All forms should be filled up legibly with correct information duly attested by the employer to ensure faster and early settlement.
SETTLEMENT OF YOUR EMPLOYEES PROVIDENT FUND ACCOUNT; FORM 19
1. NAME OF THE MEMBER : Fill your name legibly in capital letters. The name furnished in Form* 9/5, Claim Form and Bank account should be identical.
2. FATHER'S NAME : Fill your father or husband name legibly in capital letters claim form and bank account should be identical -- submitted by employer at the time of joining.
3. NAME AND ADDRESS OF COMPANY: Furnish the name of company and full address and correct pin code.
4. Account Number :Please fill up legibly State Code / Office Code / Establishment Code / Extn Code (If any) / Member Account Number. The Account Number allotted to the member shall continue till the member leaves that establishment and the accumulation are settled/transferred.
Example :
State / Office / Estt / Extn / Member
TN / MAS / 5587 / A / 37
5. Date of Leaving service : Correct date of leaving should be billed in.
6. Reason for leaving service : From the following please fill the reason applicable to you,
* Retired from Service after attaining 55 years ( OR ) Attained 55 years and resigned from service (OR) Retired on Disability to the work (OR) Under Voluntary Retirement Scheme(OR)Migration to abroad on Permanent settlement (OR) Retrenched from Service (OR) Resigned / Left Service *
[ * For cases of Resignation / Left Service, the claim should be submitted by the member only after two months from the Date of Leaving service. ]
7. Full Postal address : Fill full postal address should be given clearly in Block letters with correct pincode.
8. Mode of Remittance : It is safer to have the payment through cheque. Account Payee cheque will be sent directly to the Scheduled bank / Coop Bank / Post Office in which Savings bank Account of the member is maintained. If less than Rs.2000 amount will be sent through money order. kindly attach the xerox copy of the first page of your saving bank account pass book.
9. Signature of the member : Member should be sign in the application you should sign the application in the presence of the employer.
10. Attestation by the employer: The authorized official of the company should attest in the claim form with the seal of his designation. If the establishment is under permanent closure get the attest from the following authorized official...
[ Manager of the bank you holding the savings bank account (OR) A gazetted officer (OR) Sub Post Master (OR) MP/MLA (OR) The Magistrate (OR) President of village/panchayat]
11. Advance Stamped Receipt : Wherever payment is sought through account payee, the advance stamped receipt should be signed by the member duly affixing one rupee revenue stamp. The amount need not be filled in which shall be filled in by the RPFC / OIC of the EPFO office.
