[email protected]
Manager Operations
[email protected]
H.r Manager At Vasai.
Manager - Human Resources
+6 Others

Please send me a sample filled Employees Provident Fund Form No. 10 C & form 19 so that i cam fill it up for my self.......... Thanking you...
From India, Coimbatore
I am hereby giving checklist for filling of such forms :
Check List for Claims in Form 19 (Provident Fund)

· Whether all the columns in the Form 19 are correctly and completely filled in ( as per the details furnished to this office), in ink, without any overwriting.
· Whether the reason and date of leaving service have been correctly filled in, with reference to Form 10 already given, in the appropriate columns in the Form 19
· Whether the member has furnished his full postal address, with the postal pin code number, for communication and for payment of amount, if preferred by postal money order.(Money order is issued only where the amount payable is below Rs.2000/-)
· If the payment is preferred by account payee cheque, through bank, please check to:
· Whether the member has got a Savings Bank account in any of the branches or a nationalised / Scheduled / Co-operative Bank / Post Office.
· Whether the account opened is only an individual account and not a joint account.
· Whether the name, branch and address of the Bank have been clearly furnish in the Form 19. The Employer should attest any correction. (Attach the first page of Savings Bank passbook showing the name and account number of the member)
· Whether the member has completed the advance stamped receipt (furnished in the Form 19 itself) and appended his signature on one rupee revenue stamp affixed in the relevant portion)
· If the reason for leaving service is “left” “Resigned”, etc., ensure that 2 months period has been completed from the date of leaving service to the date of preference of the claim. However this will not be applicable if the member has completed 55 years of age or being a female member resigned for her marriage.
· In case the member is an illiterate, whether thumb impression of the member affixed at the relevant portion.
· Whether Form 5 and Form 10 particulars are reproduced in the claim Form
a) Whether Form 3A, if any , for the broken period of currency is enclosed
b) Whether Form 3A for previous currency period is sent, if not, enclose Form 3A for the previous years also.
c) Whether Form 3A is completed and signed and reasons for ‘Nil’ contribution is given.
d) Whether the period of non-contributory service is indicated where the wages are not drawn for a full month.
· Whether the remittances are made up to date and returns submitted. If for any reasons, any remittance is outstanding in respect of the claimant, the amount due on his / her account needs to be indicated.
· Whether the specimen signatures of the authorised officials of the establishment are already submitted to the Regional Provident Fund Commissioner. If not, it shall be done and be updated whenever there is change in the officials
· Whether the claim has been attested by the authorised officials of the establishment, duly affixing his official seal and date.

Thanks & warm regards

Jana Venkata Ramakrishna
Asst Manager Human Resources,
V Link Taxis Pvt Ltd, MERU CABS
Hyderabad - 84
91-9849524856 / 9703100700

From India, Hyderabad

Checklist Form Claims in Form 10 C

(Form to be used by a member of Employees Pension Scheme 1995 for claiming Withdrawal Benefit / Scheme Certificate)

· To check whether all columns in the claims are properly filled
· Whether the particulars are written clearly without any overwriting or cutting, Correction, if any, is attested
· Whether the member has appended his signature on One Rupee Revenue Stamp affixed in the relevant portion. (To be given where withdrawal benefit is admissible and opted for payment by cheque)
· Whether the details of wages and period of non-contributory service were already informed through Form 3A.
· If the member is not eligible for pension and has rendered 10 or more years of eligible service, he/she is entitled for Scheme Certificate only.
· Wherever the member is having less than 10 years eligible service, he/she may be advised to opt for scheme Certificate instead of withdrawal Benefit.
· Option to be specifically stated either for Scheme Certificate or Withdrawal Benefit.
· In case of opting for “Scheme Certificate”, it is not necessary to furnish the Savings Bank Account and enclosing of attested photos.
· These points are in addition to common points furnished under “Check list for claim in Form – 19”

