{"id":5412,"date":"2012-04-25T10:36:30","date_gmt":"2012-04-25T10:36:30","guid":{"rendered":"http:\/\/www.yourhrworld.com\/formats\/?p=5412"},"modified":"2012-04-25T10:36:30","modified_gmt":"2012-04-25T10:36:30","slug":"epf-form-19-10-c-format","status":"publish","type":"post","link":"https:\/\/www.yourhrworld.com\/formats\/hr\/epf-form-19-10-c-format\/","title":{"rendered":"EPF Form 19 &#038; 10-C Format"},"content":{"rendered":"<p><strong>\u00a0I have Attached EPF Form 19 &amp; 10-C Format<\/strong><\/p><div class=\"69eb924294c115e6505da44099e8df92\" data-index=\"1\" style=\"float: none; margin:10px 0 10px 0; text-align:center;\">\n<script type=\"text\/javascript\"><!--\r\ngoogle_ad_client = \"pub-0867779017855679\";\r\n\/* 300x250, created 4\/20\/11 *\/\r\ngoogle_ad_slot = \"1035864135\";\r\ngoogle_ad_width = 300;\r\ngoogle_ad_height = 250;\r\n\/\/-->\r\n<\/script>\r\n<script type=\"text\/javascript\"\r\nsrc=\"http:\/\/pagead2.googlesyndication.com\/pagead\/show_ads.js\">\r\n<\/script>\n<\/div>\n\n<table width=\"676\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\">\n<col width=\"185\" \/>\n<col width=\"119\" \/>\n<col span=\"2\" width=\"40\" \/>\n<col width=\"26\" \/>\n<col span=\"2\" width=\"40\" \/>\n<col width=\"26\" \/>\n<col span=\"4\" width=\"40\" \/>\n<tbody>\n<tr>\n<td width=\"185\" height=\"26\"><\/td>\n<td align=\"left\" valign=\"top\" width=\"119\"><img loading=\"lazy\" decoding=\"async\" src=\"file:\/\/\/C:\/DOCUME%7E1\/ADMINI%7E1\/LOCALS%7E1\/Temp\/msohtml1\/01\/clip_image002.gif\" alt=\"\" width=\"113\" height=\"116\" \/><\/p>\n<table cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td width=\"119\" height=\"26\"><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/td>\n<td width=\"40\"><\/td>\n<td width=\"40\"><\/td>\n<td width=\"26\"><\/td>\n<td width=\"40\"><\/td>\n<td width=\"40\"><\/td>\n<td width=\"26\">Mobile:\u00a0 98427 98427<\/td>\n<td rowspan=\"2\" colspan=\"4\" width=\"160\">Serial No.<\/td>\n<\/tr>\n<tr>\n<td height=\"26\"><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td height=\"26\"><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td colspan=\"4\">For Office Use Only<\/td>\n<\/tr>\n<tr>\n<td height=\"26\"><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td colspan=\"4\">In Words No.<\/td>\n<\/tr>\n<tr>\n<td height=\"26\"><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td colspan=\"4\">Form No.10 C (E.P.S)<\/td>\n<\/tr>\n<tr>\n<td height=\"26\"><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td colspan=\"4\">[Withdrawl Benefit]<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">EMPLOYEES&#8217; PENSION SCHEME, 1995<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">FORM TO BE USED BY A MEMBER OF THE EMPLOYEES&#8217; PENSION SCHEME,1995<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">FOR CLAIMING WITHDRAWL BENEFIT \/ SCHEME CERTIFICATE<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"46\">1.\u00a0\u00a0\u00a0\u00a0 a) Name of the member (In Block Letters)<\/td>\n<td colspan=\"10\">ABC<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"46\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 b) Name of the Claimant (s)<\/td>\n<td colspan=\"10\">ABC<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"13\"><\/td>\n<td colspan=\"10\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"46\">2.\u00a0\u00a0\u00a0\u00a0 Date of Birth<\/td>\n<td>0<\/td>\n<td>5<\/td>\n<td><\/td>\n<td>0<\/td>\n<td>8<\/td>\n<td><\/td>\n<td>9<\/td>\n<td>2<\/td>\n<td colspan=\"2\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"46\">3.\u00a0\u00a0\u00a0\u00a0 a) Father&#8217;s Name<\/td>\n<td colspan=\"10\">XYZ<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"46\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 b) Husband&#8217;s Name (If applicable)<\/td>\n<td colspan=\"10\">NOT APPLICABLE<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"46\">4.