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Family Members Certificate for EPF Claims

The document outlines the criteria for defining family members eligible for benefits under the Employees' Provident Fund Scheme, detailing specific relationships for both male and female members. It includes sections for certifying family members of a deceased member, personal details of the member, and declarations regarding employment status for pension claims. The document requires signatures from a magistrate or employer and the claimant to validate the information provided.

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sivajireddyvelagala
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195 views2 pages

Family Members Certificate for EPF Claims

The document outlines the criteria for defining family members eligible for benefits under the Employees' Provident Fund Scheme, detailing specific relationships for both male and female members. It includes sections for certifying family members of a deceased member, personal details of the member, and declarations regarding employment status for pension claims. The document requires signatures from a magistrate or employer and the claimant to validate the information provided.

Uploaded by

sivajireddyvelagala
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

EMPLOYEES' PROVIDENT FUND ORGANISATION

SUB-REGIONAL OFFICE: NAD POST, VUDA LAYOUT, MARRIPALEM, VISAKHAPATNAM-530 009.

FAMILY MEMBERS CERTIFICATE

Whereas the following are entitled to be family members defined under Para 2(g) of Employees’ Provident Fund Scheme:

IN CASE OF MALE MEMBERS IN CASE OF FEMALE MEMBERS

1. Wife and Children 1. Husband and Children

2. Dependent parents of the member 2. Dependent parents of the member and


her husband

3. Grand children restricted to the Children 3. Grand children restricted to the Children of
of the deceased son(s) of the member. the deceased son(s) of the member

I certify that the following persons are the family members of the deceased______________________
__________________ son of ________________________________ as define under Para 2(g)
of E.P.F. Scheme.

Relationship Marital status and


Sl. No Name Age
with the member Religion
1 2 3 4 5
1.

2.

3.

4.

5.

6.

7.

SIGNATURE OF MAGISTRATE/EMPLOYER
WITH NAME AND OFFICE SEAL
DECLARATION

PARTICULAR OF THE MEMBER

a) Name of the member _______________________________________

b) Father’s / Husband’s Name _______________________________________

c) PF A/C No _______________________________________

d) Scheme Certificate No. _______________________________________

e) Date of Birth of the member _______________________________________

(as per Scheme Certificate)

f) Marital Status of the Member: Un-married/Married/Widow/Widower

___________________________________________________________________________________

CERTIFICATE FROM MEMBER FOR MEMBER PENSION

I Certify that I have neither employed prior to joining nor taken any employment after the date of
my exit from the present service to till date of this application, in any covered establishment under
Employees’ Provident Fund & Miscellaneous Provisions Act. 1952.

Date:

Place:

Signature / Thumb
Impression of claimant

________________________________________________________________________________________

CERTIFICATE FROM WIDOW/CLAIMANT FOR WIDOW

PENSION/CHILDREN PENSION/ORPHAN PENSION

i) Applicant’s Name (Widow/Widower/Guardian)

I certify that the deceased member has neither employed prior to joining nor taken any
employment after the date of his exit from the service to till date of this application in any covered
establishment under the Employees’ Provident Fund & Miscellaneous Provisions Act, 1952. I
have also not claim pensionary Benefits except from this establishment and also will not claim in
future from any other covered establishment under the EPF & MP Act 1952.

Date:

Place:

Signature / Thumb
Impression of claimant

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