[Company Logo][Company Name]
PF NOMINATION DETAILS FORM (INTERNAL WORKSHEET)
- Employee Name:
- [Employee Name]
- Employee ID:
- [Employee ID]
- UAN:
- [UAN]
- Date:
- [Date]
Important: This is an internal company worksheet and not an official EPFO form. You must also complete the official EPFO nomination (e-nomination on the member portal or as required).
Part 1: Family Members
| Name | Relationship | Date of Birth | Dependent (Yes / No) |
|---|---|---|---|
| [Name] | [Relationship] | [DD/MM/YYYY] | [Yes / No] |
| [Name] | [Relationship] | [DD/MM/YYYY] | [Yes / No] |
| [Name] | [Relationship] | [DD/MM/YYYY] | [Yes / No] |
| [Name] | [Relationship] | [DD/MM/YYYY] | [Yes / No] |
Part 2: Proposed Provident Fund Nominees
| Nominee Name | Relationship | Date of Birth | Address | Share (%) |
|---|---|---|---|---|
| [Nominee Name] | [Relationship] | [DD/MM/YYYY] | [Address] | [%] |
| [Nominee Name] | [Relationship] | [DD/MM/YYYY] | [Address] | [%] |
| [Nominee Name] | [Relationship] | [DD/MM/YYYY] | [Address] | [%] |