\u00a0\u00a0\u00a0\u00a0 Name &amp; Address of the Establishment<\/td>\n<td colspan=\"10\">ABC COMPANY INDIA PVT LTD.,<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"23\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 in which, the member was last employed<\/td>\n<td colspan=\"10\">X-18, 6th Cross Cut Road, Perundurai, Erode &#8211; 52.<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"23\"><\/td>\n<td colspan=\"10\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"13\"><\/td>\n<td colspan=\"10\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"46\">5.\u00a0\u00a0\u00a0\u00a0 Code No. &amp; Account No.<\/td>\n<td colspan=\"4\">Region\/SRO Code<\/td>\n<td>TN<\/td>\n<td>\/<\/td>\n<td>SL<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"46\"><\/td>\n<td colspan=\"3\">Estt.Code No.<\/td>\n<td rowspan=\"2\"><\/td>\n<td colspan=\"3\">A\/c No.<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"46\"><\/td>\n<td colspan=\"3\">XXXXX<\/td>\n<td colspan=\"3\">YYY<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"13\"><\/td>\n<td colspan=\"10\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"26\">6.\u00a0\u00a0\u00a0\u00a0 Reason for leaving service<\/td>\n<td colspan=\"10\">CESSATION (SHORT SERVICE)<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"26\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 &amp; Date of leaving<\/td>\n<td colspan=\"10\">1-Feb-2012<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"46\">7.\u00a0\u00a0\u00a0\u00a0 Full Postal Address (In Block Letters)<\/td>\n<td colspan=\"10\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"26\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Shri\/Smt\/Kumari<\/td>\n<td colspan=\"10\">ABC<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"26\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 S\/o, W\/o, D\/o<\/td>\n<td colspan=\"10\">XYZ<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"26\"><\/td>\n<td colspan=\"10\">1\/12 &#8211; ANTI VALASA, MAKKUVA POST &amp; TALUK,<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"26\"><\/td>\n<td colspan=\"10\">Vizianagaram, A.P..\u00a0\u00a0 PIN: 535 547<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"26\"><\/td>\n<td colspan=\"10\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"26\">8.\u00a0\u00a0\u00a0\u00a0 Are you willing to accept Scheme<\/td>\n<td colspan=\"4\"><\/td>\n<td>(a)<\/td>\n<td colspan=\"2\"><\/td>\n<td>(b)<\/td>\n<td colspan=\"2\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"26\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Certificate in lieu of withdrawl benefits<\/td>\n<td colspan=\"4\">Yes<\/td>\n<td><\/td>\n<td colspan=\"2\">No<\/td>\n<td>\u221a<\/td>\n<td colspan=\"2\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"46\">9.\u00a0\u00a0\u00a0\u00a0 Particulars of Family (Spouse &amp; Children &amp; Nominee)<\/td>\n<\/tr>\n<tr>\n<td height=\"26\">Name<\/td>\n<td>Date of Birth<\/td>\n<td colspan=\"5\">Relationship with member<\/td>\n<td colspan=\"5\">Name of guardian of minor<\/td>\n<\/tr>\n<tr>\n<td height=\"26\">(a)\u00a0\u00a0 Family Members<\/td>\n<td><\/td>\n<td colspan=\"5\"><\/td>\n<td colspan=\"5\"><\/td>\n<\/tr>\n<tr>\n<td height=\"26\">PAPARAO<\/td>\n<td>1966<\/td>\n<td colspan=\"5\">FATHER<\/td>\n<td colspan=\"5\">&#8211;<\/td>\n<\/tr>\n<tr>\n<td height=\"26\">PARVATHI<\/td>\n<td>1976<\/td>\n<td colspan=\"5\">MOTHER<\/td>\n<td colspan=\"5\">&#8211;<\/td>\n<\/tr>\n<tr>\n<td height=\"26\"><\/td>\n<td><\/td>\n<td colspan=\"5\"><\/td>\n<td colspan=\"5\"><\/td>\n<\/tr>\n<tr>\n<td height=\"26\">(b)\u00a0\u00a0 Nominee<\/td>\n<td><\/td>\n<td colspan=\"5\"><\/td>\n<td colspan=\"5\"><\/td>\n<\/tr>\n<tr>\n<td height=\"26\">PAPARAO<\/td>\n<td>1966<\/td>\n<td colspan=\"5\">FATHER<\/td>\n<td colspan=\"5\">&#8211;<\/td>\n<\/tr>\n<tr>\n<td height=\"26\">PARVATHI<\/td>\n<td>1976<\/td>\n<td colspan=\"5\">MOTHER<\/td>\n<td colspan=\"5\">&#8211;<\/td>\n<\/tr>\n<tr>\n<td height=\"26\"><\/td>\n<td><\/td>\n<td colspan=\"5\"><\/td>\n<td colspan=\"5\"><\/td>\n<\/tr>\n<tr>\n<td height=\"26\"><\/td>\n<td><\/td>\n<td colspan=\"5\"><\/td>\n<td colspan=\"5\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">10.