Professional Documents
Culture Documents
Regn. No....................................
MobilNumber:9036268073
F ANTONY DOSS
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KN/BN/35329/18807
Account No.:.DL.
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26-MAR-2012
RESIGNATION
F.ANTONY DOSS
Shri/Smt./Kum.............................
...................................................
#72, FIRST MAIN, SECOND CROSS, DEVASANDRA MAIN ROAD,
S/O/W/O/D/O..............................
....................................................
BANGALORE
5 6 0 0 3 6
Pin :
8.
Mode of remittance
000901609446
S.B. Account No...........................................
ICICI BANK LTD
Name of the BDQN.................
NUNGAMBAKAM
Branch..........................................................
110,PRAKASH PRESIDIUM
Full address of the branch...........................
21-NOV-2011
Date of joining of Establishment.........................................................................
18-JAN-1986
Contribution
Period of
break if any
Employers
Total
Month
Employee
Wages
Month
EPF
FP
EPF
FP
EPF
FP
Contribution
Period of break
if any
Employers
Total
Wages
EPF
FP
EPF
FP
EPF
FP
( information to be furnished by the Employer if the Claim Form is Attested by the Employer)
Certified that the above contributions have been included in the regular monthly remittances.
The Applicant has signed/Thumb impressed before me.
............ .....................................................
10-MAY-2012
Date......................................
Designation & Seal
Encl.
Declaration of non-employment
Note:-
In the case of submission of application for settlement under clause (s) of sub-paragraph (i) and in
clause (b) of sub-paragraph (2) of paragraph 69 of the EPF Scheme, 1952, the claim should be
submitted after two months from the date of leaving service provided the member continues to
remain unemployed in an establishment to which the Act applies.
10-MAY-2012
Date.............. ...........
AC / RC
Remarks