Instruction for Filling Forms :.

Instructions for a member while sending application to Employees' Provident Fund.

GENERAL
Use the appropriate form for claiming Provident Fund Pension, withdrawal benefit/scheme certificate, Employees' Deposit
Linked Insurance benefit, etc. as given below :

Form-19 : To claim final settlement of Provident Fund by a member.

Form-20 : To claim Provident Fund by nominee/legal heir on death of the member.

Form-10-D : To claim pension. (In duplicate : If within state, In triplicate : If outside state.)

Form-10-C : To claim withdrawal benefit/scheme certificate under Employees' Pension Scheme '95.

Form-5IF : To claim assurance benefit under Employees' Deposit Linked Insurance '76 by nominee/legal heir of a member.

Form-31 : To claim temporary withdrawal/advance under Employees' Provident Fund scheme '52.

Form-13 : To effect transfer of Provident Fund/Pension from one A/C to another.

Ensure that all columns of the application are filled completely.

Information in the application form relating to name, a/c no. should agree with the details available with Employees' Provident
Fund Organization; which were furnished by the employer at the time of enrolling to Provident Fund.
Application should be signed by the member/claimant.
It should be attested by the former employer. In case attestation by the former employer is not possible, it should be got attested
by any other authorized official specified with application form.
Application for final settlement can be sent by a member on completion of 2 months from the date of leaving service, if the
reason for leaving service is other than superannuation, medical ground, retrenchment and V.R.S./ Female members getting
married etc.
Desired mode of payment can be given legibly, if the amount involved is more than Rs. 2000/-. The amount will sent by deposit
in payees' bank a/c. To facilitate this, Bank a/c no., name and address of the bank should be furnished. An advance stamped
receipt should also accompany this application.
Application may be supported by the return Form-10, showing the details of leaving service and details of contribution for the
year in Form-3A, if not sent earlier by the employer.
SPECIFIC ADDITIONAL REQUIREMENT
Death cases:

Nominee/legal heir should apply in Form-20 /Form-10-D /Form-5IF.

If the member has not executed any nomination, application should be supported by certificate of family members issued by
employer/revenue official/sworn in an affidavit by the family/ member/legal certificate from a court of law.

Death certificate of the member.

Certificate of the employer stating whether the death was while in service of the member or not.
Pension cases:

Joint photograph of member/spouse or the claimant should accompany the application.

Option for return of capital/commutation should be specified clearly.

Details of non-contributory period during the service, wages/salary for last 12 months should also accompany, if not already
sent.

Details of the branch of the specified bank may be given legibly.

Date of birth certificates of children

In case of death away from service, an undertaking by the claimant to the effect that the member was not working / had not
worked in any other covered establishment after exit from the establishment on the basis of which pension is being claimed.

--------------------------------------------------------------------------------------------------------------------------------------------Important instructions for filling the Claim Forms

1.

Furnish the correct information in the relevant columns of the Claim form.

2.

Use Blue/Black ink to fill the claim form.

3.

Fill the columns in BLOCK LETTERS.

4.

Please avoid overwriting.

5.

Full residential address should be given in the claim.

6.

Member's name, Father/Husband name and Date of Birth of the member should correlate with Form 9, 5 details furnished at the
time of enrollment.

7.

The Savings Bank Account Number, Name of the Bank with FULL ADDRESS with MICR Number(if applicable) to be furnished
clearly in BLOCK LETTERS in Column Number (8).

8.

All required enclosures to be attached to the claim and the employer to attest all the attached xerox copies.

9.

Where the settlement amount is more than Rs.2,000/-, the claimant cannot opt for Money Order as mode of payment.

10.

If the withdrawal is preferred by the member, it should be in Claim Form 19.

11.

In cases where the claim is preferred by nominees/Legal heirs of the members, it should be in Claim Form 20.

12.

All advances/withdrawal for various purpose during the membership in the Fund should be preferred in Form 31 alongwith the
enclosures given in the instruction form.

13.

In
case
of
membership
under
Employees
Pension
Scheme,
1995,
(i) where the membership is less than 10 years, option should be clearly indicated in the Column Number ( ), either for
withdrawal
benefit
or
for
Scheme
Certificate
in
Claim
Form
10C.
(ii) in case of drawal of pension, the claim in Form 10D should be preferred.

14.

The claimant should affix his signature/Thumb impression in the certificate portion before the employer.

15.

The claimant should also affix his signature in the Advance Stamped receipt column, wherever the Provident Fund/withdrawal
payment is more than Rs.5,000/-., the signature should be appended after affixing Revenue Stamp.

16.

The claim forms should be attested by the authorized signatory of the establishment duly affixing the seal and after due
verification of the all the columns filled in the Claim Forms.

17.

No joint Savings Bank Account, either or survivor account is permitted. The Savings Bank Account, should be in Claimant's
name.

18.

Copy of First page of S.B. account pass book to be enclosed as proof.

19.

In case of Provident Fund(P.F) beneficiaries are minor, the Savings Bank account should be in Guardian's Name.

20.

MICR Number may be furnished wherever ECS facilities are available for speedy settlement.

21.

Form 3A for the current year contribution with due attestation of the employer/Authorised signatory to be invariably enclosed
with the Claim Form.

22.

While joining an establishment, furnish the details of previous employment, if any, with previous Provident Fund account number
and Scheme Certificate.

23.

Execute Form 2 on joining an establishment/in case of change of nominee with details of self, nominee for Provident Fund and
Pension and details of family, so that it is forwarded to Employees' Provident Fund Organisation by the employer.

24.

Ensure that Provident Fund is deducted at statutory rate from the total wages i.e. basic, Dearness Allowance (including cash
value of food concession), and retaining allowances, if any.

25.

Filled in applications may be submitted through post / courier or in person to the PRO wing of the Regional Office / Sub Regional
Office.

26.

The claims submitted in full complete shape will be processed and settled within 30 days of submission.

27.

Claim settlement information is placed in the EPFO website www.epfindia.com and www.epfomeerut.org.

28.

For any further assistance / inquiry, the Public Relation Officer of the Regional Office / Sub Regional Office can be approached
on all working days in person or through phone.

29.

To get your current claims status Click on "Know your Claim Status".