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Employees’ Provident Fund Organisation
(Ministry of Labour & Employment, Govt. Of India)
Head Office
Bhavishya Nidhi Bhawan, 14-Bhikaiji Cama Place, New Delhi-110066,
Telephone: 011- 26713254 Fax: 011-26166609 Email:

No: Manual/Amendment/2011/Pt/9536  Date: 21.08.2017


All Addl. CPFC (HQ/Zone),

Regional P.F. Commissioners-in charge of

Regional Offices.

Sub:  Composite Claim Form for Death Case to replace erstwhile Form ` 20,10-D & 5-IF – Revised Claim Form thereof

Ref:   HO circular No. Manual/Amendment/2011/163 dated 03.03.2017 (placed on EPFO website at SI. No. 675 ‘Office order/Circulars’ for the year 2016-17).


The Central Provident Fund Commissioner vide order dated 03.03.2017 had introduced Composite Claim Form for Death case by replacing erstwhile claim Form Nos. 20, 10-D and 5-IF with a view to simplify the submission of claim forms by the subscribers.

2. Based on various suggestions, the Composite Claim Form for Death cases has been reviewed and accordingly a revised Composite Claim Form for death cases, approved by CPFC, is attached herewith. This claim form shall come into force from the date of issue of this circular.

(This issues with the approval of FA&CAO)

Yours faithfully,

Encl: As above

(Udita Chowdhary)

Addl. CPFC (F&A)

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