Composite Declaration Form-11

www.epfindia.gov.in

Composite Declaration Form -11

(To be retained by the employer for future reference)

Name of the member

Father’s Name
2 Spouse’s Name

3 Date of Birth: ( DD / MM / YYYY )

4 Gender: (Male/Female/Transgender)
5 Marital Status: (Married/Unmarried/Widow/Widower/Divorcee)
(a) Email ID:
6
(b} Mobile No.:
Present employment details:
7 Date of joining in the current establishment (DD/MM/YYYY)
KYC Details: (attach self attested copies of following KYCs)
a) Bank Account No. :
8 b) IFS Code of the branch:
C) Aadhar Number
d) Permanent Account Number (PAN), if available
Whether earlier a member of Employees’ Provident Fund
9 Scheme,
1952
10 Whether earlier a member of Employees’ Pension Scheme, 1995
Protons employment details: [if Yes to 9 AND/O R l0 above] - Un-exempted

Establishment Universal PF Account Date of Date of exit Scheme PPO Number Non
Name & Address Account Number joinmg (DD/MM/ Certificate (if issued) Contributory
Number (DD/MM/ YYYY) No. (if Period
YYYY) issued (NCP) Days

Previous employment details: [If Yes to 9 AND/OR 10 above] — For Exempted Trusts

Name & Address of the Trust UAN Member Date of Date of exit Scheme Non
EPS joining (DD/MM/ Certificate Contributory
12 A/c (DD/MM/ YYYY) No. (if Period (NCP)
Number YYYY) issued Days

a) International Worker:

13 b) If yes, state country of origin (India/Name of other country)

d) Validity of passport [(DD/MM/YYYY) to (DD/MM/YYYY)]

 UNDERTAKING

I) Certified that the particulars are true to the best of my knowledge.

2) 1 authorize EPFO to use my Aadhar ft verification/authentication/e-KYC purpose for Service delivery.
3) Kindly transfer the funds and service details, if applicable, from the previous PF account as declared above to the
present P.F. Account as I am an Aadhar verified employee in my previous PF Account.*
4) In use of changes in alive details, the same will be intimated to employer at the earliest.

galuru SignatureOf Member

DECLARATION BY PRESENT EMPLOYER

A. The Member Mr/ Ms/Mrs ......................................................................... has joined on......................,................

allotted PF No. .........,............................................................and UAN.................................................................................................

B. In case tfie person was ‹arlier not a member of EPF Scheme, 1952 and UPS, 1995:
• Please Tick the Appropriate Option:
The KYC details of the above member in the UAN
database O Have not been uploaded
O Have been uploaded but not approved
O Have been uploaded and approved with DSC/e-Sign.

C. In case the person was earlier a member of I\PF Scheme, 1952 and UPS,
1995: Please Tick the Appropriate Option:-
O The KYC details of the above member in the UAN datbase have been approved with E-sign/Digital Signature
Certificate and transfer request has been generated on portal
O The previous Account of the member is not Aadhar verified and hence physical transfer from shall be initiated
.

Date: Signature of Employer with Seal of Establishment

*Auto transfer of’ previous PF account would be possible in respect of Aadhar verified employees only. Other employees are requested

