PF CLOSURE GUIDELINES

Associates willing to close the Provident Fund from Cognizant have to fill composite claim form, (as well as two
copies of form 15G along with PAN and Aadhaar).

TIME DURATION FOR SETTLEMENT:

PF Closure forms will be processed only after 60 days from your Date of Release or received (whichever is higher).

Post submission of forms to PF Office, it takes around 2 TO 4 Months for crediting the amount in your Bank A/c.

You can check the status by logging on to http://epfindia.gov.in/site_en/ upon submission of your forms to PF Office.
PLEASE READ THE INSTRUCTIONS BEFORE FILLING THE FORM
FAILURE TO COMPLY WITH THE INSTRUCTIONS WILL RESULT IN THE REJECTION OF YOUR PF CLAIM

 Do not overwrite or use white ink or eraser for corrections

GUIDELINES TO FILL FORM 19,10C & 15G
 You need to sign under appropriate places in the Forms. In case of Signature missed out the claim will be
rejected.
 Two copies of Form 15G must be filled manually and submitted along with two self-attested PAN card
copies.(Failing to furnish these will result in TDS being deducted from your PF amount)
 Copy of Aadhaar and PAN with Signature of the member is Mandatory.
 Proof for your Bank A/c. (Cancelled Cheque (or) Bank statement (or) Copy of Bank Pass Book) – (Mandatory)
 Bank A/c Differs, Joint A/c, Member name differs, & A/c number not visible in the bank proof will be rejected.
 If the Associate is currently active or if a duplicate form is submitted, it will be rejected.

Pre-filled form have been attached for your reference, please refer the same prior to filling your details.

Form No-15G – (Two Copies of Filled Form 15G along with a PAN Card Copy is mandatory)

As per the recent amendment in Income Tax Act, 1961, Income Tax shall be deducted at source (TDS) at
The following rates if at the time of payment of the accumulated PF balance is more than or equal to Rs.
50,000/-, with continuous membership with PF less than 5 years:-

 TDS will be deducted @ maximum marginal rate (i.e. 34.608%) if a member fails to submit PAN and
Form No 15G or 15H (Senior Citizen).

 TDS will be deducted @ 10% provided PAN is submitted.

 No tax deduction if both PAN and Form 15G/H declared.

 Form 15G and 15H may not be accepted if amount of withdrawal is more than
Rs. 2, 50,000/- and Rs. 3, 00,000/- respectively.

TDS shall not be deducted in respect of the following cases:-

 Transfer of PF from one account to another PF account.

 Termination of service due to ill health of member.

 If employee withdraws PF after a period of five years of continuous membership, including service with
previous employer/s.

 If PF payment is less than Rs. 50,000/- but the member has rendered service of less than 5 years.

pg. 1
Documents to be enclosed along with the PF Closure Forms:

 Proof for your Bank A/c. (Cancelled Cheque (or) Bank statement (or) Copy of Bank Pass Book) – (Mandatory).
Account Number, Branch Address, IFSC Code are mandatory in (Cancelled Cheque /Bank Pass Book / Bank
statement). Printed Member Name required in Cheque Leaf if not Member signature is required with name in
BLOCK LETTER. Joint Account, NRI & NRO Not Accepted, CITI Bank Account Not Advisable.

 Two Copies of PAN & one copy of Aadhaar with Signature of the member. (Mandatory)

 A letter addressed to The Regional Provident Fund Commissioner, Chennai - justifying the reason for closing your
PF A/c. – (Mandatory)

Please send the forms through courier or in person as any other mode is not advisable.
Also furnish your email ID & contact no for PF Office to communicate further, if needed.

FOR ANY FURTHER QUERIES YOU CAN REACH:

Point Of Contact - Provident Fund Team

E-mail - hrss@cognizant.com
Address - PF Team:-
Cognizant Technology Solutions
DLF Info City, 1/124, Sivaji Gardens
Block 9, B Wing, 11th Floor,
Mount P.H.Road , Manapakkam, Chennai – 600 089.

