PF Withdrwal Application

APPLICATION FORM TOWARDS PROVIDENT FUND SETTLEMENT
To,
The Trustees Application Number: TLBA6B4EC19B
Teamlease Services Limited EPF Trust Date: 05-05-2020
1.I, Mr./Ms Pavan Hk ceased to be an employee of Teamlease Services Limited, with effect from 10-02-2020 on account of:- (Mention your
last working day)
2.I, Mr.Ms.............................................................................................. (nominee) submit the application on behalf my.........................

Mr.Ms............................................................................................... who ceased to be an employee of Teamlease Services Limited, with effect
from............................................on account of
(Please fill (1) if the claiment is Self or please fill in (2) if the claimant is Nominee)
Retirement Medical Unfitness Death End Of Contract Permanent Settlement Abroad

Resignation Retrenchment VRS Termination Others
(please tick whichever is applicable.)

You are requested to settle my Pavan Hk Provided Fund a/c at the earliest Ihereby solemnly declare that since last two months,
Iam not employed in any establishment to which EPF Act of 1952 is applicable, Ialso authorize the Trustees to deduct Tax at
source ( TDS) as applicable in my case*
Signature of Employee/ Claimant

( please enclose a letter from the current employer if employed, and not covered by EPF Act 1952
EMPLOYEE PARTICULARS (TO BE FILLED IN BLOCK LETTERS)

1)Name of the Employee Mr/Ms Pavan Hk
2)Address for Communication 78 haralahalli haralahalli lalanakere nagamangala mandya karnataka ,,KAR,001-
571802
(please state the address where you desire to your Phone: 9632565391 Email: pavanhk@gmail.com
cheque to be sent)
3)Location Unit BANGALORE 4)PF NO BG/BNG/0035224/000/1362384 5)Transfer In
6)Emp Code 1720624 7)EPS No 8)Tran In Date
9)DOB 25-09-1996 10)DOJ 01-10-2019 11)DOJ(PF) 01-10-2019
12)Bank Account
917010039769415 13)IFSC Code UTIB0001185 14)PAN No
No
15)Bank Name and
AXIS BANK
Address
16.Nomination Details (To Be filled in case of death)
Name Of Nominee Relation Percentage
ADVANCED STAMP RECIPT
Received a sum of Rs...................................
(Rs............................................................................................................................................................................ ) only from Teamlease services
Limited EPF Trust by deposit in my savings bank account towards the settlement of my PF Fund
Rs.1/-
Revenue
Signature or left hand thumb impression or the member on the stamp
Stamp
TEAMLEASE SERVICES LIMITED EPF TRUST

ACKNOWLEDGMENT FOR RECEIPT OF PF SETTLEMENT APPLICATION FORM
Employee Number: 1720624 Application Number: TLBA6B4EC19B
Pavan Hk Seal & Signature of person receiving: .............................................
Name of the Employee:
INSTRUCTION FOR FILLING IN THE APPLICATION

*TDS is applicable if your membership is less than 5 years and if you have taxable income in any of the previous years during service. No
TDS is applicable if you wish to transfer the accumulations to your present employer ( if any).
1. Sr. No. 5- The PF no. allotted to the employee should be entered, the same is available in salary slip.
2. Sr. No. 6- The EPS No. allotted to the employee should beentered , it is same as PF number.
3. Sr. No. 7 If the applicant has transferred his previous PF accumulations to the current PF a/c, the applicant should tick"Y" or else “N" if
there is any previous Transfer in to the current PF a/c.
4. Sr No.10- The Date of Joining the Company by the employee should be entered.
5. Sr. No. 11- The date of joining the PF membership by the employee should be entered. PF membership date is the date from which the
member commenced contribution to PF. In case the member of PF in his/her previous employment. Then that date has to be mentioned.
General
The application should be signed by the HR/ Unit Head/ Coordinator before forwarding to Bangalore and date of forwarding the
application should also be entered for better tracking of applications.
Form 10C/ 100 should be filled and enclosed with the application ,the same shall be forwarded to RPFC accordingly.
(Form l0C is to be filled in for settlement of pension by RPFC if the applicant has not completed 1 0 years of eligible service- Form l0D to
be filled in for settlement of pension by RPFC if the applicant has completed 10 years of eligible service.)
If you are in need of any further inputs or clarification, please send your queries to info@teamlease.com with captioned subject and with
your employee code or please call us on 080 -60000655

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APPLICATION FORM TOWARDS PROVIDENT FUND SETTLEMENT

2.I, Mr.Ms.............................................................................................. (nominee) submit the application on behalf my.........................

Retirement Medical Unfitness Death End Of Contract Permanent Settlement Abroad

(please tick whichever is applicable.)

Signature of Employee/ Claimant

EMPLOYEE PARTICULARS (TO BE FILLED IN BLOCK LETTERS)

TEAMLEASE SERVICES LIMITED EPF TRUST

INSTRUCTION FOR FILLING IN THE APPLICATION

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