Account C

ONLINE TRANSFER CLAIM FORM [FORM ** (REVISED) ]

( Tracking ID: 10089682360305005 )

Claim Date : 21/05/2019

EMPLOYEES' PROVIDENT FUND SCHEME, 1952

(PARA 57)

:

Bank Account Number

PART A : PERSONAL

2.

Name

3.

Mobile Number

: 306********

:

4.

: 979*******

Bank IFSC

E-mail id

SBIN0003351

VISWAKUMAR JAYAKUMAR

:

5.

1.

adftsg@r.postjobfree.com

The Regional P.F. Commissioner,

3, Rajaji Salai, Tambaram

(This form has been printed on the basis of Online Transfer Claim Form filled up by the member under Unified Portal for submission to the employer.)

I request that my Provident Fund balance along with my Pension Service Details may please be transferred to my present account under intimation to me. My details are as under : TAMBARAM,

To,

Sir,

2.

:

Address of the Establishment

PART B : DETAILS OF PREVIOUS PF ACCOUNTS (WHICH IS TO BE TRANSFERRED) 3.

PF Account No. (with EPFO

:

Name of the Establishment

1. TBTAM00625640000016676

: HLF SERVICES LIMITED

27A, DEVELOPED INDUSTRIAL ESTATE GUINDY CHENNAI 685 4. PF A/C No. held by : TAMBARAM

5. NOT APPLICABLE

NOT APPLICABLE

:

PF A/C No. in Trust

Bank A/C No. of Trust :

:

7.

6.

Name of the Trust

NOT APPLICABLE

IFS Code of the Bank Branch of

Trust where account is

10.

Member's Name

16/03/1986

:

Date of Birth

: NOT APPLICABLE

8.

:

9. : VISWAKUMAR JAYAKUMAR

11.Father's/Spouse Name JAYAKUMAR

:

:

12. :

14. 18/04/2016

Relationship FATHER

13.

Date of leaving

Date of joining 01/06/2015

ORION EDUTECH PVT. LTD.

Father's/Spouse Name

:

Address of the Establishment

Member's Name

PF Account No. (with EPFO

Date of Birth

:

:

: 16/03/1986

:

5.

:

:

VISWAKUMAR JAYAKUMAR

Relationship

:

9.

1.

JAYAKUMAR

Name of the Establishment

12.

:

Name of the Trust

PF A/C No. in Trust NOT APPLICABLE

PART C : DETAILS OF PRESENT PF

6.

163/1, VIP ROAD, SCHEME-VIIM, KOLKATA 433

10.

3.

2.

NOT APPLICABLE

WBCAL00546520000028543

11.

FATHER

13. Date of joining : 01/02/2019

:

Bank A/C No. of Trust

8.

7. : NOT APPLICABLE

NOT APPLICABLE

IFS Code of the Bank Branch of

Trust where account is

4. PF A/C No. held by : RO KOLKATA

Signature of the member

Note : Member should take a printout of this form and a signed copy of the same should be submitted to the Present Establishment i.e. ORION EDUTECH PVT. LTD.

I, Certify that all the information given above are true to the best of my knowledge and I have ensured the correctness of my present and previous account numbers.

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