Please align the form in below Order

Cheque Leaf

Cancelled
Name of the Member

Proof for your Bank A/c. (Copy of Bank Pass Book / Bank statement / Cancelled Cheque) (Mandatory)

Member Name Mandatory in Cheque Leaf

Joint Account, NRI & NRO Not Accepted
CITI Bank Account Not Advisable

pg. 2
Associate ID:..................
PF Number: TN/MAS/31309/................. www.epfindia.gov.in
र्ोबाइभ िम्बर
8888888888
Mobile Number

कर्मचारी भविष्य विवि संगठि

EMPLOYEES’ PROVIDENT FUNDS ORGANISATION
संयक्
ु E ाािा ्रपत् )रिार रवहE(
COMPOSITE CLAIM FORM (NON-AADHAR)

[फार्म सं.- 19 )भविष्य विवि के अंवEर् वितटाि/10सी )तेंशि ्रपत्याहरल भाभ( / 31 भविष्य विवि का रंवशक ्रपत्याहरल(]
[ FORM NO. – 19 (PF FINAL SETTLEMENT)/10C (PENSION WITHDRAWAL BENEFITS)/31 (PF PART WITHDRAWAL)]

1 ाािा विसके वभए रिेाि ककया गया है: i) भ.वि. का अंवEर् वितटाि ) ( ii) तेंशि ्रपत्याहरल भाभ ) ( iii) भ.वि. हरल ) ( )िो भागू हो, उस तर  का विशाि भगाएं(
Claim applied for: i) Final PF Settlement ( ) ii) Pension Withdrawal Benefits ( ) iii) PF PART WITHDRAWAL ( )
)िो भागू हो, उस तर  का विशाि भगाएं( (Tick whichever is/are applicable)
2 सास्य का िार् )स्तष्ट अ्षरर र्ें( / Name of the member:(IN CAPITAL LETTERS)
DINESH N
3 (क) यूवििसमभ खाEा संखया )यू.ए.एि.( / Universal Account Number(UAN) क(: 100xxx000xxx
ख(: TN/MAS/31309/XXXXXX
(ख( भ.वि. खाEा संखया )यका यू.ए.एि. उतभब्ि िह है( / P.F Account No.(in case UAN not available)
4 रिार संखया )सील ग के वभए(/Aadhar Number (for seeding): 888xxx888xxx
5 क( वतEा का िार् / Father’s Name: क(: NANDA KUMAR
ख(:
ख( तवE का िार् /Husband’s Name:
6 िन्र् वEव /Date of Birth: 12-12-1988
7 स् ातिा र्ें कायमरहणहल करिे कत वEव /Date of joining the establishment: 12-12-2012

8 िौकरी छोड़िे कत वEव : )यका रिेाि भ.वि. के रंवशक ्रपत्याहरल के वभए है Eो रिययक िह (
12-12-2013
Date of leaving service: (not required if applying for PF Part Withdrawal)

9 क) स् ायी खाEा संखया )तैि(: )के िभ तांच िर्म के कर् का सेिा काभ होिे तर(
(फार्म सं.15िी /15एच कत ाो ्रपवEयां संभग्न करें , यका भागू हो( 1x2x3xAFxx
Permanent Account No.(PAN): (Only in case of service less than 5 years)
(Please enclose two copies of Form No. 15G/15H, if applicable)
ख) िौकरी छोड़िे का कारल/ Reason of leaving Service: RESIGNED
- सेिा सर्ावि )क( खराब स्िास््य के कारल )ख( वियोक्Eा के ययातार के संकुचि विछछेाि के कारल या )ग(
सास्य के वियं्ल से तरे को कारल
- Service terminated on account of (a) ill health of member (b) Contraction /Discontinuation
of employer’s business or (c) Other Cause beyond the control of the member
- ययवगगE कारल / Personal Reasons
10 क( भ.वि. के रंवशक ्रपत्याहरल का उदेशेयय )िो भी भागू है उस तर √ का विशाि भगाएं क्रसं.
भ.वि. के रंवशक ्रपत्याहरल का उदेशेयय Purpose of PF Part Withdrawal 
Purpose of PF Part Withdrawal:(Tick  whichever applicable) SN

I रिासीय ऋल/ सा ट/र्काि/फ्भैट कत खरीा या विर्ामल/बढािे के वभए,

र्ौिूाा र्काि र्ें तररिEमि/ रिासीय ऋल कत अाायगी )तैरा
ख( रावश )ेंतये र्ें(Amount (in Rs.): ______________________________________ 68बी/68बीबी/68बीसी(/
Housing Loan/Purchase of site/House/Flat or for

ग( सा ट/र्काि/फ्भैट या “एिेंसी” के र्ाध्यंर् से विर्ामल या रिासीय ऋल या एभ.र .सी. कत अाायगी के उदेशेयये से Construction/Addition, alteration in existing

भी िािे िाभी रावश के वभए ्रपािाकEाम का तEा और चैक विसके त्षर र्ें बिाया िािा है ाशामए।ं For purpose house/Repayment of Housing loan

of Site/House/Flat or Construction through “agency” or Repayment of Housing Loan or LIC, (Para 68B/68BB/68BC)

indicate cheque to be drawn “ in favour of” and payee’s address. Ii फै क्री र्ें Eाभा बंा होिा। )तैरा 68एच( Lockout or closure of factory
(Para 68H)
Iii सास्य/तररिार कत बीर्ारी )तैरा 68िे(
Illness of member/family (Para 68J)
iv स्ियं/ तु्/तु्ी/भा /बहि का वििाह )तैरा 68के (
Marriage of self/son/ daughter /brother/ sister (Para 68K)
v बछच कत र्ैररक के बाा कत वश्षरा )तैरा 68के (
Post Matriculation education of children (Para 68K)
vi ्रपाकृ वEक रताा (तैरा 68एभ(
Natural calamity (Para 68L)
vii स् ातिा र्ें वबिभी कत कटौEी )तैरा 68एर्(
Cut in electricity in establishment (Para 68M)
viii शारीररक ेंत से विकभांग के वभए अवरहणर् )तैरा 68एि(
Advance for Physically handicapped (Para 68N)
ix सेिावििृवि से एक िर्म तूिम)तैरा 68एिएि(
One year before retirement (Para 68NN)
x िररष्ठ तेंशि बीर्ा योििा र्ें वििेश
)तैरा 68एिएिएि(
Investment in Varistha Pension BimaYojana (Para 68NNN)
11 भुगEाि के वभए बैंक खाEे का वििरल /Bank Account details for payment: बचE बैंक खाEा सं./ Saving Bank Account No.
)कृ तया विरस्E चैक कत ्रपवE/बैंक तासबुक के तहभे तृष्ठ कत सत्यावतE ्रपवEवभवत संभग्न करें । XXXXXXXXXX2023
.........................................................................................................................
(Please attach a copy of cancelled cheque/attested copy of first page of Pass Book)
DCDC BANK
बैंक का िार् एिं तEा / Name & address of the Bank ........………………………
NO: XX , SKSSDL , Road , Chennai - 600000
…………………………………………………………………………………….

र .एफ.एस को ./IFS Code ……………………………………................

IFSC0001235
12 तूरा ाक तEा /Full Postal address
NO>XX ,PUNE ,MAHARASHTRA

411046
वति Pin...............................................
- सास्य यह ोोर्ला करEा है कक िह ाो र्ाह से िौकरी िह कर रहा है )हां /िह ( / - ्रपर्ावलE करEा हं कक वििरल र्ेरी िािकारी के अिुसार सही है।
The member hereby declares that he has not been employed for two months (Yes/No.) - Certified that the particulars are true to the best of my knowledge.
- यका रावश का उतयोग उतयुमग कॉभर् )10( र्ें काए गए उदेशेयय के अभािा ककसी अन्य उदेशेयय के वभए होEा है Eो र्ैं संतूलम रावश को ब्याि सवहE िातस करिे के वभए उियराायी हं।
In case the amount is used for any purpose other than stated in column (10) above, I am liable to return the entire amount with penal interest.

