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    For SSC Use Only: Address For Communication Permanent Address

    Uploaded by

    Shakti singh gaur
    The document is a withdrawal application form for provident fund accumulation. It contains the applicant's personal details like name, address, bank account, PAN number, employment history with the company including date of joining, date of leaving and reason for leaving. It requests withdrawal of the total amount standing in the provident fund account and provides bank details for fund transfer. It includes declarations for tax deduction if PF membership is less than 5 years and authorizes the trustees to deduct any due amounts from the applicant's accounts for full and final settlement. Required documents like identity and address proofs, employment records and bank details are also listed.

    Copyright:

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

    For SSC Use Only: Address For Communication Permanent Address

    Uploaded by

    Shakti singh gaur
    143 views4 pages
    The document is a withdrawal application form for provident fund accumulation. It contains the applicant's personal details like name, address, bank account, PAN number, employment history with the company including date of joining, date of leaving and reason for leaving. It requests withdrawal of the total amount standing in the provident fund account and provides bank details for fund transfer. It includes declarations for tax deduction if PF membership is less than 5 years and authorizes the trustees to deduct any due amounts from the applicant's accounts for full and final settlement. Required documents like identity and address proofs, employment records and bank details are also listed.

    Original Description:

    PF form

    Original Title

    PF

    Copyright

    © © All Rights Reserved

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    The document is a withdrawal application form for provident fund accumulation. It contains the applicant's personal details like name, address, bank account, PAN number, employment history with the company including date of joining, date of leaving and reason for leaving. It requests withdrawal of the total amount standing in the provident fund account and provides bank details for fund transfer. It includes declarations for tax deduction if PF membership is less than 5 years and authorizes the trustees to deduct any due amounts from the applicant's accounts for full and final settlement. Required documents like identity and address proofs, employment records and bank details are also listed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    143 views4 pages

    For SSC Use Only: Address For Communication Permanent Address

    Uploaded by

    Shakti singh gaur
    The document is a withdrawal application form for provident fund accumulation. It contains the applicant's personal details like name, address, bank account, PAN number, employment history with the company including date of joining, date of leaving and reason for leaving. It requests withdrawal of the total amount standing in the provident fund account and provides bank details for fund transfer. It includes declarations for tax deduction if PF membership is less than 5 years and authorizes the trustees to deduct any due amounts from the applicant's accounts for full and final settlement. Required documents like identity and address proofs, employment records and bank details are also listed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

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    Request No. : 18R032008724 ͩͭͭͭͪͪͭͪͭͪͩͭͪͪͩͩͩͩͪ
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    Mobile No. : 7710807371 ͩͭͪͪͪͩͪͪͩͩͭͩͩͪͭͪͭͭͪͩͪͩͪ


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    Personal E-mail ID : [email protected] ͩͪͪͪͪͪͩͩͩͪͩͭͩͪͪͭͭͭͩͪͩͭͪͭ


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    Date of Receipt :
    PS No. : 20048911

    (APPLICATION FOR WITHDRAWAL OF PROVIDENT FUND ACCUMULATION)

    To,
    The Board of Trustees,
    LARSEN & TOUBRO OFFICERS AND SUPERVISORY STAFF PROVIDENT FUND,
    Shared services Centre (Retirement Benefit Section),
    4th Floor, Krislon house, Off Saki Vihar Road,
    Saki Naka, Andheri (East),
    Mumbai ±

    I hereby request you to pay me the amount standing to the credit of my provident fund account.

    PS No. 20048911

    Name of the Member ABIRAMI RAJAGOPAL

    Name of the Applicant


    (in case of Death of the Member)

    Relationship with Member

    Other PS Nos. (allotted if any)

    Address for Communication Permanent Address


    Shakti Singh Quarter no 36 Type 03 CBI door no 226 tc 24/424 brindavan thycaud
    Colony
    Sector 12 Near Rajpoot bhavan sangeeth nagar trivandrum

    Gandhi nagar Gujarat Opposite PRS appartments

    KERALA KERALA

    Pin code : 382012 Pin code : 695014

    Entity L&T

    Unit EAIC Location POWAI

    Cadre EXECUTIVE II Dept. Code 300202316

    Date of Joining 05-OCT-2012 PF Membership 05-OCT-2012


    Date
    Date of Leaving 19-FEB-2018 Reason for Leaving RESIGNATION

    Reason for withdrawal Started Own Business


    Mode of Payment NEFT

    Bank Details Bank Account No. 124701503200

    Bank Name ICICI BANK LTD - (LT


    POWAI)
    Bank Branch LT POWAI
    IFSC Code ICIC0001247

    PAN Number* ATSPR1143G

    I certify that the particulars given above are true to the best of my knowledge.

    Place:

    Date:

    In case this information is not properly filled up and necessary enclosures are not attached,
    it will not be possible for us to issue the TDS Certificate.

    Enclosure(s):

    Sr. No. Description

    1 Proof of Employment (Copy of anyone - Service Certificate / Relieving letter / Pay slip /
    Appointment letter)
    2 Proof of Identity - (Copy of anyone - PAN Card / Aadhaar Card / Passport / Driving License)

    3 A Cancelled cheque with your name mentioned. In case, name is not appearing on the cheque
    leaf, a copy of Passbook/Bank Statement giving your Name & Account Number should be sent
    along with a cancelled cheque.

    Received a sum of `. ( rupees only) from


    the trustees of LARSEN & TOUBRO OFFICERS AND SUPERVISORY STAFF PROVIDENT FUND by cheque/NEFT
    in full and final settlement of my provident Fund account no.TH/THA/0000424/000/0153925

    Place:

    Date:
    Annexure to PF Withdrawal Form

    Declaration from Employee Seeking withdrawal of PF accumulation having less than five
    years of PF Membership

    To,
    The Board of Trustees,
    LARSEN & TOUBRO OFFICERS AND SUPERVISORY STAFF PROVIDENT FUND
    Mumbai - 400072

    6XE7D[GHGXFWLRQIURP3)DFFXPXODWLRQ

    I hereby confirm that, I accept the tax deduction at source from my PF accumulation at applicable rates on
    account of not completing five year of c ontinuous service with the employer or PF membership with the
    provident fund trust. I request you to settle my PF dues after deduction of applicable tax under the provisions
    of Rule 10 to read with rule 9 of the fourth schedule of Income Tax Act, 1961. The copies of all necessary
    Form-16 are enclosed for tax calculation.

    Place :

    Date :
    AUTHORISATION TO THE TRUSTEES

    I, the applicant above named, do hereby a uthorize the trustees LARSEN & TOUBRO OFFICERS AND
    SUPERVISORY STAFF PROVIDENT FUND to deduct and pay on my behalf to the company and/or to the LTKSPM
    all such amounts as are due and payable by me to the company and/or to the LTKSPM towards the full and final
    settlement of all my accounts with them.

    Place :
    

    Date :

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