For Web Circulation Only apoterdt srferer feritt aateet Employees’ Provident Fund Organi: (Re ea ste ATA, HTT ATA) (Ministry of Labour & Employment, Govt, Of Inia) appa arta Head Office sar FAR arct, 14, Tea Te, RETA - 110066. Bhavistye Nidhi Bawa, 14-Bhikaiji Cama Place, New Delhi-1 10066 tion No: Manual/Amendment/201 1/Pt % ‘Date: 20.02.2017 Ko onons 20 FEB 2007 In the matter of Introduction of Composite Claim Forms (Aadhar and Non-Aadhar) to replace existing Claim Forms No. 19, 10C & 31 and Forms No. 19 (UAN), 10C(UAN) & 31 (UAN) Employees’ Provident Fund Organisation has embarked upon its next phase of e-governance reforms with a view to make its services available to its stakeholders in an efficient and transparent manner. EPFO has since implemented Universal Account Number (UAN) for its subscribers. It is now possible for subscribers, who have seeded with Aadhar number and Bank account details, to submit claim forms directly to EPFO without the attestation of employers. 2. The Central Provident Fund Commissioner vide order No. WSU/10(1)2011/Changes in MAP/34106 dated 01.12.2015 had prescribed new Forms No. 19(UAN), 1OC(UAN) & 31(UAN) for all employees whose Aadhar number and Bank account details had been seeded with Universal Account ‘Number (VAN). The said order is being modified to prescribe a Composite Claim Form (Aadhar) to replace the existing Forms No. 19 (VAN), 10C(UAN) & 31(UAN) with a view to simplify the submission of claim forms by subscribers. This new Composite Claim Form (Aadhar), enclosed herewith can be submitted to respective jurisdictional EPFO office, without the attestation of employers 3.___In pursuance of provisions of paragraph 72(5) of the Employees’ Provident Funds Scheme, 1952, Central Provident Fund Commissioner, hereby prescribes the new Composite Claim Form (Non- ‘Aadhar) to replace the existing Forms No. 19, 10C & 31 with a view to simplify the submission of claim forms by subscribers. The new Composite Claim Form (Non-Aadhar), enclosed herewith shall be submitted with the attestation of employers to the respective jurisdictional EPFO office. 4. Further, the submission of Composite Claim Form (Aadhar) / Composite Claim Form (Non- Aadhar) will be further simplified and modified to include self-certification by EPF subscribers in place of various certificates prescribed at present. These include:- Il Para 68B: The “New Declaration Form” required to be appended with Form No. 31 for housing loan/purchase of site/house/flat or for construction/addition, alteration in existing house/repayment of housing loan shall stand discontinued. Similarly, the present practice of calling for “Utilization Certificate” shall also be dispensed ‘No document would be required to be submitted by the subscriber in respect of these partial withdrawals, I Para 68H: Grant of advances in case of closure of factories: No document would be required to be submitted by the subscriber along with the Composite Claim Form (Aadhar) / Composite Claim Form (Non-Aadhar), Ill, Para 68K: Marriage advance & for availing advance for post-matriculation education of children: No document, including marriage card, would be required to be submitted by the subscribers. IV. Para 68L: Advance in abnormal condition: Member may self-certify that his property has been damaged. No document would be required to be submitted by the subscriber.V. Para 68 J & 68N: Orders i separately. respect of certificates under these paras will be issued 5. It may be noted that the submission of Composite Claim Form (Aadhar) / (Composite Claim form (Non-Aadhar) duly signed by the EPF subscriber shall be construed as ‘self-certification’ for the above said partial withdrawals, for which no document as specified above would be required to be submitted to the EPFO offices 6. This order shall be made operational with immediate effect. F. V.P. Joy) ‘Central P.F. Commissioner Enclosures: 1. Composite Claim Form (Aadhar) 2. Composite Claim Form (Non- Aadhar).worm epi. gov EMPLOYEES’ PROVIDENT FUNDS ORGANISATION COMPOSITE CLAIM FORM (AADHAR) ema NAS WHEE