EMPLOYEES' PROVIDENT FUND ORGANISATION

(Ministry of Labour& Employment, Government of India)

[Application for revision of Pension under the Employees’ Pension Scheme, 1995
on actual wages more than the wage ceiling of Rs.5000/- or Rs.6500 per month]

(To be submitted to the RPFC concerned through the employer of the establishment where the member worked last)
1 Name of Pensioner S. Surya Prakash
2 PPO No.
3 EPF/EPS Account No.
4 Name of the Pension disbursing Bank & Branch
5 Bank A/c No.
6 Mobile No. 8500601956
7 Aadhaar No.
Declaration by Pensioner

1. I am a pensioner drawing my monthly pension under the Employee’s Pension Scheme, 1995with effect from 1--6-2014
with the above noted PPO Number issued from the EPFO, RO Hyderabad
2. I am a retired employee of M/s NREDCAP LTD Hyderabad with the above noted EPF/EPS Account Number.
3. My monthly wages for the purpose of subscribing contributions under the EPF Act,1952 and Schemes framed there
under were increased beyond the statutory ceiling amount w.e.f.16-11-1995 I was subscribing to the EPF at the rate of
12% of my monthly wages more than the ceiling amount till my retirement/till 30-5-2014
4. I understand that the monthly wages ceiling ‘for the purpose of contributions to EPF was Rs.5000/- p.m. till Apr’2001
andRs.6500/- p.m. thereafter till May 2014.
5. My employer was also depositing every month w.e.f. 16-11-1995, 12% of my actual monthly wages, more than the
above said statutory wage ceiling(s) as the employer’s share of contribution on the basis of the Option exercised jointly
by me and my employer, under the provisions of Paragraph 26(6) of the Employees’ Provident Fund Scheme,1952. But,
the monthly contributions to the Employees’ Pension Fund diverted out of the employer’s share was limited to Rs.417/-
or Rs.541/- p.m. on the basis of the above said wage ceiling.
6. I therefore understand that I need to pay the difference between the Pension Fund contributions (@ 8.33% of such
actual monthly wages more than the ceiling amount) and Rs.417/- or Rs.541/- (as the case may be) together with
accrued interest year to year till date to become eligible for pension on the basis of my actual salary on which my
employer deposited the contributions, in accordance with the Circular No.Pen-I/12/33/EPS Amendment/96/Vol.II dated
23/03/2017 of the EPFO Headquarters.
Accordingly, I may please be intimated the amount, I need to pay to the Employees’ Pension Fund ón account of
the aforesaid provisions to draw enhanced pension on the basis of my actual salary more than the said ceiling as shown in
the Contribution Cards in Form 3A(R) for the FY 1995-96(16-11-1995) to FY 2014-15, enclosed herewith duly certified by my
employer.

Place : Hyderabad Signature of the Pensioner

Date : Name (in Capital Letters): D.Sampath Kumar
Address:

Undertaking by the Employer

Certified that Sri. S. Surya Prakash was an employee of this establishment and a member of EPS’1995 with EPS
Account No AP/6430/00050 During his/her service, he/she was in receipt of wages more than the statutory wages ceiling as
described in the EPF Act & Scheme,1952 for the period w.e.f. 16-11-1995 till cessation of his/her service on 30-05-2014 and
the employer had deposited the employer’s share of contribution on his actual salary, though more than the wage ceiling as
in force from time to time, as per the provisions of Paragraph 26(6) of the Employees’ Provident Funds Scheme,1952.
Certified true copies of the Contribution Card in Form-3A(R) in respect of the said individual for the period when his/her
contributions were paid on wages more than the ceiling amount, i.e. from FY 16-11-1995to FY2014-15, are forwarded
herewith along with his/her request for revision of pension as per EPFO HO Circular dated 23/03/2017.

Place : Signature of the Authorised Signatory of the Establishment

Date : Name of the Authorised Officer (in Capital Letters):
Official Seal :
To
The VC & Managing Director
NON-CONVENTIONAL ENERGY DEVELOPMENT
CORPORATION OF AP LTD ( NREDCAP LTD)
D.No. 12-464/5/1, River Oaks Apartment
TADEPALLY, GUNTUR. 522 501

Sir,

Sub:- Application for revision of pension under EPF Pension Scheme 1995 – Request to
Certify and forward the prescribed application along with 3 A Forms to Regional
Provident Fund Commissioner- Hyderabad – Reg.

