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Joint Declaration For Any Changes

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prathamtagad1
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12 views

Joint Declaration For Any Changes

Uploaded by

prathamtagad1
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Letter No….. Date: ……….

(Revised Form 5/10) / Joint Declaration Form


To
The Regional P F Commissioner
EPFO,

Sub: Correction of the member details / Joint declaration by the member and the employer in respect of
Sh. / Smt. ______________________________________having PF A/c No: - ____________________ &
UAN No: - ____________________________

Dear Sir,
This is to inform you that the member details as available on EPFO Member Portal are
not correct in respect of the member mentioned above :-

Particulars / Data Description Data as per EPFO Office / Portal Corrected data of the Member
Name of the Member

Date of Birth (DD/MM/YYYY)

Father’s / Husband’s Name

Date of Joining (DD/MM/YYYY)

Date of leaving (DD/MM/YYYY)

Gender
PF/ EPS Account No.

The following documents as evidence in respect of _________________________ are enclosed


Documentary Evidence
1.
2.
3.
It is requested that the member data may be corrected accordingly. An early action in this
regard will be highly appreciated.

Yours Faithfully,

Signature and Name of Member

(Signatory and Name of Authorized Signatory


With Establishment Seal)

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