Annexure-II
JOINT OPTION FORM FOR CATEGORY- C (Retired Employees – Superannuated after 01.09.2014)
To,
The Regional Provident Fund Commissioner,
______________________________________________
______________________________________________
_______________________________________________
Sub: Joint Option Form under EPS, 1995 in pursuance of the Hon'ble Supreme Court's
Judgment dated 4th November, 2022
Sir/Madam,
1. As abundant caution for compliance and in order to meet the deadline stipulated in the
aforesaid judgment, we (Ex-Employee and Employer) hereby submit the Joint Option
Form as required under pre-amended paragraph 11(3) and amended paragraph 11(4)
of the EPS'95 for claiming pension on actual salary, i.e. exceeding statutory wage limit
from time to time decided by EPFO under the Employees' Pension Scheme from 16-11-
1995 or from the date of joining as Member of Employees' Pension scheme.
2. Particulars of the Ex-Employee are as under:-
(i) Name
(ii) Employee ID
(iii) WBPDCL Office & Location
(iv) Date of joining in WBPDCL
(v) E.P.F. Account Number
(vi) E.P.S. Account Number
(vii) UAN Number
(viii Mobile Number
)
(ix) Aadhaar Number
(x) E-mail ID
(xi) PPO Number
(xii) Date of attaining the age of 58
years of age (eligible for
Pension under EPS-1995)
(xiii) Date of Actual
Superannuation/Cessation
Service
(xiv) Name of Pension disbursing
Bank and Branch
(xv) Bank Account Number where
Pension is being credited with
IFSC Code & MICR No.
Annexure – II (Page-2)
Declaration by Ex- Employee
It is certified that immediately after joining WBPDCL, I had been contributing towards the Provident
Fund on my actual salary/wages and an equal amount was being contributed to my Provident Fund
by the Employer as provided under Para 26(6) of EPF Scheme, 1952. It is to further certify that an
amount @ 8.33% of the statutory wage ceiling i.e. Rs.5,000/Rs.6,500/Rs.15,000 out of the Employer’s
contribution had been remitted every month towards Employees’ Pension Scheme, 1995 since 16 th
November, 1995 or the date of joining whichever is later.
I, do hereby opt for depositing 8.33% of my actual salary/wages out of Employer’s contribution
towards the pension fund (after adjusting the amount already deposited in pension fund) from the
date of joining the EPS’95 till my attaining the age of 58 years.
Since I have already withdrawn entire Provident Fund on my retirement, I am ready to pay the
differential amount along with the due interest as may be applicable.
I also undertake that if any other legal/administrative formality is required in this regard, I am ready
to do accordingly.
I shall also be ready to bear any financial liability arising out of the option availed for higher
pension on actual salary/wages.
Place : Signature:
Date : Name :
Contact No.: Employee ID :
Declaration by the Employer/Establishment
Mr./Mrs.____________________________, having EPF Account No.___________________ and EPS
Account No.____________________________ was an Employee of WBPDCL. He/She has contributed to
the Provident Fund on his/her actual salary/higher wages, as per the terms of Para 26(6) of the EPF
Scheme, 1952. This establishment has no objection if an amount of 8.33% on his/her actual
salary/higher wages is deposited towards his/her Pension Fund from the date of commencement of
the Scheme i.e. 16/11/1995 or from the date of his/her salary exceeded the statutory limit or from the
date of joining the scheme, whichever is later, along with the due interest as may be applicable.
Disclaimer
The joint option submitted by eligible Ex-Employee does not confer any right to receive higher
pension nor does it create any liability/obligation of any kind for WBPDCL as an Employer.
NAME OF AUTHORIZED SIGNATORY:
SIGNATURE WITH ESTABLISHMENT SEAL:
ESTABLISHMENT CODE:
