DECLARATION

To, Date:______________

The Regional PF Commissioner

SRO, K R Puram

Bangalore

Sub: Declaration regarding not being a PF member at present-reg.

Sir,

I, hereby certify that I am not employed in any establishment which is covered under PF Act and

that I am not an EPF member. I request that my application for withdrawal i.e. Form-19 and Form-

10C may please be processed. I have also enclosed KYC documents like Aadhar/PAN/Bank

Account number etc. along with the application.

Yours faithfully

Sign:_____________________

Name:_____________________

PF Code Number:____________________

UAN:_____________________