Please send me a sample filled Employees Provident Fund Form No. 10 C & form 19 so that i cam fill it up for my self.......... Thanking you...

I am hereby giving checklist for filling of such forms :
Check List for Claims in Form 19 (Provident Fund)

· Whether all the columns in the Form 19 are correctly and completely filled in ( as per the details furnished to this office), in ink, without any overwriting.
· Whether the reason and date of leaving service have been correctly filled in, with reference to Form 10 already given, in the appropriate columns in the Form 19
· Whether the member has furnished his full postal address, with the postal pin code number, for communication and for payment of amount, if preferred by postal money order.(Money order is issued only where the amount payable is below Rs.2000/-)
· If the payment is preferred by account payee cheque, through bank, please check to:
· Whether the member has got a Savings Bank account in any of the branches or a nationalised / Scheduled / Co-operative Bank / Post Office.
· Whether the account opened is only an individual account and not a joint account.
· Whether the name, branch and address of the Bank have been clearly furnish in the Form 19. The Employer should attest any correction. (Attach the first page of Savings Bank passbook showing the name and account number of the member)
· Whether the member has completed the advance stamped receipt (furnished in the Form 19 itself) and appended his signature on one rupee revenue stamp affixed in the relevant portion)
· If the reason for leaving service is “left” “Resigned”, etc., ensure that 2 months period has been completed from the date of leaving service to the date of preference of the claim. However this will not be applicable if the member has completed 55 years of age or being a female member resigned for her marriage.
· In case the member is an illiterate, whether thumb impression of the member affixed at the relevant portion.
· Whether Form 5 and Form 10 particulars are reproduced in the claim Form
a) Whether Form 3A, if any , for the broken period of currency is enclosed
b) Whether Form 3A for previous currency period is sent, if not, enclose Form 3A for the previous years also.
c) Whether Form 3A is completed and signed and reasons for ‘Nil’ contribution is given.
d) Whether the period of non-contributory service is indicated where the wages are not drawn for a full month.
· Whether the remittances are made up to date and returns submitted. If for any reasons, any remittance is outstanding in respect of the claimant, the amount due on his / her account needs to be indicated.
· Whether the specimen signatures of the authorised officials of the establishment are already submitted to the Regional Provident Fund Commissioner. If not, it shall be done and be updated whenever there is change in the officials
· Whether the claim has been attested by the authorised officials of the establishment, duly affixing his official seal and date.

Checklist Form Claims in Form 10 C

(Form to be used by a member of Employees Pension Scheme 1995 for claiming Withdrawal Benefit / Scheme Certificate)

· To check whether all columns in the claims are properly filled
· Whether the particulars are written clearly without any overwriting or cutting, Correction, if any, is attested
· Whether the member has appended his signature on One Rupee Revenue Stamp affixed in the relevant portion. (To be given where withdrawal benefit is admissible and opted for payment by cheque)
· Whether the details of wages and period of non-contributory service were already informed through Form 3A.
· If the member is not eligible for pension and has rendered 10 or more years of eligible service, he/she is entitled for Scheme Certificate only.
· Wherever the member is having less than 10 years eligible service, he/she may be advised to opt for scheme Certificate instead of withdrawal Benefit.
· Option to be specifically stated either for Scheme Certificate or Withdrawal Benefit.
· In case of opting for “Scheme Certificate”, it is not necessary to furnish the Savings Bank Account and enclosing of attested photos.
· These points are in addition to common points furnished under “Check list for claim in Form – 19”
Thanks & Regards,
SuMita