Check List for Claim in Form – 20 (Provident Fund)
(Forms to be used by a nominee / a legal heir in case of death of a member)
Note: the points given below are in addition to common points such as attestation, Form 3A, mode of payment, completion of form etc., as given in the check list for claims in Form 19.
· In case of death of the member, whether death certificate in original is enclosed
· Whether complete details of the deceased member / the claimant are furnished in the appropriate columns of the Form 20
· Whether the claim has been preferred by the nominee(s) as per the nomination Form 2 as Executed by the deceased member.
· In case the member has not executed any valid nomination during his lifetime, ensure that the claim is preferred by eligible members of the family or eligible legal heir of the member, as the case may be. (in such case, a list of members of the family duly certified by the employer or the Revenue official or affidavit by the family members sworn before a Notary Public should be enclosed).
· In case, the parents of the deceased member are included in the list of family members, whether or not the parents were dependent on the member to be specified
· In case of the claims preferred by any person other than natural guardian on behalf of the minor member / nominees / legal heirs, ensure that the required Guardianship certificate etc. are enclosed.
· Whether the age and marital status of the family members / Legal heirs are furnished as on the date of death of the member and NOT the date of the claim.
· Separate application should be preferred by each eligible claimant. In the case of minor, guardian is to prefer the claim.

Checklist for claims in Form – 10D

(Form to be used for claiming Superannuation Pension, Retirement Pension, Short-service Pension, Disablement Pension, Widow Pension, Children Pension and Orphan Pension)
· Whether all columns are properly filled in without any overwriting
· Whether the application in Form – 10D has been attested by the employer or his authorised official with his official seal and date
· Whether the date of birth of the member has been furnished as per records already submitted to the RPFC.
· In case of death of the member (For Widow, Children or Orphan Pension) ensure that he death certificate is submitted in original and family members certificate is furnished.
· The descriptive roll/finger impressions/Specimen signatures of the claimant are obtained in the prescribed forms (in duplicate) and attested by the employer.
· Whether 3 copies of Passport size photograph of the member with spouse (taken together/ or claimant) are submitted and the employer has attested with seal on the back side of the Passport size photos duly furnishing the name and Account number of the member
· Whether the birth certificate of the children of the member, is submitted in original, with one Xerox copy duly attested by the employer.
· Whether the Personal marks of identification, if any, on the hand / face or body of the claimant is furnished.
· The monthly Pension can be disbursed to the pensioner through Indian Bank/IOB/SBI/HDFC and post offices. Please check whether the member has opened a Savings Bank Account in any Branch of Indian Bank/IOB/SBI/HDFC and Post office and he has furnished Savings Bank Account Number and complete postal address of Bank/Post Office in the relevant column of the Form – 10D.
· Whether the claimant has exercised any option for Return of Capital, in the relevant column of Form – 10D. If so, Please specify he Para such as 13(1), 13(2) or 13(3). In case of opting for Para 13(2), the nomination should be made in favour of person other than the spouse. Similarly it should be made in favour of person other than the spouse. Similarly it should be ensured that the member furnished his option for commutation under para 12A
· While furnishing family details, the relationship with the member may be furnished correctly in Form 10D
· Whether the particulars of wages etc. at page 7 of the claim form is duly checked and correctly filled up by the employer.
· Separate Savings Bank Account for the minor children may also be opened in the same branch at which the Savings Bank Account opened to the widow/ widower.

Checklist for Claims in Form 13

(Form to be used for transfer of PF accumulation)
· To check whether all columns in the claims are properly filled
· Whether the particulars are written clearly without any overwriting or cutting, correction, if any, is attested.
· Whether the previous employment particulars such as name, address and code number and the account number of the member are correctly furnished.
· In case the PF transfer is due from the PF trust of an exempted establishment, the application is to be sent direct by the employer to the PF trust of the exempted establishment with a copy to the RPFC concerned for details of the Pension Scheme membership
· This form should be submitted by the member to the present employer for onward transmission to the RPFC by whom the transfer is to be effected.