\u00a0\u00a0 In case of death of member after attaining the age of 58 years without filing the claim :-<\/td>\n<\/tr>\n<tr>\n<td colspan=\"6\" height=\"46\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 (a) Date of death of the member\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <span>:<\/span><\/td>\n<td colspan=\"6\">Not Applicable<\/td>\n<\/tr>\n<tr>\n<td colspan=\"6\" height=\"46\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 (b) Name of the Claimant(s) \/ and relationship with the members\u00a0 <span>:<\/span><\/td>\n<td colspan=\"6\">Not Applicable<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"20\">11.\u00a0\u00a0 MODE FOR REMITTANCE [PUT A TICK IN THE BOX AGAINST THE ONE OPTED]<\/td>\n<\/tr>\n<tr>\n<td colspan=\"10\" height=\"26\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 (a)\u00a0\u00a0\u00a0 By postal money order at my cost to address given against item No.7<\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 (b)\u00a0\u00a0\u00a0 Account payee cheque sent direct for credit to my SB A\/c (Scheduled Bank) under intimation<\/td>\n<\/tr>\n<tr>\n<td colspan=\"10\" height=\"26\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 to me<\/td>\n<td>\u221a<\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"46\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 S.B Account No.<\/td>\n<td colspan=\"10\">1<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"26\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Name of the Bank (In Block Letters)<\/td>\n<td colspan=\"10\">STATE BANK OF INDIA<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"26\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Branch (In Block Letters)<\/td>\n<td colspan=\"10\">PERUNDURAI<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"26\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Full Address of the Bank<\/td>\n<td colspan=\"10\">KOVAI MAIN<\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"26\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 (In Block Letters)<\/td>\n<td colspan=\"10\">PERUNDURAI<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"26\">12.\u00a0\u00a0 Are you availing pension under EPS-95?\u00a0\u00a0 <span>:<\/span><\/td>\n<td colspan=\"2\">\u00a0\u00a0\u00a0 No<\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td height=\"26\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 If so indicate:<\/td>\n<td><\/td>\n<td colspan=\"2\">\u00a0\u00a0\u00a0\u00a0 PPO No.<\/td>\n<td colspan=\"2\"><\/td>\n<td colspan=\"3\">By whom issued<\/td>\n<td colspan=\"3\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"13\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"40\">Certified THAT THE PARTICULARS ARE TRUE TO THE BEST OF MY KNOWLEDGE<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" colspan=\"12\" align=\"left\" valign=\"top\" width=\"676\" height=\"26\"><img loading=\"lazy\" decoding=\"async\" src=\"file:\/\/\/C:\/DOCUME%7E1\/ADMINI%7E1\/LOCALS%7E1\/Temp\/msohtml1\/01\/clip_image003.gif\" alt=\"Text Box: @\" width=\"42\" height=\"26\" \/><\/p>\n<table cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td rowspan=\"2\" colspan=\"12\" width=\"676\" height=\"26\"><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" colspan=\"8\" height=\"52\"><\/td>\n<td colspan=\"4\">Signature or left Hand<\/td>\n<\/tr>\n<tr>\n<td colspan=\"4\" height=\"26\">Thumb Impression of the<\/td>\n<\/tr>\n<tr>\n<td colspan=\"8\" height=\"26\">Date: <span>02-04-2012<\/span><\/td>\n<td colspan=\"4\">Member \/ Claimant(s)<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"46\">ADVANCE STAMPED RECEIPT<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"46\">[To be furnished only in case of (b) above]<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">Received a sum of Rs._________________\u00a0 (Rupees__________________________________________________<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">only from the Regional Provident Fund Commissioner \/ Officer-in charge of Sub-Regional<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">Office _____________________________<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">by deposit in my savings bank A\/c towards the settlement of my Pension Fund Accounts<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"46\">(The space should be left blank which shall be filled by Regional Provident Fund Commissioner \/ Officer-in-<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"46\">charge)<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"4\" colspan=\"7\" align=\"left\" valign=\"top\" width=\"490\" height=\"92\"><img loading=\"lazy\" decoding=\"async\" src=\"file:\/\/\/C:\/DOCUME%7E1\/ADMINI%7E1\/LOCALS%7E1\/Temp\/msohtml1\/01\/clip_image003.gif\" alt=\"Text Box: @\" width=\"42\" height=\"26\" \/><\/p>\n<table cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td rowspan=\"4\" colspan=\"7\" width=\"490\" height=\"92\">Signature or left thumb impression of the member on the stamp<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/td>\n<td rowspan=\"4\" colspan=\"3\" width=\"106\">Rs.1\/-<br \/>\nRevenue<br \/>\nStamp<\/td>\n<td rowspan=\"4\" colspan=\"2\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"23\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">Certified that the particulars of the member given are correct and the member has signed \/ thumb impressed<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">before me.<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"46\">\u00a0\u00a0 The details of wages and period of non-contributory service of the member are as under :-<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"46\">\u00a0\u00a0 Form 3A\/7 (EPS) enclosed for the period for which it was not sent to Employee&#8217;s Provident Fund Office)<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\" height=\"26\">\u00a0\u00a0 Wages (Basic+DA) as on 15.11.1995 (if applicable) <span>:<\/span><\/td>\n<td colspan=\"9\">Not Applicable<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\" height=\"26\">\u00a0\u00a0 Wages as on the date of exit\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <span>:<\/span><\/td>\n<td colspan=\"9\">Rs.100.00 per day<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">\u00a0 <span>Period of non contributory Service<\/span><\/td>\n<\/tr>\n<tr>\n<td height=\"26\">\u00a0\u00a0 Year \/ Month<\/td>\n<td>No. of Days<\/td>\n<td colspan=\"10\"><\/td>\n<\/tr>\n<tr>\n<td height=\"23\">2011 \/ 10<\/td>\n<td>17.0<\/td>\n<td colspan=\"10\"><\/td>\n<\/tr>\n<tr>\n<td height=\"23\">2011 \/ 11<\/td>\n<td>4.0<\/td>\n<td colspan=\"10\"><\/td>\n<\/tr>\n<tr>\n<td height=\"23\">2011 \/ 12<\/td>\n<td>2.0<\/td>\n<td colspan=\"10\"><\/td>\n<\/tr>\n<tr>\n<td height=\"23\">2012 \/ 01<\/td>\n<td>19.0<\/td>\n<td colspan=\"10\"><\/td>\n<\/tr>\n<tr>\n<td height=\"23\"><\/td>\n<td><\/td>\n<td colspan=\"10\"><\/td>\n<\/tr>\n<tr>\n<td height=\"23\"><\/td>\n<td><\/td>\n<td colspan=\"10\"><\/td>\n<\/tr>\n<tr>\n<td height=\"23\">TOTAL<\/td>\n<td>42.0<\/td>\n<td colspan=\"10\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"8\" height=\"26\"><\/td>\n<td colspan=\"4\">Signature of Employer\/<\/td>\n<\/tr>\n<tr>\n<td colspan=\"8\" height=\"26\">Date: <span>04-02-2012<\/span><\/td>\n<td colspan=\"4\">authorised official<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">(FOR THE USE OF COMMISSIONER&#8217;S OFFICE)<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"13\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">(Under Rs.