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TATA CONSULTANCY SERVICES EMPLOYEES PROVIDENT FUND

APPLICATION FOR SETTLEMENT OF PROVIDENT FUND ACCOUNT


(TO BE FILLED BY APPLICANT)
To,
The Trustees,
Tata Consultancy Services Employees Provident Fund,
Mumbai.
Dear Sir,
As have resi!ned " retired #rom the TCS $imited %ith e##ect #rom &&&&&&&&&&&&&&&&&, re'uest you to
settle my Provident Fund account and pay the said amount at an early date.
(. )ame*+&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
,. Fathers " -usbands )ame*+&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
.. Employee )umber * &&&&&&&&&&&&&& Address for correspondence
/. Date o# 0oinin! Service * &&&&&&&&&&&&&&
1. Date o# cessation o# service * &&&&&&&&&&&&&&
2. Period o# Service * &&&&&&&&&&&&&&
3. Pan card )o. *&&&&&&&&&&&&&&
4. Trans#erred previous PF to TCS * 5es " )o Mobile No !
# 5es, )ame o# Previous employer *&&&&&&&&&&&&&&&&&& Person"l E#"il Id !
6. 7an8 Account Details* Savin!s 7an8 A"c )o.* &&&&&&&&&&&&&& MC9"FSC Code )o.* &&&&&&&&&&&&
)ame o# the 7an8*&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& 7ranch *&&&&&&&&&&&&&&&&&&&&&&&
:)ote* ;indly provide cancelled che'ue copy o# the a#oresaid ban8 account<
(=. Select the reason #or %ithdra%al o# Provident Fund Accumulations
Tick Signature Tick Signature
a. 9etirement b. >oin! Abroad ?
Permanent mi!ration #rom ndia
c. Permanent @ total d. Anemployed #or
Disablement ? incapacitation , Months

(Please tick the applicable reason & sign in the text block)
DECLARATION OF NON$EMPLOYMENT
declare that have not been employed in any Factory"Establishment to %hich the Act applies #or a continuous period o# not less
than , months immediately precedin! the date o# my application #or #inal %ithdra%al o# my Provident Fund money.
Place* &&&&&&&&&& 5ours #aith#ully,
Date* &&&&&&&&&&
BBBBBBBBBB
CSi!natureD
No%e!$ T&e PF 'i%&dr"'"l "#o(n% is s(b)ec% %o %"*+ If con%rib(%or, ser-ice .incl(si-e of ser-ice rendered in
pre-io(s e#plo,#en% pro-ided %&e PF is %r"nsferred %o TCS/ is less %&"n fi-e ,e"rs
ADVANCE STAMPED RECEIPT
9eceived a sum o# 9s.&&&&&&&&&&&&&&C9upees&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
&&&&&&&&&&&&&&&&&&&&&&&&&&&&&onlyD #rom the Trustees o# TCS Employees Provident Fund to%ards #ull
@ #inal settlement o# my Provident Fund account.



C Please si!n across the Stamp D
TCS Confiden%i"l
Affix.
1 Rs. Revenue
Stamp
The details !iven in tem )o. ( to 1 are veri#ied.

Date * C Si!nature E# Employer D
TCS Confiden%i"l

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