Joint Declaration Employee With Employer 2

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Joint Declaration by The Member and The Employer

Date : -

To,
The Regional Provident Fund Commissioner
______________________
__________________
____________

From,

Name of the employee :


Pension Account No. :
Universal Account Number (UAN) :
Establishment Name :
Establishment Code No. :
Group No. :

Subject : Joint declaration by the member and the employer

Dear Sir,

With reference to above membership details, I would like to request you for correction / update of
my information as given below in UAN records and portal.

Particulars Incorrect Details (update Nil Correct Details to be updated


if blank on EPFO portal)
Name
Father’s / Husband’s Name
Relation with the member i.e.
Father / Husband
EPS Account No.
Date of Birth (DD/MM/YYYY)
Date of Joining (DD/MM/YYYY)
Date of Leaving (DD/MM/YYYY)
Gender
Other (Please specify)

I am also enclosing herewith self-attested copy of ID proof ( Any One – PAN card/Voter's Identity
Card / Passport / Driving License / Aadhar Card / Marriage Certificate) for your ready reference.

Therefore, you are requested to make necessary changes in your records ( if required ) under
intimation to me.
An early action in this regard will be highly appreciated.

Yours Faithfully

Name & Signature of Applicant :

Name of Authorized Signatory :

Signature with Establishment Seal :

Encl As above

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