EMPLOYEES' PROVIDENT FUND ORGANISATION — NOMINATION (FORM 2)
Declaration and nomination under paragraph 33 & 61(1) of the EPF Scheme, 1952 and paragraph 18 of the EPS, 1995.
Establishment / Company Name: [Company Name] PF Code: [__________]
| Member Name | [Employee Name] | UAN / PF A/c No. | [__________] |
| Father's / Husband's Name | [Name] | Date of Birth | [DD/MM/YYYY] |
| Sex | [Male/Female] | Marital Status | [__________] |
| Permanent Address | [Address] | ||
Part A — EPF Nomination: I nominate the following person(s) to receive the Provident Fund amount on my death.
| Name of Nominee | Address | Relationship | Date of Birth | Share (%) |
|---|---|---|---|---|
| [Nominee Name] | [Address] | [Relationship] | [DD/MM/YYYY] | [___%] |
| [Nominee Name] | [Address] | [Relationship] | [DD/MM/YYYY] | [___%] |
Part B — EPS (Pension) Family Particulars:
| Name of Family Member | Relationship | Date of Birth |
|---|---|---|
| [Name] | [Relationship] | [DD/MM/YYYY] |
| [Name] | [Relationship] | [DD/MM/YYYY] |
Place: [Place] Date: [DD/MM/YYYY] _______________________
Signature / Thumb impression of Member
Compliance note: A nomination in favour of a person other than family members is void if the member later has a family. Total share must equal 100%. File a fresh Form 2 on marriage or change of family.