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EMPLOYEES PROVIDENT FUND SCHEME,1952

Form to be used by a major member of the Employees Provident Funds Scheme, 1952 for
claiming the
Employees Provident Fund Dues ( Para 69 )
(Refer to the Instructions)
____________________________________________________________________________________
_____________

1. Name of the member (in Block Letters)


:
_______________________________________________________

----------------------------------------------------------------------------------------------------------------------------- -----------------------------------2. Father's Name


( or husband's name in case of married woman ):
________________________________________________________
_____________________________________________________________________________________________
______________

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