ELVES COMPETE DEANS oA NAG NER MACON ETHIE AKL AK ‘Re. =19 (FEI SETTLEMENT 06 (PENSION VTTDRAWAL EMEP) 34 ART WITHORAWALSS ‘Claim applied for: i) Final PF Settlement (i) Pension Withdrawal Benefits () Ti) PF PART WITHORAWAL() ] (ck whichever is/are applicable) Name of the member: (IN CAPITAL LETTERS) rivera Account Warbar (UANY ‘adhar Namber: Date oF ning the establishment 2) Purpose of PF PART Withdrawal: (Tick V whichever applicable) 3H Purpose of F Pan Withdrawal 7 T [Housing Loan/Purchase of site/House/Fat [or for Construction/Addion alteration in ©) For purpose of Site/House/Flat or Construction through “agency” or ‘esting house/Repayment of Housing loan 1b) Amount (in Rs): Repayment of Housing Loan or LIC, indicate cheque to be drawn (Para 686/6868/685C) _| “in favour of and payee’s addres, [Lockout or cisure of factory Para 68H) [ness of merberfamiy (Para 68) IW ]Mariage of sal/son/daughter/brther7 sister (Para 684) V_ [Post Matriculation education of children (Para 68) ‘i_[ Natural calaity (Para 680) wi [Gutin elecriciy in establishment (Para 63m) vil [Purchasing ~ eauipment — by physialy handiapped (Para 6BN} Be_| One year before retirement (Para 6BNN) X_ [Investment in Varistha Pension BimaYoyana (Para GBNNN) Date of leaving senice: (not required W appiving for PF Par Withdrawal) <3)Permanent Account No.{PAR): (Only incase OF service ess than 5 years) (Pease enclose two copies of Form No. 15G/15H, if applicable) b) Reason of leaving Service: + Service terminated on account of (a) i health of member (b) Gontracton /Dscontination of employer's business or (e) Other Cause beyond the contol ofthe member Personal Reasons Ful Postal adress Pin. {erie tat the particulars are true to the best of my knowledge. I crt that Ihave gone through the data seeded in UAN Poca and ini at data, Incuding Form No-11 (New), bank account detais and Aachar number, to be correc. Please make the payment ih the ae ra meoned inthe UAN Portal, A canceled cheque (containing members name, bank account number an IFS Code) [cae the amount i used for any purpose ater than stated in column (6) above, Iam lable to retum the entre amount wih pena interest. Member's SignatureINSTRUCTION SHEET FOR FILLING COMPOSITE CLAIM FORM (AADHAR) ‘The Composite Claim Form (Aadhar) is applicable in cases where a member's complete detain Form-11 (New), ‘Aadhar number and bank account details are available on the UAN Portal and UAN has been activated. Such ‘members can submit this form dlrecty to the conceried EPFO office, without attestation of claim form by the employers. Purpose of advance & documents required: (The purpose may be one ofthe following): 5 Housing Loan/ Purchase of site/house/ lat or for construction/Addition alteration in existing house/Repayment of Housing loan: No document is required. New Declaration Formy/Utlization Certificate required earlier has been discontinued. '1) Mines of member/family |) Certificate of doctor and i) Certifate by employer that ESIC facity Is ot availabe to the member may be submitted by the member. Marriage of self/son/daughter/brother/sister: No document/Marriage Card is required. Post Matriculation education of children: No document is required, Lockout or closure of factory/Cut in supply of electricity: No document is required Natural calamity: No document is required. Purchasing equipment by physically handicapped: Medical certificate is required. One year before retirement: 90% of total PF balance can be withdrawn. No document is required Investment in Varistha Pension Bima Yojana: 90% of total PF balance can be transferred to LIC. No document is required, "No Revenue stamp (Re. 1/-) is required to be affixed by the member. Income Tax (TDS) is deducted ifthe service is less than 5 years (60 months). No Income Tax (TDS) is deducted in {se the total balance is less than Rs. 50,000/-. However, TDS Is deducted @10% if the member eubmits PAN in ‘such cases, In case PAN isnot submitted, then TDS @34,608% is deducted, The ‘otal service in the present establishment as well as previous establishment is counted