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    Form 2 (PF Nomination Form)

    Uploaded by

    Vipin Handigund
    The document contains a form for employees to provide details of family members who would be eligible for widow or children's pension benefits in the event of the employee's death, including their name, address, date of birth, and relationship. It also includes a section for nominating individuals to receive monthly widow pension if the employee dies without an eligible family. The form must be signed by the employee and certified by an authorized employer representative.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Form 2 (PF Nomination Form)

    Uploaded by

    Vipin Handigund
    147 views2 pages
    The document contains a form for employees to provide details of family members who would be eligible for widow or children's pension benefits in the event of the employee's death, including their name, address, date of birth, and relationship. It also includes a section for nominating individuals to receive monthly widow pension if the employee dies without an eligible family. The form must be signed by the employee and certified by an authorized employer representative.

    Original Description:

    PF Nomination

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    The document contains a form for employees to provide details of family members who would be eligible for widow or children's pension benefits in the event of the employee's death, including their name, address, date of birth, and relationship. It also includes a section for nominating individuals to receive monthly widow pension if the employee dies without an eligible family. The form must be signed by the employee and certified by an authorized employer representative.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    147 views2 pages

    Form 2 (PF Nomination Form)

    Uploaded by

    Vipin Handigund
    The document contains a form for employees to provide details of family members who would be eligible for widow or children's pension benefits in the event of the employee's death, including their name, address, date of birth, and relationship. It also includes a section for nominating individuals to receive monthly widow pension if the employee dies without an eligible family. The form must be signed by the employee and certified by an authorized employer representative.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Part B (EPS)

    I hereby furnish below particulars of the members of my family who would be eligible to receive widow/children pension
    in the event of my death.

    Sl.No. Name and address of the family members Date of Birth Relationship with
    the member

    (1) (2) (3) (4)


    1
    2
    3
    4
    ** Certified that I have no family, as defined in para 2(vii) of Employees’ Pension Scheme, 1995 and should I acquire a
    family hereafter I shall furnish particulars thereon in the above form.

    I hereby nominate the following persons for receiving the monthly widow pension (admissible under para 16 2(a) (i) and (ii)
    of Employees’ Pension Scheme, 1995 in the event of my death without leaving any eligible family member for receiving
    Pension.

    Name and Address of the Nominee Date of Birth Relationship with the member

    (1) (2) (3)

    Dated the: ______________


    ………………………………………
    Signature or thumb impression
    of the subscriber
    **Strike out whichever is not applicable.

    .
    CERTIFICATE BY EMPLOYER
    Certified that the above declaration and nomination has been signed/thumb impressed before me by
    Shri/Smt./Kumari________________________________________________________employed in my establishment
    after he/she has read the entries/the entries have been read over to him/her by me and got confirmed by him/her.

    Place: ___________________

    Dated the __________________


    ………………………………………………………….
    Signature of the Employer or other authorised
    Officer of the establishment

    Designation……………………………………….
    Name and address of the Factory/Establishment
    or rubber stamp thereof

    PF - Form 2 (Revised)

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