TATA CONSULTANCY SERVICES EMPLOYEES PROVIDENT FUND

APPLICATION FOR SETTLEMENT OF PROVIDENT FUND ACCOUNT

(TO BE FILLED BY APPLICANT)
To,
The Trustees,
Tata Consultancy Services Employees Provident Fund,
Mumbai.

Dear Sir,
As I have ceased to be an employee of TCS Limited with effect from _________________, I request you to settle my
Provident Fund account and pay the said amount at an early date .
1. Name:-________________________________________________________ ___________________

2. Fathers / Husbands Name:___________________________________________________________

3. Employee Number : ______________ Address for correspondence
4. Date of Joining Service : ______________
5. Date of cessation of service : ______________

6. Period of Service : ______________

7. PAN card No. :______________
8. Transferred previous PF to TCS : Yes / No Mobile No. :
If Yes, Name of Previous employer :__________________ Personal Email Id :
9. Bank Account Details: Savings Bank A/c No.: ______________ MICR/IFSC Code No.: ____________
Name of the Bank:___________________________________ Branch :_______________________
10. Reason for withdrawal of Provident Fund Accumulations
Tick Signature Tick Signature

a. Retirement b. Going Abroad \

Permanent migration from India

c. Permanent & total

Disablement \ incapacitation

(Please tick the applicable reason & sign in the text block)
DECLARATION OF NON-EMPLOYMENT
(This declaration is not applicable if any of the above reason for withdrawal is selected)

I declare that I have not been employed in any Factory/Establishment to w hich the Act applies for a continuous period of not less
than 2 months immediately preceding the date of my application for final w ithdraw al of my Provident Fund money.

Place: __________ Yours faithfully,

Date: __________

(Signature)
Note:- The PF withdrawal amount is subject to tax, If contributory service (inclusive of service rendered in
previous employment provided the PF is transferred to TCS) is less than five years.
ADVANCE STAMPED RECEIPT
Received a sum of Rs .______________(Rupees_____________________________________________
_____________________________only) from the Trustees of TCS Employees Provident Fund towards full & final
settlement of my Provident Fund account.
Affix.
1 Rs. Revenue
Stamp

(Please sign across the Stamp)

The details given in Item No. 1 to 5 are verified .

Date: (Signature of Employer)