Date :
From :
To
The Trustees
EIT Services India Private Limted.,
Employees' Provident Fund Trust
Bangalore – 560 100.
Dear Sir,
I would like to withdraw the amount in my Provident Fund Account with you.
I hereby declare that, I have not been employed in any establishment which is covered under the EPF Scheme. The
brief particulars of my employment with EIT Services India Private Limted. Ltd are given below:
1. Name in Full              :       _______________________________________________________
2. Father’s Name                 :    _______________________________________________________
3. Address for
   Correspondence            :        _______________________________________________________
                                      _______________________________________________________
4. Present Address           :        _______________________________________________________
                                      _______________________________________________________
5. Date of Joining           :        _______________________________________________________
6. Date of Leaving           :        _______________________________________________________
7. Badge No.                 :        _______________________________________________________
8. P.F. Number               :        ______________________________________________________
9. Reason for leaving        :        ______________________________________________________
10. PAN                      :        ______________________________________________________
11. Personal Mail ID         :        ______________________________________________________
12. Contact No.              :        _______________________________________________________
13. Bank Account No.         :        ________________________________________________________
14. Bank Name                :        ________________________________________________________
15. IFSC Code                :        ________________________________________________________
16. MICR Code                :     ________________________________________________________
( Two cancelled Cheque leaf of the bank to be attached )
                                                                                            Signature
Certificate by the Employer
The above particulars are correct. You can settle the PF Account.