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Beneficiary Nomination-Provident Fund

This document is a nomination and declaration form for an employee's provident fund and pension scheme. It contains the employee's personal details like name, date of birth, PF and EPS account numbers. It allows the employee to nominate individuals to receive the PF and pension funds in the event of the employee's death. The employee also provides family details if any to receive widow or children's pension. The form is signed by the employee and certified by the employer to confirm the details provided.

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BharatSubramony
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282 views2 pages

Beneficiary Nomination-Provident Fund

This document is a nomination and declaration form for an employee's provident fund and pension scheme. It contains the employee's personal details like name, date of birth, PF and EPS account numbers. It allows the employee to nominate individuals to receive the PF and pension funds in the event of the employee's death. The employee also provides family details if any to receive widow or children's pension. The form is signed by the employee and certified by the employer to confirm the details provided.

Uploaded by

BharatSubramony
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Date of Appointment :

FORM 2 (REVISED)
NOMINATION AND DECLARATION FORM
FOR UNEXEMPTED / EXEMPTED ESTABLISHMENTS
Declaration and Nomination Form under the Employees’ Provident Funds
and Employees’ Pension Scheme
( Paragraph 33 and 61 (1) of the Employees’ Provident Fund Scheme, 1952 and Paragraph 18
of the Employees’ Pension Scheme, 1995).
1. Name : ___________________ __________________________ __________________
( IN BLOCK NAME FATHER’S/ HUSBAND’S NAME SURNAME
LETTERS)

2. Date of Birth______________________ 3. PF Account No.MH/BAN/48736/


4. EPS Account No :MH/BAN/48736/ 5. Sex : Male / Female :______________________

6.Marital Status: Married/ Unmarried/ Widow/Widower 7. Permanent Address: ________________


_________________________________________________________________________________
________________________________________________________________________________
8.Temporary Address :______________________________________________________________
_________________________________________________________________________________
________________________________________________________________________________
PART –A (EPF)
I hereby nominate the person (s) / Cancel the nomination made by me previously and nominate the
person (s), mentioned below to receive the amount standing to my credit in the
“................................................................” in the event of my death.
Name & Address of the Nominee’s Date of Birth Total amount If the nominee is minor,
Nominee (s) relationship or Share of name relationship & address
with the accumulations of the guardian who may
member in P.F. to be receive the amount during
paid to each the minority of nominee
nominee
1 2 3 4 5

1.Certified that I have no family as defined in the Rules of the


“................................................................................” and should I acquire a family hereafter the
above nomination should be deemed as cancel.
2. Certified that my father/ mother is/are dependent upon me.
• strike out which is not applicable.

X Signature or thumb impression of the subscriber


EMP NO :
P.T.O.
PART –B (EPS)
(Para-18)
I hereby furnish below particulars of the members of my family who would be eligible to receive
Widow / Children Pension in the event of my death.
Sr. Name and Address of the Family member/s Date of Birth Relationship with the
No. member
(1) (2) (3) (4)

** Certified that I have no family, as defined para 2 (vii) of the Employees’ Pension
Scheme,1995 and should I acquire a family hereafter I shall furnish particulars there on in the above
form.
I hereby nominate the following person for receiving the monthly widow pension [ admissable under
para 16 (2) (a) (i) & (ii) in the event of my death without leaving any eligible family member / s for
receiving pension.
Sr. Name & Address of the Nominee Date of Birth Relationship with the
NO. member
(1) (2) (3) (4)

Date : _____________
** Strike out which is not applicable

X Signature or thumb impression of the subscriber


CERTIFICATE BY EMPLOYER
Certified that the above declaration and nomination has been signed / thumb impressed before me by
Shri. / Smt /Miss__________________________________________ employed in my establishment
after he / she has read the entries / the entries have been read over to him / her by me and got
confirmed by him /her.
For The Boston Consulting Group (India) Pvt. Ltd

Authorised Signatory

Place : Mumbai For The Boston Consulting Group (India) Pvt. Ltd

Date : ____________ Nariman Bhavan, 14 th Floor, 227, Nariman Point,


Mumbai -400 021

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