Settlement of Provident Fund & EDLI accumulation and grant of pension

Date:    26 Aug 2014

The Regional P.F. Commissioner,

Sub: Settlement of Provident Fund & EDLI accumulation and grant of pension in respect of Late Avinash Chander bearing PF A/c No DL/8640/4938– reg.

Dear Sir,

Please refer to Form No.20, 5IF, & Form 10D for refund of PF accumulation & grant of pension benefit in respect of MRS XYZ, JKM (wife and children of deceased employee LATE ABC)

The following documents/Papers enclosed herewith duly filled and completed in all respects for immediate settlement of their claim:-

1. Form No. 20 & 5IF                                                                       —           2 copies
2. Form 10D                                                                                         —        3 copies
3. List of Family Members                                                                —        3 copies
4. Age proof of the nominee                                                              —        1 copy for each claimant
5. Form No. 3A for (2009-10 to 2014-2015)                                   —       1 copy
6. Death Certificate                                                                              —         1 copy
7. Bank account details with SBI                                                       —           1 copy for each claimant
8. Photographs                                                                                       —           4 copies

Please acknowledge the receipt.

Thanking you,

Yours faithfully,

For PVT LTD.

Authorized Signatory.

Encl: As Above.