and, therefore, it is ‘visable to merge all PF accounts, Pension Withdrawal benefits can be availed only Ifthe service i less than 10 years.ww epfindia govin ote Number EMPLOYEES’ PROVIDENT FUNDS ORGANISATION Cia (fick whichever iace applicable) ‘applied fori) Final PF Setlement (Jil) Pension Withdrawal Bangs () i) PF PART WITHORAWAL(—) Name ofthe member:(IN CAPITAL LETTERS) 2) Universal Acourt NariberUAN) b): BF. Recount Non case UAN not avaiable) By Dy ‘adharWrber (or seeding) 3) Father Name: ) Husband’s Name: ¥ by ate of Bt Date of joing the establishment: Date of leaving service (not required appiving for PF Part Withdrawal) '3} Permanent Account No (PAN): (Only incase Of service less an 5 years) (Pease encose two copies of Form No. 15G/15H, if applicable) 'b) Reason of leaving Serve: ~ Service terminated on account of (a) i heath of member (6) Contraction [Discontinuation of employer's business or (c) Other (Cause beyond te conta o te member Personal Reasons 0 8) Purpose of PF Part Withdrawal(Tck ¥ whichever applicable) 1b) Amount (in Rs): ©) For purpose of Ste/House/Flat or Constrction through "agenoy" or Repayment of Housing Loan or LIC, indcate cheque tobe crawn In favour of and payee’ adores. EY Purpose of PE Part Withawal T [Housing Loan/Purchase of siteHouse/Fat or for Consruction/Addton, alteration in @xstng house/Repayment of Housing oan (Para 685/686 /688C) (ara 68) Lockout or cosure of factory (ara 685) nes of member family (Para §8)) {| Mariage of slfsor/daughterrathe7 sister (Para 68K) —_| Post Matriculation educator of chidren ‘| Natural calamity (Para 68 am) We [Gut in elecricty in establghment (Para an) ‘Wil | Advance Tor Physical handicapped (Para (Para GBNNN) [bc One year before retirement (Para GEN] X [Investment in Varsha Pension BimaYojona ‘Bank Account deals Tor payment (Ptease attach a copy of canceled cheque/attested copy of fst page of Pass Book) Saving Bank Recount No Name8. address ofthe Bank 1S Code cia Fal Postal adress ‘The member hereby declares that e has nct been employed fr two months (Yes/No) Certified thatthe particulars are true to thebestof my knowledge. {Incase the amount used for any purpose other than stated in column (10) above, Tar lable to return the entire amount wth penal Interest Member's Sonature Employers Signature Designaton® Seal of EmployerINSTRUCTION SHEET FOR FILLING THE COMPOSITE CLAIM FORM (NON-AADHAR) 1, Purpose of advance & documents required: (The purpose may be one ofthe following): 9 ‘iy » ») vi) vii) vill) i) Housing Loan/Purchase of site/house/lat or for construction/Addition alteration in existing house/Repayment of Housing loan: No document is required. New Declaration Formy/Utiization Certificate required earlier has been discontinued. Tilness of member/family: i) Certificate of doctor and ii ) Certificate by employer that ESIC facility is ‘ot available to the member may be submitted by the member. Marriage of self/son/daughter/brother/sister: No document/Marriage Card is required. Post Matriculation education of children: No document is required, Lockout or closure of factory/Cut in supply of electricity: No document is required ‘Natural calamity: No document is required, Purchasing equipment by physically handicapped: Medical certificate is required, One year before retirement: 90% of total PF balance can be withdrawn. No document is required. Investment in Varistha Pension Bima Yojana: 90% of total PF balance can be transferred to LIC. No document is required. No Revenue stamp (Re, 1/-) Is required to be affixed by the member. Income Tax (TDS) is deducted i the service is less than 5 years (60 months), No Income Tax (TDS) is deducted in ‘ase the total balance is less than Rs. 50,000/-. However, TDS is deducted @10% if the member submits PAN in ‘Such cases. In case PAN fs not submitted, then TDS @34.608% Is deducted. ‘The total service in the present establishment as well as previous establishment is counted and, therefore, it is advisable to merge all PF accounts. 5. Pension Withdrawal benefts can be availed only ifthe service is less than 10 years.