IMPORTANT GUIDELINES FOR FILLING UP THE FORMS

All Forms should be filled up legibly with correct information duly attested by the employer to ensure faster and early settlement. SETTLEMENT OF YOUR EMPLOYEES PROVIDENT FUND ACCOUNT

Form 19
Sl. Number Particulars Instructions for furnishing the particulars

Fill your name legibly in capital letters. The Name of the member name furnished in Form* 9/5, Claim Form and Bank account should be identical. Fill your Father / Husband name legibly in capital letters.Father/Husband name furnished in Fathers Name Form* 9/5, Claim Form and Bank account should be identical. * - submitted by employer at the time of joining. Name and address of the Furnish the name of the Establishment with full factory / establishment in which postal address and pin code Number. the member was last employed Please fill up legibly State Code / Office Code / Establishment Code / Extn Code (If any) / Member Account Number. The Account Number allotted to the member shall continue till the member leaves that establishment and the Account number accumulation are settled/transferred. Example State / Office / Estt / Extn / Member TN / MAS / 5587 / A / 37 Correct Date of leaving should be filled in From the following please Indicate the reason applicable to you: 1. Retired from Service after attaining 55 years 2. Attained 55 years and resigned from service 3. Retired on Disability to the work 4. Under Voluntary Retirement Scheme 5. Migration to abroad on Permanent settlement 6. Retrenched from Service 7. Resigned / Left Service * * For cases of Resignation / Left Service, the claim should be submitted by the member only after two months from the Date of Leaving 1

Date of Leaving service

Reason for Leaving Service

Full postal address

Mode of Remittance

Service. However, Female members who leave the service for getting married can get immediate settlement. Full Postal address should be given clearly in Block letters. The father name / Husband name should be mentioned for clear identification. Postal address with House Number , Street name, Block, village , City, State etc. be filled in legibly. Postal Index Number should invariably be furnished. The payment of PF accumulations by Money Order is restricted upto Rs.2,000/-. In cases, where the payment involves more than Rs.2,000/- , the payment is allowed only through Cheque. It is safer to have the payment through cheque. Account Payee cheque will be sent directly to the Scheduled bank / Coop Bank / Post Office in which Savings bank Account of the member is maintained. So, furnish correct SB account number with full address of the Branch of the Bank. wherever applicable furnish the MICR Number also. Please furnish the Xerox copy of the First page of Saving Bank account pass book or monthly statement wherein the account number and address of the Bank is clearly visible. In the table provided in Page 3 contribution for the current financial year with wages should be furnished or Form 3A for the current financial year with attestation of the employer should be furnished. Member should sign in the application. He should sign the application in the presence of the employer. The authorized official of the establishment should attest the claim under the seal of his designation. It should be ensured, the specimen signature of the attesting official should have been already furnished to the EPFO. If the establishment is under permanent closure, attestation of the claim can be obtained from any one of the following authorized official:1. Manager of the bank where the member is holding the savings bank account 2. Head of Recognized Educational Institution 3. A Gazetted officer 4. Sub Post Master 2

Contribution for the current financial year

10

Signature of the member

11

Attestation by the Employer

12

Advance Stamped Receipt

5. The Magistrate 6. Member of Central Board of Trustees or Regional Committee of Employees PF Organisation 7. Chairman / Secretary / Member of the Municipal / District / Local Body 8. President of the Village Union / Panchayat 9. Member of Parlimantary / Member of Legislative Assembly 10. Any other Officer approved by the Regional PF Commissioner 11. Official Liquidator appointed by the Court of Law Wherever payment is sought through account payee cheque, the advance stamped receipt should be signed by the member duly affixing One Rupee Revenue Stamp. The amount need not be filled in, which shall be filled in by the RPFC / OIC of the EPFO Office.