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    NOMINATION

    Uploaded by

    Gulshan Kumar

    Copyright:

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

    NOMINATION

    Uploaded by

    Gulshan Kumar
    5 views2 pages

    Copyright

    © © All Rights Reserved

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    Copyright:

    © All Rights Reserved
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    5 views2 pages

    NOMINATION

    Uploaded by

    Gulshan Kumar

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 2

    The Employees' Pension Scheme,

    FORM 2
    EMPLOYEES' PROVIDENT FUNDS SCHEME, 1952
    [Paragraphs 33 AND 61(1)]
    EMPLOYEES' PENSION SCHEME, 1995
    [Paragraphs 18]

    DECLARATION AND NOMINATION FORM UNDER THE EMPLOYEES' PROVIDENT FUNDS


    SCHEME AND EMPLOYEES' PENSION SCHEME

    1. UAN : 102142285345
    2. Name (in block letters) : RAJESH KUMAR
    3. Father's / Husband's Name : BHAGWAN SAHAI
    4. Date of Birth : 10/09/1971
    5. Gender : MALE
    6. Marital Status : --

    7. Address (Permanent) : SON OF BHAGWAN SAHAI, Alampur, Bhiwadi Alwar, ALWAR,


    RAJASTHAN, 301019
    8. Address (Temporary) : SON OF BHAGWAN SAHAI, Alampur, Bhiwadi Alwar, ALWAR,
    RAJASTHAN, 301019
    9. (A) Date of Joining of EPF Scheme, : 21/12/2000
    (B) Date of Joining of FPS Scheme, : --
    (C) Date of Joining of EPS Scheme, : 21/12/2000

    PART A (EPF)
    I hereby nominate 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

    If the Nominee is
    Total amount or minor, name and
    Nominees's share of relationship and
    Name of the
    relationship with accumulations in address of the
    Nominee / Nominees Address Date of Birth
    the Member Provident Fund to guardian who may
    be paid to each receive the amont
    nominee during the minority of
    nominee
    (1) (2) (3) (4) (5) (6)

    SON OF BHAGWAN Wife 01/01/1979 100% --


    SAHAI, Alampur,
    SAVITA DEVI
    Bhiwadi Alwar, ALWAR,
    AADHAAR: XXXX
    RAJASTHAN, 301019
    XXXX 5375
    Bank A/c: NOT
    AVAILABLE

    1. *Certified that I have no family as defined in Para 2(g) 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 dependant upon me.

    (Signature is not required as the document is to be digitally signed)


    The Employees' Pension Scheme,

    PART B (EPS)
    (Para 18)

    I hereby furnish below particulars of the members of my family who would be eligible to receive
    widow / children pension in the event of my death:

    Relationship with
    Sl. No. Name of the Family members Address Date of Birth
    the member
    (1) (2) (3) (4) (5)

    1 SON OF BHAGWAN SAHAI, 01/01/1979 Wife


    SAVITA DEVI Alampur, Bhiwadi Alwar, ALWAR,
    AADHAAR: XXXX XXXX 5375 RAJASTHAN, 301019
    Bank A/c: NOT AVAILABLE

    *Certified that I have no family as defined in Para 2(vii) of the Employees' Pension Scheme, 1995 and
    should I acquire a family hereafter I shall furnish particulars thereon in the above form.

    I hereby nominate the following person for receiving the monthly widow pension admissible under
    para 16(2)(a)(i) and (ii) in the event of my death without leaving any eligible family member for receiving

    Relationship with the member


    Name and Address of the Nominee Date of Birth

    -- -- --

    Date : 28-Nov-2024

    (Signature is not required as the document is to be digitally signed)

    Signature valid
    Signed by :
    Date : 28/11/2024 17:47:58
    Reason : eSign Service
    Location : India

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