In the New Form : 11 – Declaration Form, EPFO has added new validation point at Serial No. 12 asking employee to confirm whether he/she was EPF/EPS member on or before September 2014 and if he/she has withdrawn this amount or not.  Format of Form 11 is as follows:-

New Form : 11 – Declaration Form
(To be retained by the employer for future reference)

EMPLOYEES’ PROVIDENT FUND ORGANISATION
Employees’ Provident Fund Scheme, 1952 (Paragraph 34 & 57) and
Employees’ Pension Scheme, 1995 (Paragraph 24)

(Declaration by a person taking up Employment in any Establishment on which EPF Scheme, 1952 and for EPS, 1995 is applicable)

1. Name of Member (Aadhar Name)
2. Father’s Name ……. Spouse’s Name…..

(Please tick whichever applicable)

3. Date of Birth (dd/mm/yyyy)
4. Gender (Male / Female / Transgender)
5. Marital Status ? (Single/Married/Widow/ Widower/Divorcee)
6. (a) eMail ID
(b) Mobile No (Aadhar Registered)
7. Whether earlier member of the Employee’s Provident Fund Scheme, 1952 ? Yes / No
8. Whether earlier member of the Employee’s Pension Scheme, 1995 ? Yes / No
9. Previous Employment details ? (If Yes, 7 & 8 details above)

a) Universal Account Number (UAN)

b) Previous PF Account Number
c) Date of Exit from previous Employment ? (dd/mm/yyyy)
d) Scheme Certificate No (If issued)
e) Pension Payment Order (PPO) (If issued)
10. a) International Worker Yes / No
b) If Yes, state country of origin (name of other country)
c) Passport No.
d) Validity of passport (dd/mm/yyyy) to (dd/mm/yyyy)
11. KYC Details : (attach self attested copies of following KYC’s) Must Enclose Scan copy for the following documents
a) Bank Account No. & IFS Code
b) AADHAR Number
c) Permanent Account Number (PAN), If available
12 First EPF Member Enrolled Date First Employment EPF Wages Are you EPF Member before 01/09/2014 If Yes, EPF Amount Withdrawn? If Yes, EPS (Pension) Amount Withdrawn? After Sep 2014 earned EPS Pension) Amount Withdrawn before Join current Employer?
Yes / No Yes / No Yes / No Yes / No

UNDERTAKING

1) Certified that the particulars are true to the best of my knowledge

2) I authorise EPFO to use my Aadhar for verification / authentication / eKYC purpose for service delivery

EPFO added new validation point in Form 11

3) Kindly transfer the fund and service details, if applicable, from the previous PF account as declared above to the present PF account. (The transfer would be possible only if the identified KYC details approved by previous employer has been verified by present employer using his Digital Signature

4) In case of changes in above details, the same will be intimated to employer at the earliest.

Date :
Place :

Signature of Member

DECLARATION BY PRESENT EMPLOYER

A. The member Mr./Ms./Mrs. ……………………………………… Has joined on ……………………… and has been alloted PF Number………………

B. In case the person was earlier not a member of EPF Scheme, 1952 and EPS, 1995: ((Post allotment of UAN) The UAN alloted or the member is)

Please Tick the Appropriate Option : The KYC details of the above member in the JAN database

……….. Have not been uploaded ………..Have been uploaded but not approved ………….. Have been uploaded and approved with DSC

C. In case the person was earlier a member of EPF Scheme, 1952 and EPS 1995;

………… The KYC details of the above member in the UAN database have been approved with Digital Signature Certificate and transfer request has been generated on portal

………… As the DSC of establishment are not registered with EPFO, the member has been informed to file physical claim (Form-13) for transfer of funds from his previous establishment.

Date :

Signate of Employer with Seal of Establishment

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2 Comments

  1. Anuradha Bhatta says:

    Wanted to check whether I can encash my EPS certificate which was issued in the year 2019 by EPS trust account (employer was non-profit trust)

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