AN APPLICATION (PERFORMA) AND
ADVANCE STAMPED RECEIPTS (PERFORMAS)
Sub: – Settlement of claim Employees’ Provident Fund (EPF) Employees’ Family Pension Fund/Employees’ Deposit Linked Insurance (EDLI) PF No.__________________
Dear Sir,
I had applied for settlement of PF/EPF/EDIL PF No. __________________ to be credited to my (Name)_______________________ S.B.A/c No.________________________(Bank & Branch with address_________________________________________________________Vide Cheque No.(S)__________________________dated ___________________for Rs.________________ on A/c of settlement of my claim, but the cheques sent by your office has/have been returned/undelivered by the Bank Authority. Now I am enclosing the photocopy of Pass-Book with complete Bank address duly certified the Bank and you are requested to send Cheque again at the under mentioned address.
| SAVING BANK A/C NO. |
|
| NAME OF BANK |
|
| FULL BANK ADDRESS |
|
| NAME OF MEMBER |
|
| FATHER/HUSBAND NAME |
|
| FULL RESIDENTIAL ADDRESS |
|
Thanking you,
Yours faithfully
ATTESTED BY EMPLOYER/
(Signature of Member)
ADVANCE STAMPED RECEIPT
Rceived a sum of Rs. _________________vide Cheque No.______________Dated _________
From officer-in charge,SAO East Delhi by deposit in my Saving Bank A/c towards the settlement of PF/EPF/EDLI.
Affix Rs.1/-REVENUE STAMP
WTH FULL SIGNATURE ON REVENUE STAMP
