Need Help with Form 10C Submission and Affidavit for EPFO in Bangalore?

Hi Venkat, I am writing from Bangalore. I have received Form 10C from my previous employer, and they have instructed me to submit it to the Employee Provident Fund Organisation (EPFO) in Bangalore. They have requested that I submit Form 10C along with an affidavit on a non-judicial stamp paper. I am unfamiliar with this affidavit. Can anyone assist me with the following queries?

1) Could someone provide a sample affidavit format for submitting Form 10C?
2) What is the procedure for filing Form 10C with the EPFO?

Thank you in advance for your help.

Regards,
Venkat

An affidavit to this effect is only required when there is a gap of more than 2 years. It is very simple: declare your personal information (name, father's name, address), then provide details of your previous employer (employer name, address, and PF number). State that you have neither applied for nor withdrawn this pension amount earlier. If any information is found to be false later on, you will be solely responsible.

The procedure to deposit is again simple - just go to EPFO and deposit.

Regards,

Thank you, Naresh, for your prompt reply. The Form 10C is more than 2 years old; hence, I have to submit an affidavit for this purpose. I have a few more queries regarding certain parts of the affidavit:

"I state that I left the service on [date of relieving] on personal grounds. However, I did not submit the claim application for the sanction of EPF and other benefits earlier due to [reason for non-submission to be mentioned here]."

I was initially a contract employee and then transitioned to a permanent role in my company. The pension pertains to the contract period. As I received Form 10C after two years, I need to explain the reason for the delay in submission here. Could you please assist me with this?

Upon completion of the bond, two solvent sureties must sign in front of a metropolitan magistrate. Do I need to obtain the signatures from the sureties, or will this be arranged by the EPFO office?

The statement at the end reads as follows:

"We, the undersigned, hereby undertake to indemnify the Central Board of Trustees, EPFO in case of need as per the terms of this bond and bind ourselves severally and jointly liable to indemnify the said CBT."

Thank you in advance for your assistance, Naresh.