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categoriesFeaturedRecentPeopleAuthorsStudentsResearchersPublishersGovernment & NonprofitsBusinessesMusiciansArtists & DesignersTeachers+ all categoriesMost FollowedPopularSign Up|Log IninShare1Embed DocCopy LinkReadcastCollections2CommentGo BackDownload Serial No:Form No. 10 C (E.P.S) EMPLOYEES' PENSION SCHEME, 1995FORM TO BE USED BY A MEMBER OF THE EMPLOYEES' PENSION SCHEME,1995 FOR CLAIMING WITHDRAWAL BENEFIT/SCHEME CERTIFICATE (Read the instructions before filling up this form)1. a) Name of the member :- _____________________________ ( In Block Letters)b) Name of the claimant (s) _____________________________ 2. Date Of Birth3. a) Father's Name _____________________________ b) Husband's Name _____________________________ (If applicable)4. Name & Address of the Establishmentin which, the member was last employed ______________________________ 5. Code No. & Account No.Region/SRO Code Estt. Code No. A/c No.6. Reason for leaving service ______________________________ & Date of leaving ______________________________ 7. Full Postal Address :-(In Block Letters) ___________________________________ Sh/Smt./Km ___________________________________ S/o, W/o, D/o ___________________________________ ___________________ PIN _____________ For Office Use OnlyIn Words No. 8. Are you willing to accept Scheme (a) (b)Certificate in lieu of withdrawal benefits Yes No9. Particulars of Family (Spouse & Children & Nominee)Name Date of Birth Relationship With Member Name of the guardan of minor(a) FamilyMembers(b) Nominee10. In case of death of member after attaining the age of 58 years without filing the claim:-(a) Date of death of the member :(b) Name of the Claimant(s) / and relationship with the members :11. MODE FOR REMITTANCE [PUT A TIC IN THE BOX AGAINST THE ONE OPTED](a) By postal money order at my cost to address given against item No. 7(b) Account payee cheque sent direct for credit to my SB A/c (Scheduled Bank) under intimationto meS.B. Accounts No. ______________________________________________ Name of the Bank ______________________________________________ (in block letters)Branch ______________________________________________ (in block letters)Full Address Of the Branch ______________________________________________ (in block letters) ______________________________________________ ______________________________________________ 12. Are your availing pension under EPS-95 ?If so indicate : PPO NO._________________By Whom Issued______________ Certified THAT THE PARTICULARS ARE TRUE TO THE BEST OF MY KNOWLEDGESignature or left HandThumb Impression of theMember / claimant(s)Date ______________ ADVANCE STAMPED RECEIPT[To be furnished only in case of (b) above]Received a sum of Rs.(Rupees.)Only from Regional Provident Fund Commissioner /Officer-in charge of Sub-RegionalOffice___________________ by deposit in my savings Bank A/c towards the settlement of my Pension Fund Accounts.(The Space should be left blank which shall be filled by Regional Provident Fund Commissioner /Officer-in-charge)Signature & left hand thumb impression of the member on the stampCertified that the particulars of the member given are correct and the member has signed/thumb impressedbefore me.The details of wages and period of non-contributory service of the member are as under:-Form 3A/7 (EPS) enclosed for the period for which it was not sent to employee's Provident Fund Office)Wages (Basic + D.A) as on 15.11.95(if

applicable)Wages as on the date of exitPeriod of non contributory ServiceYear/Month No.of daysDateSignature of Employer/ authorised Official Rs 1/-RevenueStamp of 4 Leave a Comment Comment must not be empty. You must be logged in to leave a comment.SubmitCharacters: 400 Ashfak Khan ak reply05 / 17 / 2012 brandfactory shoba_mgri@yahoo.com reply04 / 18 / 2010 Comment must not be empty.You must be logged in to leave a comment.SubmitCharacters: ...EPF form no 10 C Employee Provident Fund form no 10C for withdrawal Download or Print85,306 ReadsInfo and Rating Category:Uncategorized. Rating:(8 Ratings) Upload Date:10/14/2008 Copyright:Attribution Non-commercial Tags:This document has no tags. Flag document for inapproriate content This is a private document. Uploaded by api_user_11797_thammir... FollowDownload Embed Doc Copy Link Add To Collection Comments Readcast Share Share on Scribd: ReadcastSearchTIP Press Ctrl-F F to quickly search anywhere in the document. SearchSearch History: Searching...Result 00 of 0000 results for result for p. More From This UserRelated DocumentsMore From This User 4 p.LIFO_FIFO_VHDL 3 p.FA from 2 HAs 9 p.ECAD LAB VHDL programs Next 2 p.V Pradarshina2007_pamplet11 p.Staff-Load June 2007_Nov20076 p.JUly2009_timetables_ECEPrev Next 5 p.Embedded SYstems Syllabus_R05_LessonPlan5 p.Embedded Systems Syllabus_R059 p.PHD_PT_09_JNTUPrev Next 2 p.CMOS Harmonic Crystal6 p.BJT in Terms of Currents4 p.BJT Based POWER DevicesPrev Next 89 p.07 Bipolar Junction Transistors21 p.Common Collector Design and Analysis9 p.Bjts Nice IllustrationsPrev Next 15 p.Bjt With Manufacyring Perspective25 p.BJT SImple Operaions15 p.Bjt Regions With Simple ExamplesPrev Next 30 p.BJT REgions2 p.Planetary Fact Sheet - Ratio to Earth Values_NASA2 p.Planetary Fact Sheet - Metric_NASAPrev Next 3 p.Notes on the Fact Sheets_NASA3 p.Earth Fact Sheet_NASA51 p.View Graphs

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