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Sample Composite Form 11

1) The document is a composite declaration form for an employee to provide personal and employment details upon joining an establishment covered under the Employees' Provident Fund (EPF) and Pension Scheme (EPS). 2) The form collects details like name, father's name, date of birth, gender, marital status, contact and bank details, Aadhaar number, PAN, and previous PF/EPS membership details if applicable. 3) The current employer needs to declare if the employee's UAN details have been uploaded/approved and initiate transfer of previous PF account based on Aadhaar verification status.

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Yuga Nayak
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102 views

Sample Composite Form 11

1) The document is a composite declaration form for an employee to provide personal and employment details upon joining an establishment covered under the Employees' Provident Fund (EPF) and Pension Scheme (EPS). 2) The form collects details like name, father's name, date of birth, gender, marital status, contact and bank details, Aadhaar number, PAN, and previous PF/EPS membership details if applicable. 3) The current employer needs to declare if the employee's UAN details have been uploaded/approved and initiate transfer of previous PF account based on Aadhaar verification status.

Uploaded by

Yuga Nayak
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as RTF, PDF, TXT or read online on Scribd
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www.epfindia.gov.

in

Composite Declaration Form -11


(To reJained by tire employer for fldllre reference)
EMPLOYEES' PROVIDENT FUND ORGANJSA TION
Employees' Provident Funds Scheme, 1952 (Paragraph 34 & 57) &
Employees' Pension Scheme, 1995 (Paragraph 24)
(Dttlantion by a prrson taking ■p rm ployme■t ia a■y estabmb111C11t on wbicb EPF Sc:hane. 1952 a■d /or EPS, 1995 is applicable)

I Name of the member


All are Mandatory Fields
2
Father's Name
□
3
Spouse's Name
Date ofBirth: ( □I YYYY )
DD/ MM
4 Gender: (Male/Female/fransgender)
5 Marital Status: (Married/Unmarried/Widow/Widower/Divorcee)
(a) Email ID:
6
(b) Mobile No.:
Present employment details:
7 Date of joining in the current establishment (DD/MM/YYYY)
KYC Details: (attach self attested copies of following KYCs)
a) Bank Account No. :
8 b) IFS Code of the branch:
c) AADHAR Number
d) Permanent Account Number (PAN), if available

9
Whether earlier a member of Employees' Provident Flllld Scheme, Yes/No Select as applicable
1952
10 Whether earlier a member ofEmoloyees' Pension Scheme, 1995 Yes/No
Previous employment details: [if Yes to 9 AND/OR 10 above)- Un-exempted

Establishment Unive PF Date of Date of Sche PPONum Non


Name & Address rsal Account joining exit me ber Contribut
Acco Number (DD/MM/ (DD/MM Certific (if issued) ory
unt YYYY) / YYYY) ate No.
Period
Fill the previous
Numemployment PF details here – If you have selected
(if “YES” in point(NCP)D
9
11 avs
ber iss
ued

Previous employment details: [if Yes to 9 AND/OR 10 above)- For Exempted Trusts

Name & Address of the Trust UAN Member Dateof Date of exit Scheme Non
EPSNc joining (DD/MM/ Certificate Contributory
Number (DD/MM/ YYYY) No. (if Period (NCP)
12 YYYY) issued Days
Fill the previous employment Pension details here – If you have selected “YES” in point 10

a) International Worker: Yes /No

13 b) lfyes, state country of oril!in (India/Name


If you are anofInternational
other country) Worker – please provide the information at here – b), c) & d)
c) Passport No.

d) Validity of passport [(DD/MM/YYYY) to (DD/MM/YYYY)]


UNDERTAKING

I) Certified that the particulars are true to the best of my knowledge.


2) I authorize EPFO to use my Aadbar for verification/authentication/e-KYC purpose for service delivery.
J)Kindly transfer the ftmds and service details, if applicable, from the previous PF accountt as declared above to the present P.F.
Account as I am an Aadhar verified employee in my previous PF Account.•
4) In case of changes in above details, the same will be intimated to employer at the earliest. Employees Signature

Date:
Place: Signature of Member

DECLARATION BY PRESENT EMPLOYER

A. lbe member Mr/Ms/Mrs ······· ···················································-······· ·has joined on ···························-·····


·· ···· and has been

allotted PF No. -········-···········-···············-·····················.and UA.N....... ·-···································-···--·······-

·························

B. In case the person was earlier not a member ofEPF Scheme, 1952 and EPS, 1995:

• Please Tick the Appropriate Option:


lbe KYC details of the above member in the UAN database
D Have not been uploaded
D Have been uploaded but not approved
D Have been uploaded and approved with DSC/e-sign.

C. In case the person was earlier a member ofEPF Scheme, 1952 and EPS, 1995:
• Please Tick the Appropriate Option:-
□ The KYC details of the above member in the UAN database have been approved with E-sign/Digital Signature
Certificate and transfer request has been generated oo portal
D The previous account of the member is not Aadhar verified and hence physical transfer form shall be initiated.

Date: Signature of Employer with Seal of


Establishment

• Auto transfer of previous PF account would be possible in respect of Aadhar verified employees only. Other employees are
requested to tile physical claim (Fonn-13) for transfer of account from the previous establishment.

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