Professional Documents
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Form 2 and EPFO
Form 2 and EPFO
FORM 2 (Revised)
(For Unexempted /Exempted EstabIi!3hments)
(Declaration and Nomination Form under the Employees' Provident Funds and Employees’ Pension Scheme)
(Paragraphs 33 8 61 (1) of the Employees’ Provident Funda Scheme, 1952 and paragraph :1B of the Employees’ Pension Scheme, 1995)
Father's/Husband’s Name :
First Name Middle Name Last Name
Date of birth :
Sex :
Account No.
(PF/EPS Number)
Temporary
I hereby nominate the person(s)/cancel the nomination made by me previously and nominate, the person(s) mentioned below to receive the amount
standing to my credit in the Employees’ Provident Fund, in the event of my death:
Name and Address of the nominee/ nominees Nominee’s relationship Date of Birth Total amount If the nominee is a minor, name and
with the member or share of relationship and address of the
accumulations in guardian who may receive the amount
Provident Fund to during the minority of nominee
be paid to each
nominee (%)
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 nomination should be deemed as cancelled.
2 * Certified that my father/mother is/are dependent upon me.
3. * Strike out whichever is not applicable.
Signature or thumb impression of the subscriber
Note: - A Fresh nomination shall be made by the member on his marriage and any nomination made before such marriage shall be deemed to be invalid
# If Married —> Spouse, Children (married or unmarried), his/her dependent parents, deceased son's widow and children. If unmarried then Parents,
Brother, Sister or any other person(s).
I hereby furnish below particulars of the members of my family who would be eligible to receive widow/children pension in the event of my death.
SI.No. Name and address of the family members Date of Birth Relationship with the member
(1) (2) (3) (4)
** 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 monthly widow 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) (2) (3)
**Strike out whichever is not applicable. Signature or thumb impression of the subscriber
Certified that the above declaration and nomination has been signed/thumb impressed before me by
Shri/Smt./Kumari employed in my establishment after he/she has read
the entries/the entries have been read over to him/her by me and got confirmed by him/her.
Place:
Designation..............................................
Signature of the Employer or other authoFiSed Name and address of the Factory/Establishment
Officer of the establishment or rubber stamp thereof
Employee Code: New Form No.-11-Declaration Form
(To be retained by the employer for future reference)
3 Date of Birth:(DD/MM/YYYY)
4 Gender:(Male/Female/Transgender)
5 Marital Status:(Married/Unmarried/Widow/
Widower/Divorcee)
b) AADHAR Number
UNDERTAKING
Date:
Place: Signature of Member
DECLARATION BY PRESENT EMPLOYER
B. In case the person was earlier not a member of EPF Scheme, 1952 and EPS, 1995:
* (Post allotment of UAN) The UAN allotted for the member is………………………………………….
C. In case the person was earlier a member of EPF Scheme, 1952 and EPS, 1995:
* The above PF Account number/UAN of the member as mentioned in (A) above has been tagged with his/her UAN/Previous
The KYC details of the above member in the UAN database have been approved with Digital Signature Certificate and
As the DSC of establishment are not registered with EPFO, the member has been in formed to file physical claim (Form-13)