THE EMPLOYEES PROVIDENT FUND SCHEME, 1952(Paragraph 34) andTHE EMPLOYEES PENSION SCHEME, 1995(Paragraph 24)

Self-Declaration from Employee towards PF contribution on statutory limit of Basic Wages.

Date :

I, ______________________________S/O, W/O, Daughter of _____________________________

do hereby solemnly declare that:-

A) I am employed in M/s._______________________ (Service Provider Name/ Subcontractor Name) working at Project Site of

Affix Site Address Seal

B) My PF A/c No. is DL/5574/________________.

C) I am unwilling to contribute my PF on basic wages beyond Rs.6500/-.

Hence I request to remit my PF contribution in the above mentioned PF number considering the basic wages up to Rs.6500/- only.

Signature or left hand thumb impression of the employee.

Address: