Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 5

(On letter pad of Establishment)

Joint Declaration Form

I…………………………………………………………………………………………………………………….
……having UAN................................................................................................................................................PF
account………………………………….and Aadhaar…………………………. is/ was with establishment
M/S…………………………………. The personal details furnished to EPFO earlier were found to be incorrect
/blank, and therefore request for change/updation in the member profile as follows.
S. No. Details/particulars Incorrect details Correct details
1 Aadhaar
2 Name
3 DOB
4 Gender
5 Fathers/Mothers
6 Relationship
7 DOJ
8 DOL
9 Reason of leaving
10 Marital Status
11 Nationality

I…………………………….……. s/o…………………………, authorized signatory of the establishment, have


verified the request, document attached and the records of the establishment and certify that the facts mentioned
above are correct. I am also enclosing … … … . . ……………………………………,.......................................,
…………………… and …………………………. (Documents of Establishment) in support of the request of the
employee mentioned above.

We…………………………………………...(Employee) and …………………………..................................

(Authorized Signatory) hereby declare we have not concealed any facts and the above- mentioned facts are
correct. We also indemnify that in case of wrong payment/over payment/under payment because of the above
furnished information shall be jointly held responsible.

Authorized signatory Name & Signature of the member

1
2
3
4
5

You might also like