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  • Nomination and Declaration Form

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    The Silent Monk
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    This document contains forms for employees to nominate beneficiaries for their Employees' Provident Fund (EPF) and Employees' Pension Scheme (EPS) accounts. Part A is for nominating beneficiaries for the EPF account and providing family details. Part B is for nominating beneficiaries for the EPS pension and providing family details eligible for widow/children's pension. The employer must certify and sign the forms after the employee fills them out.

    Original Description:

    Form 2 pdf file filled

    Original Title

    Form 2

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    This document contains forms for employees to nominate beneficiaries for their Employees' Provident Fund (EPF) and Employees' Pension Scheme (EPS) accounts. Part A is for nominating beneficiaries for the EPF account and providing family details. Part B is for nominating beneficiaries for the EPS pension and providing family details eligible for widow/children's pension. The employer must certify and sign the forms after the employee fills them out.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    751 views2 pages

    Nomination and Declaration Form

    Uploaded by

    The Silent Monk
    This document contains forms for employees to nominate beneficiaries for their Employees' Provident Fund (EPF) and Employees' Pension Scheme (EPS) accounts. Part A is for nominating beneficiaries for the EPF account and providing family details. Part B is for nominating beneficiaries for the EPS pension and providing family details eligible for widow/children's pension. The employer must certify and sign the forms after the employee fills them out.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 2

    Employee Code

    FORM 2 (Revised)
    (For Unexempted / Exempted Establishments)
    NOMINATION AND DECLARATION FORM
    (Declaration and Nomination Form under the Employees' Provident
    (Paragraphs 33 & 61 (l) of the
    Funds and Employees' Pension Scheme)
    Employees' ProvidentFunds Scheme, 1952 and paragraph 18 of the Employees'
    PensionScheme, 1995)
    1 Name (in Block Letters)
    2 Father's/Husband's Name
    3 Date of birth
    4 Sex
    s Marital Status
    6 Account No. (PF/EPS Number)
    Address (Residential)
    7 Permanent

    Temporary
    66, a

    PARTA (EPF) #
    I hereby nominate the person(s)/cancel the nominationmade by me previously
    to my credit in the Employees' ProvidentFund, in the event of my death: and nominate,the person(s) mentionedbelow to receive the amount standing
    Name and Address of the nominee/ nominees
    Nominee's Date of Birth Total amount or If the nominee is a minor,
    relationship share of name and relationship and
    with the accumulations address of the guardian who
    member in Provident may receive the amount during
    Fund to be paid the minority Ofnominee
    to each
    nominee (0/0)
    (Max subject
    t0100%)

    (1) (2) (3) (4) (5)

    100 %

    1 • Certified that I have no family as defined in para 2(g) of the Employees' Provident Funds Scheme, 1952, and should I acquire a family hereafter, the above
    should be deemed as cancelled. nomination
    2 • Certified that my father/rnotheris/are dependent upon me.
    3. • Strike out whichever is not appliable.

    Signature or thumb impression of thé subscriber


    Note; - A Fresh nominationshall be made by the member on his marriage and any nominationmade before such marriage shall be deemed to be invalid

    If Married Spouse. Children (married or unmarried), his/her dependentparents, deceased son's widow and children.
    If unmarried then parents, Brother, Sister or any other person(s).
    Part B (EPS) (Para 18) *
    I hereby furnashbelow particulars of the members of my family who would be eligible to
    event of my death. receive widow/childrenpension in the

    Sl. No. Name and address of the family members


    Date of Birth Relationship
    with the
    member
    (1) (2) (4)
    (3)

    2.

    Certified that I have no family. as defined in para 2(vii) Of Employees' Pension


    Scheme. 1995 and should I acquire a family hereafter I shall furnish particulars thereon in
    the above form

    I hereby nominate the following persons for receiving the monthlywidow pension
    (admissible under para 16 2(a) (i) and (ii) of Employees' Pension Scheme, 1995 in the event of
    my death without leaving any eligible family member for receiving Pension

    Name and Address of the Nominee Date of Birth Relationship with


    the member
    (1) (3)

    Date

    outwhichever
    *Strike isnotapplicable. Signature r thumb impression of the subscriber
    CERTIFICATE BY EMPLOYER
    Certified that the above declarationand nominationhas been signed/thumbimpressedbeforeme by :

    Shri/Smt./Kumari employed in my establishment

    after he/she has read the entries/the entries ave been read over to him/her by me and got confirmed by him/her.

    Place : Signature of the Employeror other authorised


    officer of the establishment
    Dated the : Designation....................... .
    2
    Name and address of the Factory/Establishment
    or rubberstamp thereof
    • - Applicableif Married-> To Spouse and Children (includechildrenadopted legally beforedeath in service.
    - Applicableto both Marriedand unmarried - (I) Married To any person(s) other than spouse and children.
    (2) Unmarried To Parents, Brother, Sister or any other person(s).

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