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EMPLOYEES PENSION SCHEME 1995

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Form 10-C (E.P.S.)

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(b ) W ho has atta ined the age of 58 years before comple t ion of 1O years se rv ice - w he t her in se rv ice lle ft the se rv ice

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Note-I: To determ ine the period of 10 years service rendered from 1.3 .1971 to 15.11.1995 (if any). shall

a lso b e ta ke n.

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0 ) If< ' ~. ~ 10 < f i q I') ' ~ 1 R < f t t 3 f I x 58

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Note-II (i)

A

m em ber w ho has com pleted 10 years service and attained the age of 58 years, w hether in

s ervic e o r n ot is e lig ib le fo r M on th ly M em be r P en sio n.

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m em be r w ho h as le ft th e se rv ice o n a cco un t o f to ta l a nd p erm an en t d isa ble me nt. irre sp ec tiv e o f

h is a ge a nd p erio d o f s erv ic e. is e lig ib le fo r m on th ly d is ab le me nt p en sio n.

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(iv) To claim the M on th ly p en sio n, a pp lica tio n in Fo rm - 10 0 sh ould b e sub mitted .

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1 1 ; 'I I 'I IIN /T yp e o f benefit eligible:

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A m em ber falling un der Item I ab ove is elig ib le to g et th e am ount tow ard s w ithdraw l b en efit.

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(iii)

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Complete particulars of nominee and family (spouse and all children) should be given without fail.

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To be furnished when the claim is preferred by nominee or the family member (s).

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To be completed only when a membef is eligible for withdrawal benefit and opted for It In lieu of scheme Cert~icate

(not applicable to those who

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entided for Scheme Certificate or opted for Scheme Certificate in lieu of

with-

drawal benefit.)

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(viii) President of the village Union / Panchayat / Member of Parliament / Member of Legislative Assembly.

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A n y

othef officer approved by the Regional P. F. Commissioner

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FORM TO BE USED BY A MEMBER OF THE EMPLOYEES' PENSION SCHEME,

1995 FOR CLAIMING WITHDRAWAL BENEFIT/SCHEME CERTIFICATE

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(Read the instructions before filling up_this form)

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(a)

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Are you willing to accept Scheme Certificate

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n lieu of w~hdrawal benefits

Yes No

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Advance Stamped Receipt

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[To be furnished only in case of (b) above)

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