Ref:- Hon’ble Supreme Court, New Delhi order dated 4.10.2016

I
It is bring to your kind notice that the Hon’ble Supreme Court, New Delhi ordered for revision of pension
scheme EPS 1995 and I am eligible for higher pension.
 Hyderabad
.2018
From
G.dinakar Rao
(Rtd Asst Manager)
H No8-7-55/B/27,Shiridi Sai Nagar
Hastinapuram Central,sagar Road,Hyderabad -500079

To
The Regional Provident Fund Commissioner,
Hyderabad

Respected Sir,

Sub— Application for revision of pension under EPF Pension scheme 1995 with a request to
consider for revision under EPF Pension Scheme 1995. -Reg,
Ref—1.Hobn’ble Supreme court, New Delhi vide SLP No 33032-33033 of 2015.
2. Circular Order No pen-1/12/33/EPS Amendment/96/vol ii dated 23.03.2017 of Employees
Provident Fund Organisation, New Delhi.

I submit to inform that I am retired Employee from New & Renewable Energy Development corporation
of AP Ltd (NREDCAP)on 31-.03-2012 as Asst Manager .My PPO No is AP/HYD/00067794

As per the decision of Hon'ble Supreme Court vide Order dated 04/10/2016,the Employees Provident
Fund Organisation ,Ministry of Labour & Employment vide. Circular No pen-1/12/33/EPS Amendment/96/vol ii
dated 23.03.2017,prescribed application format for revision of pension . I am eligible for higher pension as per
orders cited in ref 2.

I will pay the difference of amount between pension fund contributions (@8.33% of such actual monthly
wages more the ceiling amount ) and Rs 471 or Rs 541 (as the case may be) on hearing from RPFC . I am
herewith enclosing certified copies of Form 3A by my employer for the period 1995 to March 2012

I request to kindly consider my request and intimate the amount to be paid by me to fix higher pension as
per EPF Scheme 1995

Thanking you,

Yours faith fully

(G.Dinakar Rao)
 Hyderabad
.2018
From
G.Dinakar Rao
H No8-7-55/B/27,Shiridi Sai Nagar
Hastinapuram Central,sagar Road,Hyderabad -500079
To
The Vice Chairman & Managing Director,
NR EDCAP Ltd,
Tadepalli
Guntur (Dt)

Sir

Sub— Request to forward our request with application for revision of pension under EPF Pension scheme
1995 to Regional Provident Fund Commissioner, Hyderabad for fixing pension -Reg
,
Ref—1.Hobn’ble Supreme court, New Delhi vide SLP No 33032-33033 of 2015.
2. Circular Order No pen-1/12/33/EPS Amendment/96/vol ii dated 23.03.2017 of Employees
Provident Fund Organisation, New Delhi.

As per the decision of Hon'ble Supreme Court vide Order dated 04/10/2016,the Employees Provident
Fund Organisation ,Ministry of Labour& Employment vide. Circular No pen-1/12/33/EPS Amendment/96/vol ii
dated 23.03.2017,prescribed application format for revision of pension . I am eligible for higher pension as per
orders cited in ref 2.
I will pay the difference of amount between pension fund contributions(@8.33% of such actual monthly
wages more then the ceiling amount ) and Rs 471 or Rs 541 (as the case may be) on hearing from RPFC .

I request to kindly forward my request with application with relevant enclosures (certified copies of Form
3A) to Regional Provident Fund Commissioner, Hyderabad.

Thanking You

Yours faith fully

(GDinakar rao )
AP/6430/34 (EPF a/c No)
1.D.Bala Prasad Rao
2.V.Avadhanulu
3.O.Subrahmanyam
4.G.V.RanagaRao
5.C.Prathapa Reddy
6.B.JayaramiReddy
7.VVSaradhi
8.B.S.Murthy
9.C.NarendraRao
10.V.Muniratnam
11.S. Rama Chandra Raju
12.G.Dinkar
13.P.Venkatappa
14. P.Murali
15. Ch. Subba Reddy
16.K.PAnand
17. N.Pothanna
18.B.Anjaneyulu
19.MdIbrahmim
20.Ch. Prabhakara Reddy
21.A.VRamana Murthy
22.P.Ramachandra Reddy.

Encl –Application for Revision of Pension

 (Ministry of Labour& Employment, Government of India)

[Application for revision of Pension under the Employees’ Pension Scheme, 1995
on actual wages more than the wage ceiling of Rs.5000/- or Rs.6500 per month]

(To be submitted to the RPFC concerned through the employer of the establishment where the member worked last)

1 Name of Pensioner O. SUBRAMANYAM

2 PPO No. AP/HYD/00036143

3 EPF/EPS Account No. AP/6430/82

4 Name of the Pension disbursing Bank & Branch ANDHRA BANK TARNAKA BRANCH , HYDEDRABAD
5 Bank A/c No. 057810021061373

6 Mobile No. 9849024994

7 Aadhaar No. 843830575046

Declaration by Pensioner

1. I am a pensioner drawing my monthly pension under the Employee’s Pension Scheme, 1995with effect from 1-7-2005 with the above
noted PPO Number issued from the EPFO, RO/SRo RO Hyderabad
2. I am a retired employee of M/s NREDCAP with the above noted EPF/EPS Account Number.
3. My monthly wages for the purpose of subscribing contributions under the EPF Act,1952 and Schemes framed thereunder were
increased beyond the statutory ceiling amount w.e.f.16-11-1995 and I was subscribing to the EPF at the rate of 12% of my monthly
wages more than the ceiling amount till my retirement/till 30-06-2005
4. I understand that the monthly wages ceiling ‘for the purpose of contributions to EPF was Rs.5000/- p.m. till Apr’2001 andRs.6500/-
p.m. thereafter till june 2005
5. My employer was also depositing every month w.e.f. 16-11-1995., 12% of my actual monthly wages, more than the above said
statutory wage ceiling(s) as the employer’s share of contribution on the basis of the Option exercised jointly by me and my employer,
under the provisions of Paragraph 26(6) of the Employees’ Provident Fund Scheme,1952. But, the monthly contributions to the
Employees’ Pension Fund diverted out of the employer’s share was limited to Rs.417/- or Rs.541/- p.m. on the basis of the above said
wage ceiling.
6. I therefore understand that I need to pay the difference between the Pension Fund contributions (@ 8.33% of such actual monthly
wages more than the ceiling amount) and Rs.417/- or Rs.541/- (as the case may be) together with accrued interest year to year till
date to become eligible for pension on the basis of my actual salary on which my employer deposited the contributions, in
accordance with the Circular No .Pen-I/12/33/EPS Amendment/96/Vol.II dated 23/03/2017 of the EPFO Headquarters.
Accordingly, I may please be intimated the amount, I need to pay to the Employees’ Pension Fund ón account of the aforesaid
provisions to draw enhanced pension on the basis of my actual salary more than the said ceiling as shown in the Contribution Cards in
Form 3A(R) for the FY 16-11-1995. toFY 2005-06, enclosed herewith duly certified by my employer.

Place :
Signature of the Pensioner
Date : Name (in Capital Letters): O.Subrahmanyam
Address : 303.Premasagar Apts, StNo 15, Tarnaka
Secunderabad-500 017

Undertaking by the Employer

Certified that Mr/Ms O,Subramanyam .was an employee of this establishment and a member of EPS’1995 with EPS Account
No AP/6430/82 During his/her service, he/she was in receipt of wages more than the statutory wages ceiling as described in the EPF Act
& Scheme,1952 for the period w.e.f. 16-11-1995 till cessation of his/her service on 30-06-2005 and the employer had deposited the
employer’s share of contribution on his actual salary, though more than the wage ceiling as in force from time to time, as per the
provisions of Paragraph 26(6) of the Employees’ Provident Funds Scheme,1952. Certified true copies of the Contribution Card in Form-
3A(R) in respect of the said individual for the period when his/her contributions were paid on wages more than the ceiling amount, i.e.
from FY 16-11-1995.to FY2005-06 , are forwarded herewith along with his/her request for revision of pension as per EPFO HO Circular
dated 23/03/2017.

