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Artifact 4 - PF Withdrawal Form

The document is an application from a former Tata Consultancy Services employee requesting settlement of their provident fund account. It provides personal details of the applicant like name, employee ID, date of joining, date of leaving, and bank account. It specifies the reason for withdrawal as retirement, going abroad, illness/incapacitation, or unemployment for over 2 months. It notes the settlement amount will be credited to the applicant's last known salary bank account and is subject to tax if service is less than 5 years. It includes a signed receipt to acknowledge receipt of payment.

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Siva chowdary
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0% found this document useful (0 votes)
226 views1 page

Artifact 4 - PF Withdrawal Form

The document is an application from a former Tata Consultancy Services employee requesting settlement of their provident fund account. It provides personal details of the applicant like name, employee ID, date of joining, date of leaving, and bank account. It specifies the reason for withdrawal as retirement, going abroad, illness/incapacitation, or unemployment for over 2 months. It notes the settlement amount will be credited to the applicant's last known salary bank account and is subject to tax if service is less than 5 years. It includes a signed receipt to acknowledge receipt of payment.

Uploaded by

Siva chowdary
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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TATA CONSULTANCY SERVICES EMPLOYEE’S PROVIDENT FUND

APPLICATION FOR SETTLEMENT OF PROVIDENT FUND ACCOUNT


(TO BE FILLED BY APPLICANT)
To,
The Trustees,
Tata Consultancy Services Employee’s Provident Fund,
Mumbai.

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

a. Retirement b. Going Abroad

c. Illness/Incapacitation d. Unemployed for


2 Months
(Please tick the applicable reason & sign in the text block)

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.

Place: __________ Yours faithfully,


Date: __________
…………………………
(Signature)
Note:- 1) The Provident fund settlement amount will be credited to the last known salary bank account
available with us in Ultimatix. Request you not to close your salary Bank account, till all retirals are
processed. For any further clarification, kindly contact corporate retiral team on retiral.settlements@tcs.com
2) The PF withdrawal amount is subject to tax, If contributory service (inclusive of service rendered in
previous employment provided the PF is transferred to TCS) is less than five years.

ADVANCE STAMPED RECEIPT


Received a sum of Rs.______________(Rupees_____________________________________________
_____________________________only) from the Trustees of TCS Employees Provident Fund towards
full & final settlement of my Provident Fund account.
Affix.
1 Rs.
Reve
nue
( Please sign across the Stamp )

The details given in Item No. 1 to 5 are verified.

_______________________

Date : ( Signature Of Employer )

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