to
file physical claim (Fomi-13) for transfer of account from the previous establishment.
Declaration for Provident Fund to be submitted along with the Form 11 and PF
passbook copy (if applicable) by New Joiner Employee.
Part A
( For new joiners who were not member of Provident Fund i.e. Employees Provident
Fund Scheme and answered question No 9 in PF- Form 11 as “No’)
I confirm that I have never been a member of Provident Fund (PF) i.e. Employees Provident Fund
Scheme 1952 (“EPF Scheme, 1952”) and Employees’ Pension Scheme, 1995 (“EPS, 1995”) or
any other Pension Scheme (“EPFO Pension Scheme”) under the Employees Provident Fund
Organisation, earlier as I was not employed /employed but not a member of any schemes under
Employees Provident Fund Organisation.
I confirm that since I was not a member of EPF scheme earlier, I have no PF Accumulation from
earlier employment to be transferred to Accenture PF account.
Also as my basic salary is above Rs 15k per month and this is the first time I will be enrolled as a
member under the Employees Provident Fund Organisation, I am not eligible for membership of
Employees Pension Scheme , 1995 (EPS).
I understand that Accenture Solutions Private Limited is un exempted establishment , and PF at
Accenture is managed/administered externally by EPFO and any incorrect /partial information
provided may impact my PF transactions adversely .
Signature:
Name:
Employee ID:
___________________________________________________________________________________
Part B(i)
( For new joiners who were member of Provident Fund ie. Employees Provident Fund
Scheme and answered question No 9 in PF- Form 11 as “Yes”)
I have completely withdrawn/not withdrawn ( tick appropriate ) my PF accumulation with
previous Organisation/s prior to joining Accenture .
In case completely withdrawal of PF accumulation,I understand that since I have withdrawn my PF
accumulation completely, prior to joining Accenture so I would have no PF Accumulation from
earlier employment to be transferred to Accenture PF account. Also in case my basic salary is
above Rs 15k per month I will not be made member of Employees Pension Scheme , 1995 (EPS)
or treated according to prevailing PF/EPS norms .
In case, I have not withdrawn, my PF accumulation I understand that I need to transfer my PF
accumulation with previous Organisation/s prior to joining Accenture to Accenture PF account.
Also in case my basic salary is above Rs 15k per month and I was contributing to Employees
Pension Scheme, 1995 in my earlier organisations or any other pension scheme under the
Employees Provident Fund Organisation, I shall also be enrolled as a member of Employees
Pension Scheme , 1995 (EPS) and my EPS contribution will be treated as per prevailing PF/EPS
norms .
I understand that Accenture Solutions Private Limited is un exempted establishment , and PF at
Accenture is managed/administered externally by EPFO and any incorrect /partial information
provided may impact my PF transactions adversely .
Signature:
Name;
Employee ID:
_____________________________________________________________________________________
Part -B(ii)
(For new joiners who were not enrolled as member of Employees Provident Fund
Organisation but were contributing to Provident Fund in their previous employer’s
Provident Fund Trust, recognized as an exempted Provident Fund Trust by the
Employees Provident Fund Organisation)
I confirm that I have been a member of Provident Fund (PF) through my previous organisations’s
exempted Provident Fund Trust with PF number ____, (include PF number and name of exempted
PF trust) and have been/not been contributing (strikeout whichever is not applicable) to the
Employees’ Pension Scheme through my previous organization’s exempted PF trust. My Pension
account number is ___ (insert Pension Account Number).
I have withdrawn /not withdrawn (strikeout whichever is not applicable) my PF accumulation with
previous organisation’s s exempted PF trust prior to joining Accenture .
In case of complete withdrawal of PF accumulation, I understand that since I have withdrawn my
PF accumulation with previous Organisation’s PF trust prior to joining Accenture , I have no PF
Accumulation

from earlier employment to be transferred to Accenture PF account. Also since in case my basic
salary is above Rs 15k per month I will not be made member of Employees’ Pension Scheme ,
1995 (EPS) and shall be treated according to prevailing PF/EPS norms .
In case not withdrawn, I understand that I need to transfer my PF accumulation with previous
Organisation’s exempted PF trust prior to joining Accenture to Accenture PF account. Also in case
my basic salary is above Rs 15k per month and I was contributing to Employees Pension Scheme,
1995 through my previous organisation’s PF trust, I shall be enrolled as a member of Employees
Pension Scheme , 1995 (EPS) and my EPS contribution shall be treated as per prevailing PF/EPS
norms .
I understand that Accenture Solutions Private Limited is un exempted establishment , and PF at
Accenture is managed/administered externally by EPFO and any incorrect /partial information
provided may impact my PF transactions adversely .
Signature:
Name:
Employee ID: