TATA CONSULTANCY S E R V I C E S EMPLOYEE’S P R O V I D E N T

FUND APPLICATION FOR SETTLEMENT O F PROVIDENT FUND

Sample Form
To, ACCOUNT (TO BE FILLED BY APPLICANT)
The Trustees,
Tata Consultancy Services Employee’s Provident
Fund, Mum bai.

Dear Sir,
As I have ceased to be an employee of TCS Limited with effect from 09-Apr-2015, I request you to settle my
Provident Fund account and pay the said amount at an early date.
1. Name: - Mr. Durgesh Rele
2. Father’s / Husband’s Name: Mr.Manikant Rele
3. Employee Number : 315394 Address for correspondence:
4. Date of Joining Service : 12-Jan-2009 BUILDING No: 11, 2nd FLOOR, 4th
5. Date of cessation of service : 09-Apr-2015
CARPENTER ROAD, CHARNI

ROAD, GIRGAUM, MUMBAI: 400004

6. Period of Service : 6.24 Years

7. 7. PAN card no. : ACPAJ2109F
Mobile No. : 9800000000
8. Transferred previous PF to TCS: Yes/ No
Personal Email id: sample@gmail.com
If Yes, Name of Previous employer: NA
9. Bank Account Details: Savings Bank A/c No.: 011011011011011 MICR/IFSC Code No.: HDFC000133
Name of the Bank: HDFC BANK Branch : MUMBAI
10. Reason for withdrawal of Provident Fund Accumulations Select applicable reason
Supporting Tick Signature from below. Put a tick mark Tick Signature
documents and sign inside the box
required: Copy of
a. Retirement b. Going Abroad \
PAN Card &
Cancelled Cheque Permanent migration from India

Supporting documents
c. Permanent & total required: Copy of PAN Card,
Disablement \ incapacitation Cancelled Cheque & valid Visa

Supporting documents
required: Copy of PAN Card, (Please t i c k the applicable reason & sign in the text block)
Cancelled Cheque & Doctor’s
Certificate DECLARATION O F NON-EMPLOYMENT
(This declaration i s not applicable if any of the above reason for withdrawal is selected)

I declare that I have not been employed in any Factory/Establishment to which the Act applies f or a continuous period of not less
than 2 months immediately preceding the date of my application for final withdrawal of my Provident Fund money.

Sign here only if you are

Place: _______ _ Yours faithfully,
unemployed for more than 2
Date: _______ _ months. Supporting Documents
required: Copy of PAN Card & …………………………
Cancelled Cheque
(Signature)
Note: - T h e PF withdraw al amount is subject to tax, if contributory service (inclusive of service rendered in
previous employment provided the PF is transferred to TCS) is less than five years.
ADVANCE STAMPED RECEIPT
Received a sum of Rs .______________(Rupees
_______________ Only) from the Trustees of TCS Employees Provident Fund towards full & final
settlem ent of m y Provident Fund account.
Affix.
Your Signature across the revenue stamp. Revenue stamp 1 Rs. Revenue
not mandatory in States where it is not available (e.g. Stamp
Karnataka) & for employees deputed at Onsite.
(Please sign across the Stamp)

The details given in Item No. 1 to 5 are verified .

Date: (Signature of Employer)

 Instructions for Filling PF withdrawal Form

1. As per Employees’ Provident Fund and Miscellaneous Provisions Act 1952, you can withdraw your PF only in case of
one of the listed eventuality under Serial No. 9. If none of the 3 reasons for withdrawing PF applies to you, you have
to compulsorily transfer the PF fund to the new organization.

2. PF will be settled post completion of your Full and Final Settlement in TCS.

3. Mandatory required documents are Pan card copy & cancelled Cheque leaflet of India Bank a/c. The Bank account
should be of self and incase of joint account it should be with spouse only. Accepted bank account type is
current/savings or NRO.

4. If you are joining an organization to which Employees’ Provident Fund Act does not apply, you are required to submit a
letter along with the withdrawal Form stating this fact duly authorized by the said organization. In the PF withdrawal
Form you are required to sign at “Advance stamped receipt section” without selecting any reason of withdrawal
provided in the Form.

5. Against Serial No. 1 to 9 of the withdrawal Form, please enter the required details.

6. If you are unemployed for two months post your date of separation ;

(Note: You are required to sign a declaration in this regard, false declaration are tracked by Employees’ Provident
Fund Organization and you are requested to be careful while giving this declaration. TCS receives Ex-employee
verification / Back ground check enquiries from various organizations. In such instances if employee has selected
the reason for PF withdrawal as ‘Unemployed for 2 months’, it will be construed as a false declaration and the PF
withdrawal Form will not be processed).

7. If you are selecting the Going Abroad \ permanent migration from India option then you need to submit the Visa copy
or any other document which shows the validity of stay in the traveling country along with the PF withdrawal Form.

8. If you are selecting the Permanent and total disablement \ incapacitation option then you need to submit the Medical
Certificate from ESI or Medical Officer of the company should be attached along with the PF withdrawal Form
whichever is applicable.

9. Note that if you are currently working in an organization that is covered by Employees’ Provident Fund and
Miscellaneous Provisions Act 1952, you need to transfer your accumulated PF & Pension accounts. For such Transfer,
you are requested to fill ‘Revised Form 13 issued by your current employer’ in duplicate or raise the PF transfer request
in OTCP (EPFO Website) and send it to TCS on the address given below in Point 13. For detailed guidelines on
PF/Pension Transfer process you can refer the Separation Kit Document.

10. Note that the PF amount, if withdrawn is subject to applicable taxes (TDS), if your continues service (inclusive of
service rendered in the previous employment provided the PF is transferred to TCS) is less than five years.
11. For the computation of TDS as per 10 above, the details as per Form 16 (Salary TDS certificate) issued by TCS (or any
merged company) for the period of employment are required. If details of Form 16 are not available in our archives,
we will request you to furnish the same at the time of processing your settlement claim.

If Form 16 / TDS certificates are not available / provided, the TDS at the rate applicable as per highest tax slab among
the years of employment period, will be deducted from the payable PF accumulation and TDS certificate will be issued
by PF Trust to that effect.

12. In Advanced Stamped Receipt section, you need to affix a revenue stamp and sign across the stamp affixed. However
your signature is mandatory in “Advance Stamped receipt section”. Employees residing in the States where Revenue
Stamp is not in use or employees deputed at onsite can submit their withdrawal Form without affixing the Stamp.

13. Please send the dully filled-in Form to the following address.
Retiral Settlement Team,
Tata Consultancy Services Ltd.
Akruti Business Port-Gateway Park,
Table No.4C29, 4th floor,
Road no 13.MIDC,
Andheri East,
Mumbai - 400 093,
Maharashtra. India.
Mail to: retiral.settlements@tcs.com