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Annexure 1

The document outlines the necessary information and steps for completing Form 19 and Form 10C related to PF claims. It specifies required personal details, company information, and remittance modes, along with instructions on signatures and revenue stamps. Both forms require complete residential addresses and have specific instructions for members regarding withdrawal and scheme certificates.

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Irfan
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21 views2 pages

Annexure 1

The document outlines the necessary information and steps for completing Form 19 and Form 10C related to PF claims. It specifies required personal details, company information, and remittance modes, along with instructions on signatures and revenue stamps. Both forms require complete residential addresses and have specific instructions for members regarding withdrawal and scheme certificates.

Uploaded by

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

ANNEXURE – I

FORM 19:

1. Name of Member and mobile no. and Personal Email ID.


2. Father’s name/ Husbands name
3. Name of the company:
Mention the Name of company
DAKC, H - Block, Ground Floor, Wing 2,
Thane Belapur road,
Koperkhairne, Navi Mumbai - 400710.
4. PF A/c. no.
5. Date of Leaving
6. Reason of leaving : Resigned
7. Full Correspondence address: Complete residential address should be mentioned ie. Room /
house no., Street, Landmark, City, State & Pin code.
8. Mode of Remittance: B & c Option should be filled.
A. Money order (this option is stopped by PF Office)
B. Bank account details ie. Saving A/c. no, Bank name, complete address ie. Street, Landmark,
City, State & Pin code.
C. IFS / NEFT no. and MICR no.
9. Wherever Signature/Left/ Right hand thumb impression of member is mentioned employee will
have to sign. (No thumb impression is required)
10. On advance stamp receipt – affix a Re. 1/- revenue stamp and sign across it.

FORM 10 C: (Pension claim form is common for all companies ie. Exempted & Un-exempted)

1. Name of Claimant and member on both place same members name should be mentioned.
2. Date of Birth
3. Father’s name/ Husbands name
4. Name of the company
Mention the Name of company
DAKC, H - Block, Ground Floor, Wing 2,
Thane Belapur road,
Koperkhairne, Navi Mumbai - 400710.
5. Code no. & account no. Keep it blank on top of form mention employee no and email id.
6. Date of Leaving
7. Full Postal address: Complete residential address should be mentioned ie. Room / house no.,
Street, Landmark, City, State & Pin code.
8. Are you willing to accept a scheme certificate :
 If member wants to withdraw then tick NO.
 If member has worked for more than 10 years then he/she cannot withdraw they will have to
get the scheme certificate. Also attach the copy of birth proof of children if age below 25.
9. Particulars of Family.
10. Keep it blank
11. Mode of Remittance: B & c Option should be filled.
a. Money order (this option is stopped by PF Office)
b. Bank account details ie. Saving A/c. no, Bank name, complete address ie. Street, Landmark,
City, State & Pin code.
12. Keep it blank.
13. Wherever Signature/Left/ Right hand thumb impression of member is mentioned employee will
have to sign. (No thumb impression is required)
14. On advance stamp receipt – affix a Re. 1/- revenue stamp and sign across it.

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