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EPFO Joint Declaration Form

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JointDeclarationBytheMemberandTheEmployer

Date:

To

TheRegionalPFCommissioner
______________________________

Sub:Jointdeclarationbythememberandtheemployer

DearSir,

I,_____________________________________________am/wasanemployee/exemployeeof

______________________________________________furnishingbelowherewithcorrectdeailswithaforesaid

establishment:

Particulars Correct Wrong

Name

Father/HusbandName

PF/EPSAccountNo.

DateofBirth(DD/MM/YYYY)

Dateofjoining(DD/MM/YYYY)

Dateofleaving(DD/MM/YYYY)

IamalsoenclosingherewithselfattestedcopyofIDproof(
Anyone
PANcard/VotersIdentityCard/Passport/
DrivingLicense/AadharCard)foryourreadyreference.
Therefore,youarerequestedtomakenecessarychangesinyourrecords(ifrequired)underintimationtome.
Anearlyactioninthisregardwillbehighlyappreciated.

YoursFaithfully

Name&SignatureofApplicant :

NameofAuthorizedSignatory :

SignatureWithEstablishmentSeal :

Encl.:AsAbove

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