Member signature
For Cognizant Technology solutions India Pvt. Ltd.
(X)
सास्य के हस्Eा्षरर /Member’s Signature वियोक्Eा के हस्Eा्षरर/ Employer’s Signature
वियोक्Eा का तािार् एिं सीभ /Designation& Seal of Employer
Authorized Signatory
 There is no sample For Filling Form 15G, Please get help from Income Tax People (IT)

(15G Form & PAN Card) Address Proof - Aadhaar copy (Mandatory if Aadhaar having)

Declaration Letter-1

pg. 3
 Declaration Letter

Personal Details

pg. 4
 www.epfindia.gov.in

संयुक्तiतदावातप्रपत्रत(आधारतरहिi)तभरनेतिे iुतअनुदेशतशीट
INSTRUCTION SHEET FOR FILLING THE COMPOSITE CLAIM FORM (NON-AADHAR)

1. निम्निंEकितनहे तनु आवेदिनकियंनजंनसितंनहै :-नThe application can be made for :

i) यननिि निेनअEनतमननिपटंिन/नFinal P.F. Settlement
भववष्न
ii) पेंशिनप्रतनयंहरणनलंभन(िेवलन10नवर्षनसेनिमनिंनसेवंिंलनहोिेनपर)नन
Pension Withdrawal Benefits (only if the service is less that 10 years)
iii) भववष्न
यननिि नआEिशिनप्रतनयंहरणन/नPF Part Withdrawal,
तदिुसंरनबॉक्नसनमेंननिशंिनलगंएE/नTick the boxes accordingly.
2. िंम:निंमनस्न टनअक्षरोंनमेंनिलखें /नName :नName in CAPITAL LETTERS
पष्न
3. a) यू.ए.एि.: 11न अEिोंन िीन यूनिवसषलन खंतंन सEख्नयंन िंन ्लनलेखन िरें न / UAN:न Kindly mention the 11 digit Universal Account
Number
यननिि नखंतंनसEख्नयं/नb) PF Account Number:
b) भववष्न
4. िृपयंनबंरहनअEिोंनिीनआ ंरनसEख्य
न ंनिंन्लन
लेखनिरें /नKindly mention 12 digits Aadhar Number:
5. ि)नवपतं िंनिंम: स्न
पष्न
टनअक्षरोंनमें निलखें/ a) Father’s Name : Kindly write clearly.
ख)नपनतनिंनिंम: स्न
पष्न
टनअक्षरोंनमेंनिलखेंन/नb) Husband’s Name: Kindly write clearly.
6. जन्नमननतिि: ददि/मंह/वर्षनिेनफंमेटनमेंन/नDate of Birth : In DD/MM/YYYY format
7. स्निंपिंनमेंनिंयष ग्रहणनिीननतिि -नददि/मंह/वर्षनिेनफंमेटनमेंन/ Date of Joining the establishment:नIn DD/MM/YYYY format
8. िौिरीनछोड़िेनिीननतिि - ददि/मंह/वर्षनिेनफंमेटनमेंन/ Date of leaving service:नIn DD/MM/YYYY format
9. स्निंयीन खंतंन सEख्नयंन (पैि):न िेवलन पंEचन वर्षन सेन िमन िंन सेवंिंलन होिेन पर / Permanent Account Number (PAN): In case of
service less than 5 years.
फंमषन15जी/15एचनिीनदोनप्रनतयंEनसEलग्न िनिरें ,नयददनलंगूनहोन/नPlease submit two copies of Form 15G/15H, if applicable.
(यददनभ.नि.नसेनआEिशिनप्रतन
यंहरणनिेनिलएनआवेदिनिरनरहे नहतनतोनपैिनिीनआवश्न
यितंनिहीEनहै )न/न(PAN not required if applying for
PF Part Withdrawal)
िौिरीनछोड़िेन िंनिंरणन- िेवलनभववष्न
यननिि नअEनतमननिपटंिनिेनमंमलेन मेंन :नइिमेंन सेन िोईनएिनिंरणनहोिंनचंदहएन/न Reason for
leaving service: Only in case of PF Final Settlement. The reason may be:
I. समंपिनिेनिंरण/नTermination on account of
a) सदस्न
यनिीनबीमंरी/नill health of member
b) नियोक्नतंनिेनव्नयंपंरनमेंनिमी/बEदनहोिंन/Contraction /Discontinuation of employer’s business or
c) सदस्न
यनिेननियEत्रणनसेनबंहरनअन्न
यनिंरण/नOther cause beyond the control of the member
d) व्नयक्तक्तगतनिंरणन/नPersonal Reasons
II. यनिेनिलए)न/नMarriage (for female member)
वववंहन(मदहलंनसदस्न
िंयीनप पनसेनबसिेनिेनिंरण/नPermanent Settlement Abroad
ववदे शनमेंनस्न
 आयिरन(टीडीएस)निंटंनजंएगंनयददनसेवंन5 वर्षन (60 मंह)नसेन िमनहै ।नआयिरन(टीडीएस)निहीEन िंटंनजंएगंनयददनिुलनशेर्न
प .न50,000 सेन िमनहै ।नयद्यवपनऐसेन मंमलोंनमेंन टीडीएसन10% िीनदरनसेन िंटंनजंएगंनयददनसदस्यनपैिनप्रस्तुतनिरतंनहै ।न
पैिनप्रस्तुतनिहीEनकिएनजंिेनिेनमंमलेनमेंन34.608% िीनदरनसेनटीडीएसनिंटंनजंएगं।
Income Tax (TDS) is deducted if the service is less than 5 years (60 months). No Income Tax (TDS) is deducted in
case the total balance is less than Rs. 50,000/-. However, TDS is deducted @10% if the member submits PAN in
such cases. In case PAN is not submitted, then TDS @34.608% is deducted.

