scan10001 (2)
TRANSCRIPT
8/18/2019 Scan10001 (2)
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Employer
Claimant
Phone
No.
Mobile
No.
orflorc
ereir
I
Serial
No.
:
urgorrb
10
-
C
(@ooreone
orpriroOuuug1)
qqrr
-
10-fr
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E.
fr)
tt+g-trEffi,
FORM:10-C(EpS)
(Supplied
free of
cost)
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For
office
use
only
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No.
& Date)
'
)
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EMPLOYEES'
PENSTON
SCF|EME,
tgg,
Fom
to
ba
used
by
a
membet
of lhe
cmployecs'
Peniion
Scheme,
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for
ctaiming
withdrawat
Benefit/Scheme
certiticate
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the
instrucfions
before
fllling
up thisfLrm)
GN)
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t
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ctaimant(s)
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Date
of
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pporpurnrfleir
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or
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Father's
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o
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Husband's
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Name l Address
of
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Scheme
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benefit.
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8/18/2019 Scan10001 (2)
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CERTIFIED THAT
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Received
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----------
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(Rupees
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froi
Regional
provident
Fund
Commissioner
/ Office-in-Charge
of
Sub-Regional
office /
Sub-Accounts
office
by
deposir
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my
saving
Bank
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penslon
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Re 1/- Revenue Stamp
8/18/2019 Scan10001 (2)
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Cedified that the
pafticulars
of the
above
member
are
correct
and
he
member
has
signed
/
thumb
impressed
before
me.
The
details of
wages
and
period
of non-contributory
service
of
the
member
are as
under :
(Form
3A /
7
(EPS)
enclosed
for the
period
for
which it
was
not
sent to
Employees'
provident
Fund
Office)
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(grlrquuenl
enpru6
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No.
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as on
15.1
1.95
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applicable)
Wages
as on
the
date
of
exit
Rs.
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er
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Employer/
Authorised
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15.1 1.95
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ortl
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net amount
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assed
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H
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No.
10
Debit
item No
AC
(Cash)
S
AO
H
For
issue
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S.C,
IDS is
enclosed with
Form
-
2
(Revised)
D.J.
APFC
(Cash)
Scheme
Certificate bearing the
control
No.
(FOR
USE
TNPENS|ON
SECTTON)
lssued on
and entered
in the
Schepe
Certificate
Control Register
DH
SS
AO
APFC
(PENS|ON)