Artifact 4 - PF Withdrawal Form
Artifact 4 - PF Withdrawal Form
Dear Sir,
As I have resigned / retired from the TCS Limited with effect from _________________, I request you to
settle my Provident Fund account and pay the said amount at an early date.
1. Name:-___________________________________________________________________________
2. Father’s / Husband’s Name:-___________________________________________________________
3. Employee Number : ______________ Address for correspondence
4. Date of Joining Service : ______________
5. Date of cessation of service : ______________
6. Period of Service : ______________
7. Pan card No. :______________
8. Transferred previous PF to TCS : Yes / No Contact No. :
If Yes, Name of Previous employer :__________________ Personal Email Id :
9. Select the reason for withdrawal of Provident Fund Accumulations
Tick Signature Tick Signature
DECLARATION OF NON-EMPLOYMENT
I declare that I have not been employed in any Factory/Establishment to which the Act applies for a continuous period of not less
than 2 months immediately preceding the date of my application for final withdrawal of my Provident Fund money.
_______________________