IMPORTANT GUIDELINES FOR FILLING UP THE FORMS

All Forms should be filled up legibly with correct information duly attested by the
employer to ensure faster and early settlement.

SETTLEMENT OF YOUR EMPLOYEES’ PROVIDENT FUND ACCOUNT

Form 19
Sl.
Particulars
Number
1 Name of the member
2 Father’s Name
Name and address of the
3 factory / establishment in which postal address and pin code Number.
the member was last employed
4 Account number
Instructions for furnishing the particulars
Fill your name legibly in capital letters. The
name furnished in Form* 9/5, Claim Form and
Bank account should be identical.
Fill your Father / Husband name legibly in
capital letters.Father/Husband name furnished in
Form* 9/5, Claim Form and Bank account
should be identical. * - submitted by employer at
the time of joining.
Furnish the name of the Establishment with full
Please fill up legibly State Code / Office Code /
Establishment Code / Extn Code (If any) /
Member Account Number. The Account
Number allotted to the member shall continue
till the member leaves that establishment and the
accumulation are settled/transferred.

Example
State / Office / Estt / Extn / Member

5 Date of Leaving service
6 Reason for Leaving Service
TN / MAS / 5587 / A / 37
Correct Date of leaving should be filled in
From the following please Indicate the reason
applicable to you:
1. Retired from Service after attaining 55
years
2. Attained 55 years and resigned from
service
3. Retired on Disability to the work
4. Under Voluntary Retirement Scheme
5. Migration to abroad on Permanent
settlement
6. Retrenched from Service
7. Resigned / Left Service *
* For cases of Resignation / Left Service, the
claim should be submitted by the member only
after two months from the Date of Leaving

1

7 Full postal address
8 Mode of Remittance
Contribution for the current
9 furnished or Form 3A for the current financial
financial year
10 Signature of the member
11 Attestation by the Employer
2
Service. However, Female members who leave
the service for getting married can get
immediate settlement.
Full Postal address should be given clearly in
Block letters. The father name / Husband name
should be mentioned for clear identification.
Postal address with House Number , Street
name, Block, village , City, State etc. be filled in
legibly. Postal Index Number should invariably
be furnished.
The payment of PF accumulations by Money
Order is restricted upto Rs.2,000/-. In cases,
where the payment involves more than
Rs.2,000/- , the payment is allowed only through
Cheque.
It is safer to have the payment through cheque.
Account Payee cheque will be sent directly to
the Scheduled bank / Coop Bank / Post Office in
which Savings bank Account of the member is
maintained. So, furnish correct SB account
number with full address of the Branch of the
Bank. wherever applicable furnish the MICR
Number also.
Please furnish the Xerox copy of the First page
of Saving Bank account pass book or monthly
statement wherein the account number and
address of the Bank is clearly visible.
In the table provided in Page 3 contribution for
the current financial year with wages should be
year with attestation of the employer should be
furnished.
Member should sign in the application. He
should sign the application in the presence of the
employer.
The authorized official of the establishment
should attest the claim under the seal of his
designation. It should be ensured, the specimen
signature of the attesting official should have
been already furnished to the EPFO. If the
establishment is under permanent closure,
attestation of the claim can be obtained from any
one of the following authorized official:-
1. Manager of the bank where the member
is holding the savings bank account
2. Head of Recognized Educational
Institution
3. A Gazetted officer
4. Sub Post Master
 5. The Magistrate
6. Member of Central Board of Trustees or
Regional Committee of Employees PF
Organisation
7. Chairman / Secretary / Member of the
Municipal / District / Local Body
8. President of the Village Union /
Panchayat
9. Member of Parlimantary / Member of
Legislative Assembly
10. Any other Officer approved by the
Regional PF Commissioner
11. Official Liquidator appointed by the
Court of Law
Wherever payment is sought through account
payee cheque, the advance stamped receipt
should be signed by the member duly affixing
12 Advance Stamped Receipt
One Rupee Revenue Stamp. The amount need
not be filled in, which shall be filled in by the
RPFC / OIC of the EPFO Office.