Affidavit for a provident fund claim without the employer (with indemnity)
Claiming your PF when the employer has closed, cannot be traced or refuses to attest, with an indemnity to the Fund.
Opens Dastavo with this paper ready to fill, on this computer or in the app. No account needed.
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Not yet reviewed by a lawyer. Check every line before it is signed.
How the paper begins
With Dastavo's sample details; the people and places are fictional. The words in blue are the ones you fill in.
AFFIDAVIT
(Provident fund claim, with indemnity)
I, Anil Verma son of Shri Ramesh Verma, aged about 31 years, resident of House No. 204, Sector 9, Shantipur, District Shantipur, Haryana, do hereby solemnly affirm and declare as under:
1.That I was employed with M/s Shantipur Textiles Pvt. Ltd., Industrial Area, Shantipur from 01-04-2017 to 31-03-2024, and was a member of the Employees' Provident Fund under PF account No. HR/SNT/0000000/000/0000001, Universal Account Number (UAN) 100000000000.
2.That I have left that employment, and I have neither withdrawn nor transferred the provident fund money of that period; no other claim for it is pending.
3.That my claim cannot be attested by the employer because the establishment has closed down.
4.That the establishment closed in 2024 and its owners have moved away from Shantipur.
5.That I am claiming the amount standing to my credit in that account, which is ₹1,86,500 (Rupees One Lakh Eighty-Six Thousand Five Hundred only) as per my passbook, by Form 19 and Form 10-C, to be paid into my savings account No. XXXX4521 with Amar Bank, Sector 9 Branch, Shantipur.
The rest of the paper is in Dastavo.
What to bring
Papers to bring
- Your Aadhaar card and PAN card (photocopies; the originals to show)
- Your PF account number and UAN, with the PF passbook or slips
- Proof of the employment: the appointment letter, salary slips showing the PF deduction, or a service certificate
- A cancelled cheque or the passbook page of your own bank account
- The claim form the PF office gives for a claim without the employer's attestation
- Any proof that the establishment has closed or cannot be traced (a notice, a news cutting, a letter returned undelivered)
Where to go
Sworn before an Oath Commissioner or Notary, then filed with the claim at the EPFO regional office that holds your account. The claim form usually also has to be attested by someone the EPFO accepts in place of the employer, such as your bank manager or a gazetted officer; ask the office.
Fee
The EPFO charges no fee for a claim. The e-Stamp paper (this paper also holds an indemnity) and the attestation fee are paid at the counter; ask there for today's amounts.
Good to know
- If your UAN is active and linked with Aadhaar, your bank account and PAN, try the online claim first; it may need no attestation by the employer.
- The EPFO may check the claim against the establishment's old records; the dates and wages you give must match them.
Papers and fees can change. Check with the office before you go. Guidance only, not yet reviewed by a lawyer.
Stamp paper
Punjab: affidavits are usually typed on e-stamp paper (buy it at an authorised e-stamp centre; check the current duty there) and sworn before an Oath Commissioner or Notary. Many state services now accept a self-declaration instead.
Haryana: use e-stamp paper (egrashry / authorised vendors; check the current duty) and swear before an Oath Commissioner or Notary.
Chandigarh: e-stamp paper from an authorised centre (check the current duty); sworn before an Oath Commissioner or Notary.