 वतषमंिनस्न
िंपिंनिेनसंि-संिनवपछलीनस्न
िंपिंनिीनिुलनसेवंनिीनगणिंनिीनजंएगी,नअत:नसभीनभववष्न
यननिि नखंतोंनिोनएिन
संिनिमलंिेनिंनसुझंवनददयंनजंतंनहै ।न
The total service in the present establishment as well as previous establishment is counted and, therefore, it is
advisable to merge all PF accounts.

10. भववष्नयननिि नआEिशिनप्रतनयंहरणनिंन्देशेश्य

न नररनआवश्न
यिनरंिश/नPurpose of PF Part Withdrawal and Amount required:
(इिमेंनसेनिोईनएिनिंरणनहोिंनचंदहए)न/नThe purpose may be one of the following:
i) आवंसीयन ऋणन /भूिमन /घरन/फ्लैटन खरीदिेन हे तु/न वतषमंिन घरन मेंन निमंषण/अनतररक्न
तन फेरन बदल/न आवंसीयन ऋणन िोन चुिंिेन िेन
िलए:न िोईन दस्न
तंवेजन अपेषितक्षतन िहीEन है ।न किसीन दस्न
तंवेजन (ियंन घोर्णंन पत्र/न ्पयोिगतंन प्रमंणन पत्रन इतनयंदद)न िीन आवश्न
यितंन
िहीEन है ।न Housing Loan/purchase of site/house/flat or for construction/Addition alteration in existing
house/Repayment of Housing loan: No document is required. No document (New Declaration Form/Utilization
Certificate etc.) is required.

