NON EMPLOYMENT CERTIFICATE SELF DECLARATION BY THE MEMBER/CLAIMANT
S/a. Wio. Ho
Residing at
do hereby sloemnly affirm and sincerely state as here under:
bearing P.F. Account No.
1. declare that I/my husband/wife was an employee of M/s S/o. W/o. H/o. and left the job on and that I/my husband/wife had not been employed in any other establishment covered under the EPF Scheme, 1952, Prior to the date of joining the establishment/after the date of Leaving service from the above establishment.
And that I declare that I am not in receipt of any pensionary benefits under Employees Family Pension 1971/Employees Pension Scheme, 1995 That what is stated above is true and correct to the best of my Knowledge.
In case, my above declaration is found to be false, I undertake to return the Pension in full with interest as declared by EPF Organisation and I am liable for any action that may be initiated by EPFO in this regard.
Solomnly affirmed at
Signature of the member/claimant
On this day the
NOTE: Strike whichever is not applicable.
