Instruction to fill up PF/FPF Forms Note: Any corrections /overwriting in the Form is liable for rejection

Form - 10C EPF

1. Fill your full name in block letters. 2. Fill in your date of Birth as declared to your ex-employer. 3. Fill your fathers name, In case of married women employee please fill in the husbands name, if already declared to the P F dept, else please fill in Fathers Name only. 4. Provide the Name and Full address with pin code of the Company in which you were last employed. 5. Provide your PF A/c number maintained by the last employer with State code, regional code and also Company code. If you are not aware, please get in touch with your ex-employer. Example: GJ/BRD/65250/ XXX. Suggest not writing No we will write correct Number 6. Provide your Date of leaving from service i.e., Last working day from the service. It should match with employer records. So please check your Full and Final settlement sheet provided by the your ex-employer at the time of resignation. Also provide specific reason for leaving the service from the employment. This should not be filled with reasons such as Better Prospects or for New Job etc., as the withdrawal is permitted only when a person is unemployed for a minimum period of 60 days of vesting period. You may use the reasons only such as Resignation.

7. Please fill your Postal Address in block letters with Father Name and Pin code. It will help the department for further follow-up of settlement. 8. Your choice has to be No as you are withdrawing the benefit. 9. This is not applicable for withdrawals. 10 This is not applicable for withdrawals. 11. Please provide your mode of remittance, This has to be Bank account details only if the amount of balance exceeds Rs 2000/- Hence please fill your correct Bank A/c number and Name of bank with full postal address of the branch where the account is held. Also provide Bank statement duly singed & seal by Bank 12. State NO if you are not receiving any pension from PF till date Page 2 Please ensure that you sign the Form 10C at two places. a) At the end of the line 12. b) Advance stamped receipt. On/ across the Revenue stamp Note: Any corrections /overwriting in the Form is liable for rejection

Form 19 Withdrawal
1 Full name in Blok letters 2. liiFrseF r eoeouFernoeFoeFdruoF FnreelocFnnoeFonairooFaioruoF liiF . FFleF eoFFesu recouFernoeFl FrieorcrFcodireocF F eoFfF Fcoa eFoiuoFaioruoF lii leF r eoeouFrrnoFeirFF 3. Provide the Name and Full address with pin code of the Company in which you were last employed. 4. Please fill your EPF A/c Number maintained by the last employer with State code, regional code and also Company code.

5. Provide your Date of leaving from service i.e., Last working day from the service. It should match with employer records. So please check your Full and Final settlement sheet provided by the your ex-employer at the time of resignation. 6. Please provide specific reason for leaving the service from the employment. This should not be filled with reasons such as Better Prospects or for New Job etc.,. You may use the reasons only such as Resignation . 7. Please fill your Postal Address in block letters with Father Name and Pin code. It will help the department for further follow-up of settlement. 8. Please provide your mode of remittance, This has to be Bank account details only if the amount of balance exceeds Rs 2000/- Hence please fill your correct Bank A/c number and Name of bank with full postal address of the branch where the account is held.
Also provide Bank statement duly singed & seal by Bank

b. Provide your Date of joining of the Establishment, which has to match with employers records. Contribution for the Current Financial Year.Do not write any this .Co will attend Page 2

Signature of Left/Right hand thumb impression of the member Please ensure that you sign the Form 19 at three places. a) At the end of the Line 9 before the Employer who have to attest the signature. b) Non declaration of employment.

c) ADVANCE STAMPED RECEIPT (To be furnished only in case of 8 (b) above Advance stamped receipt. On/ across the Revenue stamp
Collabera Technologies Pvt. Ltd. 801, 8th Floor, Ivory Terrace, Opp. Circuit House, R.C. Dutt Road, Alkapuri, Vadodara - 390 007, Baroda, Gujarat, India. Tel.: 0265 - 6199652.

P F A/c No. - GJ/65250/919 Date of Joining - 29/10/2012 Last working day- 09 April 2013 Employee ID 4415
11664 Branch Name Branch Category Address City Pin Code District State Telephone 1 Telephone 2 IFSC Code: SBIN0011664 500072 RANGAREDDY ANDHRA PRADESH (40) 23053230 (40) 990129 KUKATPALLY I E REGULAR BRANCH 12-6-2/273/1 TO 12 VC PLAZA OPP BJP OFFICE KUKATPALLYHYDERABAD