Employees Provident Fund Scheme

Form 13
For Office use only Date Seal/Reg. No.. (Para 57 of the Employees Provident Funds Scheme, 1952) Application for transfer of EPF Account To, The Commissioner Employees Provident Fund, . . Sir, I request that my Provident Fund balance along with the Membership details in Family Pension Fund may please be transferred to Present account under intimation to me, necessary particulars are furnished below : 1. 2. 1. 2. Name : RAJJAN VERMA Fathers/Husbands name in the case of female : Name and address of the ex-employer : E.P.F. A/c No. allotted by ex-employer : With whom P.F. A/c of the ex-employer is maintained. .. with regional Provident Fund Commission With Provident Fund Trust. . Previous A/c No. allotted by the employer (if allotted separately) : .. Date of leaving service with previous employer : Date of joining the present employer : Date To, M/s. .. .. (To be filled in, if Note (ii) above is applicable

3. 4. 5.

Signature /Left Hand Thumb impression of the Member. To be filled in by the present employer : 6. Name and address of the establishment. 7. EPF Code & Account No. allotted to the member :

8. 9.

13 14

.. EPF Account No. allotted to the member separately, if any : .. By whom the EPF Account of the member in the present establishment is kept. .. Being an unexempted establishment (I) By Regional Office at . (ii) Sub-Regional Office at . (iii) By exempted PF Trust, viz. Being an exempted establishment (iv) By Private PF Not covered under the Act viz. By whom the EPF Account of the (I) PF Regional Office at member in the present (ii) PF-Sub-Regional Trust, viz. establishments kept .. In whose favour transfer is to be . effected i.e. payees details . Date : (For the Use of P.F. Office Only) Signature of Employer/Authorised Official with Office Seal.

A sum of Rs. (Rupees) is authorised for transfer, vide Annexture, K (Revised) Transfer Proceeds to be sent along with Annexture K (Revised) By D.D. to the Regional P.F. Commissioner Officer-in-charge of SubRegional Office . By D.D. to the P.F. Trust of the establishment with reference to details in Serial No. 14 above Membership details under Family Pension Fund forwarded to P.F. Regional Office/Sub-Regional Office at By transfer entries to the Members Ledger Card bearing Number in the present establishment from the Ledger Card bearing Number . of the previous establishment.. Transfer intimation/copy of Annexure K (Revised) to the member placed below. P.I. No. Clerk A.S./A.A.O./A.P.F.C Scroll No. Paid by Cheque No. . Date . Cashier/Clerk S.S. A.P.F.C