____________________________________________________________________________________<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">P.I No._________________________________ M.O.\/Cheque<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Passed for payment Rs.___________________________ (in words)___________________<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">M.O Commission (if any)_________________ Net amount to be paid by M.O_______________________________<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">____________________________________________________________________________________________<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">towards withdrawl benefit.<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"46\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"46\">D.H<\/td>\n<td colspan=\"2\">S.S<\/td>\n<td colspan=\"8\">A.A.O<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">(FOR USE IN CASH SECTION)<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">Paid by inclusion in cheque No._________________ Dt_________________vide cash Book(Bank) Account<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">No. 10 Debit item No.__________________________<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"46\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"46\">D.H<\/td>\n<td colspan=\"2\">S.S<\/td>\n<td colspan=\"8\">AC(A\/cs)<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">For issue if S.S;. IDS is enclosed.<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"46\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"46\">D.H<\/td>\n<td colspan=\"2\">S.S<\/td>\n<td colspan=\"8\">A.A.O\/APFC (A\/cs)<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">(FOR USE IN PENSION SECTION)<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">Scheme Certificate bearing the Control No._________________ Issued on _______________________and<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"26\">entered in the Scheme Certificate Control Register-<\/td>\n<\/tr>\n<tr>\n<td colspan=\"12\" height=\"46\"><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" height=\"46\">D.H<\/td>\n<td colspan=\"2\">S.S<\/td>\n<td colspan=\"8\">A.A.O<\/td>\n<\/tr>\n<tr>\n<td rowspan=\"5\" colspan=\"12\" height=\"117\">APFC (PENSION)<\/p>\n<p>&nbsp;<\/p>\n<p><strong><a href=\"https:\/\/www.yourhrworld.com\/formats\/wp-content\/uploads\/2012\/04\/EPF-Form-19-10-C-Format.xls\">Click Here To Download EPF Form 19 &amp; 10-C Format<\/a><\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>\u00a0I have Attached EPF Form 19 &amp; 10-C Format Mobile:\u00a0 98427 98427 Serial No. For Office Use Only In Words No. Form No.10 C (E.P.S) [Withdrawl Benefit] EMPLOYEES&#8217; PENSION SCHEME, 1995 FORM TO BE USED BY A MEMBER OF THE EMPLOYEES&#8217; PENSION SCHEME,1995 FOR CLAIMING WITHDRAWL BENEFIT \/ SCHEME CERTIFICATE 1.\u00a0\u00a0\u00a0\u00a0 a) Name of the member (In Block Letters) ABC \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 b) Name of the Claimant (s) ABC 2.\u00a0\u00a0\u00a0\u00a0 Date of Birth 0 5 0 8 9 2 3.\u00a0\u00a0\u00a0\u00a0 a) Father&#8217;s Name XYZ \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 b) Husband&#8217;s Name (If applicable) NOT APPLICABLE 4.\u00a0\u00a0\u00a0\u00a0 Name &amp; Address of the Establishment ABC COMPANY<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[45],"tags":[1176,138,199,47],"class_list":["post-5412","post","type-post","status-publish","format-standard","hentry","category-hr","tag-19-10-c","tag-epf","tag-form","tag-format"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>EPF Form 19 &amp; 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