Place : Signature of the Authorised Signatory of the Establishment

Date : Name of the Authorised Officer (in Capital Letters):
Official Seal :
 (Ministry of Labour& Employment, Government of India)

[Application for revision of Pension under the Employees’ Pension Scheme, 1995
on actual wages more than the wage ceiling of Rs.5000/- or Rs.6500 per month]

(To be submitted to the RPFC concerned through the employer of the establishment where the member worked last)

1 Name of Pensioner G.V.RANGARAO

2 PPO No. AP/HYD/00034238

3 EPF/EPS Account No. AP/6430/93

4 Name of the Pension disbursing Bank & Branch ANDHRA BANK DILSUKHNAGAR BRANCH , HYDEDRABAD
5 Bank A/c No. 012210011425100

6 Mobile No. 9703423451

7 Aadhaar No. 980964884506

Declaration by Pensioner

1. I am a pensioner drawing my monthly pension under the Employee’s Pension Scheme, 1995with effect from 30-11-2004
with the above noted PPO Number issued from the EPFO, RO/SRo RO Hyderabad
2. I am a retired employee of M/s NREDCAP with the above noted EPF/EPS Account Number.
3. My monthly wages for the purpose of subscribing contributions under the EPF Act,1952 and Schemes framed there under were
increased beyond the statutory ceiling amount w.e.f.16-11-1995 and I was subscribing to the EPF at the rate of 12% of my
monthly wages more than the ceiling amount till my retirement/till 30-11-2004
4. I understand that the monthly wages ceiling ‘for the purpose of contributions to EPF was Rs.5000/- p.m. till Apr’2001
andRs.6500/- p.m. thereafter till November 2004
5. My employer was also depositing every month w.e.f. 16-11-1995., 12% of my actual monthly wages, more than the above said
statutory wage ceiling(s) as the employer’s share of contribution on the basis of the Option exercised jointly by me and my
employer, under the provisions of Paragraph 26(6) of the Employees’ Provident Fund Scheme,1952. But, the monthly
contributions to the Employees’ Pension Fund diverted out of the employer’s share was limited to Rs.417/- or Rs.541/- p.m. on
the basis of the above said wage ceiling.
6. I therefore understand that I need to pay the difference between the Pension Fund contributions (@ 8.33% of such actual
monthly wages more than the ceiling amount) and Rs.417/- or Rs.541/- (as the case may be) together with accrued interest
year to year till date to become eligible for pension on the basis of my actual salary on which my employer deposited the
contributions, in accordance with the Circular No .Pen-I/12/33/EPS Amendment/96/Vol.II dated 23/03/2017 of the EPFO
Headquarters.
Accordingly, I may please be intimated the amount, I need to pay to the Employees’ Pension Fund ón account of the
aforesaid provisions to draw enhanced pension on the basis of my actual salary more than the said ceiling as shown in the
Contribution Cards in Form 3A(R) for the FY 16-11-1995. To FY 2004-05, enclosed herewith duly certified by my employer.

Place :
Signature of the Pensioner
Date : Name (in Capital Letters) G.V.RANGARAO
Address : H No 17-80 Srinagar colony
Road No 4,Dildukhnagar,Hyderabad-60

Undertaking by the Employer

Certified that Mr/Ms G.V.RangaRao .was an employee of this establishment and a member of EPS’1995 with EPS
Account No AP/6430/93 During his/her service, he/she was in receipt of wages more than the statutory wages ceiling as described
in the EPF Act & Scheme,1952 for the period w.e.f. 16-11-1995 till cessation of his/her service on 30-11-2004 and the employer
had deposited the employer’s share of contribution on his actual salary, though more than the wage ceiling as in force from time to
time, as per the provisions of Paragraph 26(6) of the Employees’ Provident Funds Scheme,1952. Certified true copies of the
Contribution Card in Form-3A(R) in respect of the said individual for the period when his/her contributions were paid on wages
more than the ceiling amount, i.e. from FY 16-11-1995.to FY2004-05 , are forwarded herewith along with his/her request for
revision of pension as per EPFO HO Circular dated 23/03/2017.

