If the application is preferred by a guardian other than the natural guardian or minor member/nominee/family member/legal heir a guardianship certificate issued by competent Court of law should be enclosed.

Death certificate.

If the amount receivable exceeds Rs. 5,000 but less than 25,000 an affidavit-cum-indemnity bond (Form may be obtained from the ex-employer of Regional Provident Fund Commissioner or Officer-in-Charge of Sub-Regional Office .......................) or Estate Duty Clearance Certificate.

If the amount receivable exceeds Rs. 25,000 an Estate Duty Clearance Certificate.

Form 11 (FPF): Claim for benefits as admissible under the Employees' Pension Scheme, 1971. By whom claim application should be preferred?

(1)

If the member is minor by his guardian.

OR

(2)

On death of the member:

(i) If the deceased had "family " on the day of death the claim should be preferred by:

(a) the widow or widower.

(b) failing (a) above, by the guardian or eldest surviving minor son.

(c) failing (a) and (b) above by the guardian or eldest surviving minor, unmarried daughter.

(ii) If the deceased member had no family on the day of death, the Family Pension Fund benefit should be claimed by the person(s) eligible to receive the Provident Fund accumulation of the deceased member and if such member is a minor by the guardian.

(iii) Form 5(F) "Benefit under Employees " Deposit-Linked Insurance Scheme, 1976.

(1)

The death should have occurred while in service; and

(2)

The average balance in the accounts of the deceased employee should not be below the sum of Rs. 1,000 during the preceding three years or during the period of his membership, whichever is less.

An affidavit-cum-indemnity bond in the prescribed form should be furnished wherever the payment under Employees' Deposit-Linked Insurance exceeds Rs. 5,000 (if amount receivable under Employees' Provident Fund and Employees' Deposit-Linked Insurance does not exceeds Rs. 25,000 one affidavit-cum-indemnity bond is sufficient).

GENERAL:

(1)

All the columns in the form should be filled in, in ink, without any overwriting.

(2)

Correct postal address, including PIN CODE will enable to make prompt payment to the correct payee.

(3)

The claimant should also furnish the address in the acknowledgement attached to the claims.

(4)

The literate claimant should sign the application form.

In case of illiterate:-Left hand thumb-impression by illiterate male claimant and right hand thumb-impression by illiterate female should be affixed in the claim form.

(5)

Attestation of claim application: The application should be submitted through the employer under whom the member was last employed if for any reason, the claimant is unable to submit through the employer, the claim may be got attested with official seal by any one of the following officials: (i) Magistrate; (ii) A Gazetted Officer; (iii) Post/Sub-Postmaster; (iv) President of Village Union; (v) President of the Village Panchayat where there is no Union Board; (vi) Chairman/Secretary/Member of the Municipal/District/Local Board; (vii) Member of Parliament/Legislative Assembly; (viii) Member of C.B.T. Regional Committee of the EPF; (ix) Manager of the Bank where claimant has account; (x) Head of any recognised educational institution or; (xi) Any other official as may be approved by the Commissioner.

(6)

Instruction to employers:-While forwarding the claims the employer should ensure that all the information required in the claim is furnished correctly and requisite documents are enclosed in support of claim under Employees' Family Pension Scheme, 1971 the period of break in reckonable service (i.e., period for EPF contribution is not payable should be furnished, if not already intimated through contribution card).

For office use only

Dated Official Seal and

Registration No...........

FORMS 21-30

[Not printed]

FORM 31

Application for Advance from the Fund

[Refer: Instructions]

(For office use only)

Dated ..........................

Purpose for which advance is required.........................

Official Seal and Registration No ............................................

Amount of advance required (in words).....................................