02 July 2011
Employees Provident Fund Scheme Form 11 (Revised)
(For unexempted Establishment only)
Paragraph 34 of the Employees’ Provident Funds Scheme, 1952
Declaration by a person taking up employment in an establishment in which the Employees’ Provident Fund and Family Pension Fund Scheme are in force :
I ** son/wife/daughter of Name
hereby solemnly declare that –
(a) I was last employed in (Name and full address of the establishment) and left service on (Prior to that I was employee of from to date
**(b) I was a member of Provident Fund
and also/but not
of the Family Pension Fund from to
and my account number(s) was/were / /
(c) I have /have not withdrawn the amount of any Provident fund/Family Pnsion Scheme.
(d) I have/have not drawn any superannuation benefits in respect of my past service from any employer.
(e) I have never been a member of any Provident Fund and/or Family Pension Scheme.
Date Signature or **right/left hand thumb impression of the employee.
(To be filled in by the employer only when the person employed had not already been a member of the Employees’ Provident Fund)
Shri is appointed as (Name of the employee) (Designation) in (Name of the Factory/Establishment) with effect from (Date of appointment)
From to No. of days worked Date of completion of 120 actual working days in a period of 6 months or less or six months* continuous service or date of confirmation whichever is earliest. Date of admission as member of Employees’ Provident Fund
Account No. Signature of the Employer or Manager or other Authorised Officer.
Date ……………………………
** Strike out whichever is not applicable. N.B. – The principal employer should have filled it up also in respect of employees to be employed by or through a contractor.
02 July 2011
A declaration Form-11 is to be obtained from all employees joining the establishment.Whether their salary beloe 6500 or greater. Without maitain form No.11 epf dept treat to employee deemed under pf.and it will be penalised as per pf act.