Place : Signature of the Authorised Signatory of the Establishment

Date : Name of the Authorised Officer (in Capital Letters):

Official Seal :
 EMPLOYEES' PROVIDENT FUND ORGANISATION
(Ministry of Labour& Employment, Government of India)

[Application for revision of Pension under the Employees’ Pension Scheme, 1995
on actual wages more than the wage ceiling of Rs.5000/- or Rs.6500 per month]

(To be submitted to the RPFC concerned through the employer of the establishment where the member worked
last)
1 Name of Pensioner G.DINAKAR RAO
2 PPO No. AP/HYD/00067794
3 EPF/EPS Account No. AP/HYD/6430/34
ANDHRA BANK ,B.N.REDDY NAGAR Branch
4 Name of the Pension disbursing Bank & Branch
Hyderabad
5 Bank A/c No. 11211002522227
6 Mobile No. 9849648958
7 Aadhaar No. 378948997670
Declaration by Pensioner

7. I am a pensioner drawing my monthly pension under the Employee’s Pension Scheme, 1995with effect from 1--4-
2012 with the above noted PPO Number issued from the EPFO, RO Hyderabad
8. I am a retired employee of M/s NREDCAP LTD Hyderabad with the above noted EPF/EPS Account Number.
9. My monthly wages for the purpose of subscribing contributions under the EPF Act,1952 and Schemes framed there
under were increased beyond the statutory ceiling amount w.e.f.16-11-1995 I was subscribing to the EPF at the
rate of 12% of my monthly wages more than the ceiling amount till my retirement/till 31-03-2012
10. I understand that the monthly wages ceiling ‘for the purpose of contributions to EPF was Rs.5000/- p.m. till
Apr’2001 andRs.6500/- p.m. thereafter till March 2012.
11. My employer was also depositing every month w.e.f. 16-11-1995, 12% of my actual monthly wages, more than the
above said statutory wage ceiling(s) as the employer’s share of contribution on the basis of the Option exercised
jointly by me and my employer, under the provisions of Paragraph 26(6) of the Employees’ Provident Fund
Scheme,1952. But, the monthly contributions to the Employees’ Pension Fund diverted out of the employer’s
share was limited to Rs.417/- or Rs.541/- p.m. on the basis of the above said wage ceiling.
12. I therefore understand that I need to pay the difference between the Pension Fund contributions (@ 8.33% of such
actual monthly wages more than the ceiling amount) and Rs.417/- or Rs.541/- (as the case may be) together with
accrued interest year to year till date to become eligible for pension on the basis of my actual salary on which my
employer deposited the contributions, in accordance with the Circular No.Pen-I/12/33/EPS Amendment/96/Vol.II
dated 23/03/2017 of the EPFO Headquarters.
Accordingly, I may please be intimated the amount, I need to pay to the Employees’ Pension Fund ón
account of the aforesaid provisions to draw enhanced pension on the basis of my actual salary more than the said
ceiling as shown in the Contribution Cards in Form 3A(R) for the FY 1995-96(16-11-1995) to FY 2011-12, enclosed
herewith duly certified by my employer.

Place : Hyderabad Signature of the Pensioner

Date : Name (in Capital Letters): G.Dinaker Rao
Address: 8-7-55/B/27,Shiridi Sai Nagar
Hastinapuram Central, agar Road,Hyderabad -500079
Undertaking by the Employer

Certified that Mr/Ms G.Dinakar Rao was an employee of this establishment and a member of EPS’1995 with
EPS Account No AP/6430/00034 During his/her service, he/she was in receipt of wages more than the statutory
wages ceiling as described in the EPF Act & Scheme,1952 for the period w.e.f. 16-11-1995 till cessation of his/her
service on 31-03-2012 and the employer had deposited the employer’s share of contribution on his actual salary,
though more than the wage ceiling as in force from time to time, as per the provisions of Paragraph 26(6) of the
Employees’ Provident Funds Scheme,1952. Certified true copies of the Contribution Card in Form-3A(R) in respect of
the said individual for the period when his/her contributions were paid on wages more than the ceiling amount, i.e.
from FY 16-11-1995to FY2011-12, are forwarded herewith along with his/her request for revision of pension as per
EPFO HO Circular dated 23/03/2017.

Place : Signature of the Authorised Signatory of the Establishment

Date : Name of the Authorised Officer (in Capital Letters):
Official Seal :