यददनअिग्रमनसंईट/मिंि/फ्लैटनिीनखरीदनयंनएजेंसीनिेनमंध्न
यमनसेन निमंषणनयंनआवंसीयनऋणनिीनअदंयगीनिेनिलएनहै न तोन
क्तजसिेनपक्षनमेंनअदंनकियंनजंिंनहै ,न्सिंनिंमनदशंषएन।न
In case the advance is for purchase of site/house/flat or construction through Agency or repayment of Housing
Loan then indicate the name in whose favour the payment has to be made.

ii) फैक्नरीनिी तंलंबEदी यं बEद होिं/नकिसीनदस्न

तंवेजनिीनआवश्न
यितंनिहीEनहै न/नLockout or closure of factory: No document is
requiredन.
 iii) सदस्न
य/पररवंरनिीनबीमंरीन: i) डॉक्नटरनिंनप्रमंणनपत्रनररनii )ननियोक्नतंनद्वंरंनप्रमंणनपत्रनकिनसदस्न
यनिेनपंसनिमषचंरीनरं्नयन
बीमंन निगमन िीन सवु व ंन ्पलब्न न िहीEन है न /Illness of member/family: i) Certificate of doctor and ii ) Certificate by
employer that ESIC facility is not available to the member.
iv) स्न
वयE/बेटं/बेटी/भंई/बहिन िीन शंदी:न किसीन दस्न
तंवेज/शंदीन िंडषन िीन आवश्न
यितंन िहीEन है न /न Marriage of
self/son/daughter/brother/sister: No document/Marriage Card is required.
v) बच्चन
चोंनिीनमैदरिनिेनबंदनिीनिशक्षं:नकिसीनदस्न
तंवेजनिीनआवश्न
यितंनिहीEनहै न/नPost Matriculation education of children:
No document is required.
vi) प्रंिृनतिन आपदंन िेन असं ंरणन मंमले:न किसीन दस्न
तंवेजन िीन आवश्न
यितंन िहीEन है न /न Natural calamity of exceptional
cases: No document is required.
vii) स्न
िंपिंन मेंन बबजलीन िीन िटौतीन :किसीन दस्न यितंन िहीEन है न /न Cut in electricity in establishment:न No
तंवेजन िीन आवश्न
document is required.
viii) शंरीररिनप पनसेन वविलंEगनद्वंरंन्पिरणनिीनखरीद:निचकितनसंनप्रमंणनपत्रनिीनआवश्न
यितंनहै /नPurchase of equipment by
physically handicapped: Medical certificate is required.
ix) सेवंनिवक्तृ ततन सेन एिन वर्षन पूवनष िुलन भववष्न
यन निि न बिंयंन िंन 90%न तिन नििंलन सितेन हत।न किसीन दस्न
तंवेजन िीनआवश्न
यितंन
िहीEनहै न/One year before retirement: 90% of total PF balance can be withdrawn. No document is required.
x) वररष्नवन पेंशिनबीमंनयोजिंनमेंन निवेश:न िुलनभववष्नयननिि न रंिशनिंन 90न%तिनएल.आई.सी.नमेंन अEतररतनिरन सितेन हत।किसीन
दस्न
तंवेजनिीन आवश्न
यितंन िहीEन है न /न Investment in Varistha Pension Bima Yojana: 90% of total PF balance can be
transferred to LIC. No document is required.

11. बतिनिंनवववरणन-निृपयंनसEलग्निनिरें न-निृपयंननिरस्नतनचैिनिीनिॉपी/पंसबुिनिेनपहलेनपष्ृ नवनिीनसतनयंवपतनप्रनतनक्तजसमेंनदंवंितंषनिंन

िंमनस्न टनप पनसेनवप्रEटनकियंनगयंनहोन/नBank Details: नPlease attach a copy of Cancelled Cheque/self-attested copy of first
पष्न
page of Pass Book clearly showing member’s name printed on it.

12. िृपयंनसदस्नयनिेनपतेनिंन्लनलेखनिरें /नKindly mention the address of the member.

13. सदस्नयनद्वंरंनरंजस्नवनस्नटंEपन(प पयेन 1/-न)नलगंिेन िीनआवश्नयितंनिहीEन है न न No Revenue stamp (Re. 1/-) is required to be affixed
by the member.