I\PLO) LL PERSONAL INIORNLAION FORM
To be filled in by HR Team
Employee ID
Date of Joining (DD-MMM-YY)
Designation
Level (Grade)
Department
Location
Personal Details (to be filled in by Employee)
Full Name : kotlE AUP
Gender M ALE
Blood Group
Nationality ttNDU
Date of Birth (DD-MMM-YY) 20- AU-943
Marital Status (Single/Married)
Father Name DEVENDEP
Spouse Name (if Married)
Passport No. (if applicable)
P6660 S83
Passport validity date
Aadhar number
3484 42-8>3440
PAN
EVFPKS744H
UAN
Languages known : TELU(qu, EnlGSH, HTNDT
Mobile Number : 401348430
Personal Email ID Kotteanuf nas. Com
Current Address
533 |H||,Si 4lani En lav
Permanent Address
chengicher4, yebal, TelngnaS oe1)
Ir b8, vin Ramchandyrur, Mandal
DiSH karim Sipuy
nagal, sta Telangang, ill s8
Emergency Contact Information
Name Poyqsheean
Cel q03242541)
Contact Person Name
Contact Person Phone Number 103942S4|
Relationship with the Person
Educational Qualificatlon Detalls
Nature of Year of Grade /
Institution Name of Institute & University % Marks
Degree Passing
SSLC/SSCI
MATRICULATION
Nogariuna tHihl sehn 43:
581.
PUC/10+2/
INTERMEDIATE
Matrus Suniaw
58-1.
GRADUATION
Katat'ga unfuosi
UniArsYsciene Colege 62
POST pegula
GRADUATION
PROFFESSIONAL
COURSE (s)
Certifications
2.
Work Experience details
Company Name
Company Website
Employment Period From To
Designation Held
Reporting Manager Name
Reporting Manager Contact Details
Reason for leaving
Company Name
Company Website
Employment Period From To
Designation Held
Reporting Manager Name
Reporting Manager Contact Details
Reason for leaving
Company Name
Company Website
Employment Period From To
Designation Held
Reporting Manager Name
Reporting Manager Contact Details
Reason for leaving
Company Name
Company Website
Employment Period From To
Designation Held
Reporting Manager Name
Reporting Manager Contact Details
Reason for leaving
Key Achievements:
Hobbies/ Interests:
References:
Conduct
in a positlon to evaluate your Employment and
(Name three persons, not related to you, who are
whom you have worked)
preferably former reporting managers or people with
Name
Contact Number
Company Name
Occupation
Email ID
Relationship with you
Declaration:
liable for termination for
furnished in this document is true and I will be
Ihereby confirm that all the information
any falsification or misrepresentation of details.
Date
Employee Signature
New Form No.11- Declaration Form
(To be retained by the ennployer for future reference)
EMPLOYEES PROVIDENT FUND ORGANIZATION Emp Code:
Employees provident funds schemc, I952 (paragraph 34 & 57) &
Employees pension scheme 1995 (paragraph 24) Company:
(Declaration by a person taking up cmployment in any establishment on which EPF Scheme, 1952 end /of EPS1995 is applicable)
Name of the member
2 Father's Name ( )Spouse's Name (O)
(Please Tick Whichever Is Applicablc)
Date of Birth (DD/MM/YYYY)
4 Gender: (male /Female /Transgender )
Marital Status (marricd /Unmarricd /widow/divorce)
6 (a)Email ID:
(b)Mobile No:
7* Whether carlier a member of Employces 'provident Fund Scheme 1952
Yes No
Whether carlier a member of Employecs 'Pension Scheme ,1995
Yes No
If response to any or both of (7) & (8) above is yes.
a) Universal Account Number(UAN)
MANDATORY FILL UP THE (COLUMN 9)
b) Previous PF a/c No AP HYD EST.CODE EXTN PF NO.
9
c) Date of exit from prcvious employment
(DD/MM/YYY)
d) Scheme Certificate No (if Issued )
e) Pension Payment Order (PPO)No (if Issued)
a) International Worker:
b) If Yes , State Country Of Origin (India /Name of Yes No
10 Other Country)
c) Passport No
d) Validity Of Passport (DD/MM/YYY) to(DD/MM/YYY)
KYCDetails: (attach Self attested copies of following
a) Bank Account No .& IFS code
KYCs) **
11
b) AADHAR Number (12 Digit)
c) Permanent Account Number (PAN),If available
Certified that the Particulars are true to the best ofUNDERTAKING
1)
my Knowledge
2) Iauthorize EPFO to use my Aadhar for
3) Kindly transfer the funds and
verification le KYC purpose for service delivery
service details, if applicable if applicable, from thc
present P.F Account(The Transfer Would be previous PF account as
been verified by present employer
possible only if the identified KYC details approved by declared above to the
previous employer has
4) In case of changes In above
details the same Will be intimate to employer at the
Date: earliest
Place
DECLARATION BY PRESENT EMPLOYER Signature of Member
A) The member Mr/Ms./Mrs .has joined on ............and has been allotted PE
B) In case person was carlier not a member of Number
EPF Scheme,1952 and EPS. 1995
(Post allotment of UAN ) The UAN Allotted for the
member is.
