -F tCE, KI\DAPA
.)_ \ - ~ - I/
No. AP .:C Dl-'/PENSIDN / 10/ \ \ b1 PPU e pared on : 03/1 1/ 2010
Roceipt No.: 30004455
To: Shr 1'HMt . G.R. T.ESWAR A RCUDY pr Ale.Ne. · AP/51800/ 114143
Cl e . 6.MAHANANDl REDDY .::I .-f' 'I\Ji:) P.P.O. No. 1 APICD P/351 3 1
HN0 . 2';11:H3 - D<N l -·
RA DS f~O LLEGE 4=7-::/-D=f--~ 3\3
PA f'M A\lATHIN,'\GA R

Si r Mada,.,,

Sub : Di s bur s e1'1e11t of pension sa n e t ioned to

y ou under Ef'lp l oyees' Pen sion Schef",e '95

Re f 'rnu r ap_pl1cc1.tion in ForM 10· -D subM1tted

for sanction of pension under EPS,9S .
--·- -------
Wit!, reference to the above , i t is inforf"1ed that
you.· application has been con si d 2red and sanction of the
cof'l ["Pt ent au t ho r i ty, accorded for the pa y Ment o f f",onthly
pen sion at the followi ng ra te with effec t froM:01 /07/2009
rv r J ,., .., . .. , r-· ,.., rJ r .1 ..., ,... r . • ,._, ,- .1 ,.., r.1r.1 ,.., ,._, ,.., ,- J,-.1 r .1 r., ,..,,.., ,..,,..,.,.., ••• ,,• .,,. •. ,._, .• ., ,..,,._, ,._, ,.., ,-_,r., ,._, ,._,,.., ,-_, r.r.•.1 ,-.1r.1 ,.., ,.., ,..,,.-6 ,._., ,.J,.., ,..,

Naf'le of the Pensi oner Or iginal Monthl y Cof'lMUt aion

& T ype of Pens i on Pension Pens ion A/Tloun t 1 f any
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~-~~~~~-~~~~~~~
G. R .T.ESWAR~ RE DDY
s 1682 1682 0

Pet1s1 o n Arrears Rs . 269 12 Rel ief Arrear s Rs . 0

Please note that the a/TlOUn t of Pension Arrears i s payab ~e

• a ft:r- · adjusting the withdra1-ia l benefit aMount alr ea dy pa id , i f any.

Tre Pension Payf",en t Order bear in g Ne . shown as abov e has

a lre~dy bee n for warded t o the link branch of ICICI BAN~ LTD
for . ,nward tran sM i s si on to your bani< [ c~•: 1 8 ',
( 09'"" 0004) MAIN ROAD, ·.~ ;,_,.·J 1J... SB .,t, c.!'l • . .'~.11.
a s .:;esired b y yo u. Yo u f",ay p lease con t"act u ·,e rr,at1a9er of yo ur -
ban • along with th is letter for recei v i ng the pens ioner's c=py
of and p ayf'lents including the arrears .

Ye~

Asst. P.F. CoMMissioner <Pension>

SUB REGIONAL OFFICE, KADAPA

~ v-, Sect1on S uper v isor,A /c Sec •• Mark Section Manual., CT r ansfer-·1n cas e:
Cop/ to
r;- e Br;;;nch Manager,
ICICI M,tW L. TD
t'1 f,ItJ RDA!J , N AMDYf,L
1"r.. IIJ ROAD, N f, l'JDY AL
•
 Our Commitment to Serve You
We at ICICI Bank are committed to delivering a great customer Base Br: 0688 fl1c1c1Bank
experience and. to building lasdng reladonships based on TRUST. COpen Dt: 17-04-2008 khayaa/ aapka
• Transparent by providing you with clear information about all A/fka~e: SBGEN.
our products and services !fflffl NANDYAL
• Responsive by delivering accurate. timely and complete 25/142, SANJEEV NAGAR
solutions to all your needs
• Understanding your needs and delivering appropriate products NANDYAL
and services IFSC Code: ICIC0000688
• Serving you with consistency at all times MICR Code: 518229102
• Treating you with fairness in all our interactions Nominee: Registered
us omer
I
SB/RD Ne No. ni:;~801000001
ififflmll/m<ff;;f'!J~
3i$ft~~~ ~. 3ilffl
f.lfitct 4}$i,1Ht-1 :me MR GUDDETI RAMA THULASESWA
RA REDDY
25-684-88, NEAR RAO'S DEGREE COLL
• ~~3TI EGE PADMAVATHI NAGAR, NANDYAL
~~'Sgoc{R
• ~~~~3i'iq;)
NANDYAL 518501
• ~w fflT .?f oc{R
• 3lm ~~~~.?f~~