Checklist for Claims in Form – 31

(Form to be used for claiming advance / withdrawal)
· To check whether all columns in the claims are properly filled.
· Whether the particulars are written clearly without any overwriting or cutting, correction, if any, is attested.
· For the non-refundable withdrawal under para 68B it should be ensured that declaration in the prescribed form is furnished. In al cases the employer should ensure the genuineness of the case by forwarding the application. It should be noted that the advance granted if misused, will be recovered with penal interest.
· For the withdrawal for repayment of loans it should be ensured that the member had obtained a loan from a State Government, Cooperative Society, Housing Board, a Municipal Corporation, or a body similar to Delhi Development Authority solely for the housing purpose and the payment is made directly to such Agency.
· For closure / lockout it should be ensured that no compensation is paid to the member and the advance is eligible for the reasons other than the strike only.
· For illness if member/ family member whether the certificate has been furnished by the employer as regards to the leave granted and the non-availability of ESI benefits.
· Whether the medical certificate in proper form obtained from the factory doctor / designated medical officer / the Registered Medical Practitioner Hospital is enclosed. Before forwarding it to the RPFC, the genuineness of the certificate should be ensured.
· It should be noted that one-month hospitalization is compulsory in case of illness of family members.
· In case of treatment of heart ailment / mental derangement a certificate by specialist doctor is necessary.
· For marriage purpose certificate regarding advance required to meet the expenses in connection with the marriage needs to be furnished in the claim form.
· In the case of education, a certificate from the educational institution regarding the course of study and the anticipated expenditure needs to be submitted.
· Before forwarding the applications the genuineness of the case shall be ensured by the employer.
· In case of advance for the natural calamity (flood / earthquake/riot) whether the certificate from an appropriate authority to the effect that the movable or immovable property has been damaged as a result of the natural calamity has affected the general public in the area. It is also to be ensured that the application for advance is made within a period of 4 months from the date of declaration by the State Government.
· In the case, affected by cut in electricity it should be certified that the fall in wages amounting to 25% or more than 25% of the wages in respect of the member is due to power cut. A certificate from the State Government is also necessary to the effect that the cut in the supply of electricity was enforced in that area where the factory is situated.
· Purchase of equipment for physically handicapped member: whether the certificate from a competent medical practitioner furnishing the details like name of the person, nature of the handicap, nature of the equipment required and its approximate cost is submitted.
· Payment of withdrawal within one year before the retirement. The employer should ensure that the member has attained the age of 54 years or within one year before his actual retirement on superannuation, which ever is later and then the application is submitted. He should also ensure that the said particulars tally with the age particulars furnished in Form 9 and Form 2.

Jana Venkata Ramakrishna
Asst Manager Human Resources
5th Floor Ekta Towers, Plot # 2 & 3,
White Fields, Kondapur, Hyderabad - 500 084.
Off : 040-40520000 # 130
Mob : +91 98495 24856 / 97031 00700.

From India, Hyderabad
Can anyone please help me out in knowing that what documents needs to be attached with Form19 and 10c of Privident Fund if i am sending it on my behalf and not through the employer..
Kindly please let me know..

From India, Lucknow
Can anyone please help me out in knowing that what documents needs to be attached with Form19 and 10c of Privident Fund if i am sending it on my behalf and not through the employer..
Kindly please let me know..

From India, Mangaluru
Dear All, can anybody one help me? Please send me a one filled format of Form 13 (EPF). I wrote so may time but still i am not yet. Kindly do this very needful.
From India, Madras
sample filled Employees Provident Fund Form Please send me a sample filled Employees Provident Fund Form No. 10 C & form 19
From India, Delhi
Hi, This is jooli. I would like to know whether the 'Contribution for the current financial year' to be filled by the employee or empleyer?
From United States, Falls Church
Dear .
By asking such a simple questions you are trying to insult the experts and senior . There is nothing hard to fill this form. You have to fill your information only. like your name , date of joining date of leaving, reason for levering the job , and bank details along with one cancelled leaf of cheque . to P.F. Authority . This is otherwise along can be cleared from the consultant or the person who is dealing with P.F.
Deepak M.

From India, Thana
Please be clear.
who are you?
Are you an Employee or asking behalf of your Employer
Both of the Forms are for withdrawal purpose, which can be submitted in P.F. Office by Employee or Employer with the Signature of the Employer.
So, there will not be any value if you are going to submit with out the knowledge of your Employer.
There is standard time period to deposit withdrawal Forms in P.F. Office for withdrawal
Another thing, if the Employer has not submitted Form-10 as the details of left Employee or informed Online, your claim will not be settled by the P.F. Officials.
It will be batter ones meet the related Personnel of your Organisation.

From India

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