Please tick the Appropriate Option:
The KYC details of the above member in the UAN
database
| Have not been uploaded
Have been uploaded but not approved
Have been uploaded and approved with DSC
C) In case the person was earlier a member of EPF Schenme ,1952 and
EPS. 1995:
Theabove PF account number /UAN of the
member as mentioned in (a) above has been tagged witlh his
declared by member /her UAN/previous member ID as
Please Tick the Appropriate Option
The KYC details of thc above member in
the UAN database have becn
has been generated on portal. approvcd with digital signature Certificate and transfer
As the DSC of establishment are not requcst
registered With EPFO he member has been informed to file
of funds from his previous establishment. physical claim (Form)3)
for transer
Date
Signature of Employer With scal of
Establishnent
Employee code
(Mandatory)
FORM2 (Revised)
(For Unexempted /Exempled Establishments)
NÌMINATION AND DECLARATION FORM
(Declaralion and Nomination Form under the Employees' Provident Funds and Employees' Pension Scheme)
(Paragraphs 33 &61 (1) of the Employees' Provident Funds Schome, 1952 and paragraph 18 of the Employees' Pension Scheme, 1995)
1N Name (in Block Letters)
2 Fathèr's/Husband's Name kolJE DEVE NDER
3 Date of bith D0- 0g- 1113
4 Sex MALE
5 Marital Status STNULE
6 Account No. (u :Numbe)
7 Address (Nesndenta) Permanent
Temporary
PART A(EPF)#
Ihereby 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:
Nominee's Total amount If the nominee is a
Name and Address of the nomineel nominees Date of
relationship Birth or share of minor, name and
with the accumulations relationship and
member in Provident address of the
Fund to be guardian who may
paid to each receive the amount
during the minority of
nominee (%)
nominee
(1) (2) (3) (4) (5)
vin- Rarnehandraue Mi- saadfpul moT HER 1-1-148 00
LAK T
100%
1 *Certified that I have no family as defined in para 2(9) 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.
k.
Signature or thumb impression of the subscriber
Note: - A Fresh nomination shall be made by the member on his marriage and any nomination made before such mariage
shall be deemed to be invalid
Sfunmarried
Marte>then
Soouse.ChIdren (narried ör unmaried), bis/her derendent parents deceased sons wlcow end children.
Parents, Brother Sister or any other persons)
Page No. - 1
- Form2 (Nominutivn)
Part B (EPS) (Para 18) $
widow/chldren pension
tunish bolow parliculars of the members of my family who would be eligible to receive
Iheoby
in he event of my doalh.
Date of Birth Relationship with
SI.No. Name and address of the family members the member
(3) (4)
L1) (2)
1
2
3
Emplovees' Pension Scheme, 1995 and should Iacquire a
Certiied that | have no family, as defined in para 2(vii) of
family hereafter I shall furnish particulars thereon in the above form.
the monthly widow pension (admissible under para 16 2(a) (i) and ()
Thereby nominate the following persons for receiving member for receiving
of my death without leaving any eligible family
of Employees' Pension Scheme, 1995 in the event
Pension. SS
Date of Birth Relationship with the member
Name and Address of the Nominee
(2) (3)
(1)
Dated the: 2204) 2024
Signature or thumb impression
of the subscriber
**Strike out whichever is not applicable.
CERTIFICATE BY EMPLOYER
been signed/thumb impressed before me by
Certified that the above declaration and nomination has employed in my establishment
Shri/Smt./Kumari got confirmed by him/her.
him/her by me and
after helshe has read the entries/the entries have been read over to
Place:
Dated the
Signature of the Employer or other authorised
Officer of the establishment
Designation..
Name and address of the Factory/Establishment
or rubber stamp thereof
before death In servlce!
$ApplicableIf Mared -> To Spouse and Children (nclude chldren adoptedlegaly
$$KADolicablbto bothIMarred and unmarried4)YMarled TO any. oerson's) otherthan spoUSe and children
YUnmarrledTo Parents, Brother, Sister or any other personfs
Page No. - 2
Form2 (Nomination)
