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Part A: Personal Information

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ONLINE TRANSFER CLAIM FORM [FORM 13 (REVISED) ]

( Tracking ID: 10106821456805001 )


Claim Date : 12/12/2018
EMPLOYEES' PROVIDENT FUND SCHEME, 1952
(PARA 57)

(This form has been printed on the basis of Online Transfer Claim Form filled up by the member under Unified Portal for submission to the
employer.)

To,
The Regional P.F. Commissioner,
BANDRA(MUMBAI-I),
341, Bhavishya Nidhi Bhawan Bandra (East), Mumbai

Sir,
I request that my Provident Fund balance along with my Pension Service Details may please be transferred to my present
account under intimation to me. My details are as under :

PART A : PERSONAL INFORMATION

1. Name : PRAKASH PAUL

2. Mobile Number : 9933725228

3. E-mail id : prakashpaul697@Gmail.com

4. Bank Account Number : 0181010474740

5. Bank IFSC : UTBI0GTL274

PART B : DETAILS OF PREVIOUS PF ACCOUNTS (WHICH IS TO BE TRANSFERRED)

1. PF Account No. (with EPFO office) : MHBAN00216250000173173

2. Name of the Establishment : STERLING AND WILSON PRIVATE LIMITED

: 9TH FLOOR UNIVERSAL MAJESTIC BUILDING P L LOKHANDE MARG


3. Address of the Establishment CHEMBUR WEST 599
4. PF A/C No. held by : BANDRA(MUMBAI-I)

5. Name of the Trust : NOT APPLICABLE

6. PF A/C No. in Trust : NOT APPLICABLE

7. Bank A/C No. of Trust : NOT APPLICABLE


8. IFS Code of the Bank Branch of
Trust where account is maintained : NOT APPLICABLE

9. Member's Name : PRAKASH PAUL

10. Date of Birth : 25/12/1995

11. Father's/Spouse Name : ASIT PAUL

12. Relationship : FATHER

13. Date of joining : 07/03/2017

14. Date of leaving : 30/09/2017


PART C : DETAILS OF PRESENT PF ACCOUNT

1. PF Account No. (with EPFO office) : WBTLO00384370000010591

2. Name of the Establishment : TRANSTECH

3. Address of the Establishment : 58, B.T.ROAD, KOLKATA 427

4. PF A/C No. held by : SRO BARRACKPORE(TITAGARH)

5. Name of the Trust : NOT APPLICABLE

6. PF A/C No. in Trust : NOT APPLICABLE

7. Bank A/C No. of Trust : NOT APPLICABLE


8. IFS Code of the Bank Branch of
Trust where account is maintained : NOT APPLICABLE

9. Member's Name : PRAKASH PAUL

10. Date of Birth : 25/12/1995

11. Father's/Spouse Name : ASIT PAUL

12. Relationship : FATHER

13. Date of joining : 01/10/2017

I, Certify that all the information given above are true to the best of my knowledge and I have ensured the correctness of
my present and previous account numbers.

Signature of the member

Note : Member should take a printout of this form and a signed copy of the same should be submitted to the Previous
Establishment i.e. STERLING AND WILSON PRIVATE LIMITED

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