In the event of death of member, this form is to be used by a nominee / family member to claim the member's Provident Fund accumulation.
WHO CAN APPLY:
If the member is a minor, by his guardian OR
On the death of the member:
a. If a valid nomination subsists: by the nominee(s) of the deceased member if the nominee(s) is are minor(s) guardian of the minor(s)
b. If no nomination subsists: by the ‘family’ member(s) of the deceased member duly supported by a list of surviving family members (as on the date of death of the member) furnished by the last employer or mamlatdar/Tehsildar or executive magistrate indicating complete particulars such as name, relationship with the deceased member, age, marital status in the case of parents, whether dependent or not. If any family member is a minor, by the guardian of the minor
If both (a) and (b) above are not applicable: by legal heir(s) of the deceased member duly supported by a legal heir ship certificate.
Claimants who mention their mobile number on the form will get SMS alerts on different stages of the approval of their claim form. The claimants can also visit the epfindia.gov.in website to view the status of their claims through the link, Know Your Claim Status.
All Columns should be filled in clearly in BLOCK LETTERS and there should be no over writing.
Member’s Account Number: The account number should have the Region Code (two alphabets), Office Code (three alphabets) code number (maximum 7 digits), extension (sub code, if any, maximum three characters) and account number (maximum 7 digits). The region codes have changed after creation of the multiple regions in some states, namely Maharashtra, Tamil Nadu, Karnataka, West Bengal, Punjab, Gujarat, Andhra Pradesh, Uttar Pradesh, Haryana and Delhi. For getting the correct Region and Office Codes, please visit Establishment Search facility provided under link for Employees through the epfindia website [epfindia.gov.in].
Payment is made by directly crediting the Bank Account mentioned by the claimant. In case the bank account is in a computerised branch, payment may be made faster through electronic mode (NEFT etc). The claimant should attach a copy of blank/cancelled cheque ensuring that the IFS Code and Account numbers are clearly visible. Payment can be made through Money Order only if the total amount is less than 2000/-. The claimant should mention his/her POSTAL ADDRESS correctly with PIN Code so as to receive the money and any communication related to the claim.
Attestation of claim application
The application should be submitted through the employer under whom the member was last employed. In case the claim is through a form downloaded from the epfindia website, all pages should be signed by the claimant as well as the employer.
In case of a closed establishment whose Authorised Signatory/Employer is not available, the claimant may forward the claims duly signed in the presence of any of the following authorized official and got attested over his official seal.
Magistrate/ Gazetted Officer/Post or Sub-Post Master/President of Village Union/ President of the Village Panchayat where there is no Union Board/Chairman or Secretary or Member of the Municipal or District Local Board/Member of Parliament/Legislative Assembly/Member of Central Board of Trustees/Regional Committee of Employees’ Provident Fund/Manager of the Bank in which the Saving Bank Account is maintained/Head of any recognized educational Institution
DOCUMENTS TO BE ATTACHED
(a) Death certificate, in case the application is by the nominee/surviving family members or their guardian/legal heirs after the death of the member.
(b) Guardianship certificate issued by a competent court of law, if the application is preferred by a guardian other than the natural guardian of minor member/nominee/family member/legal heir.
(c) Copy of blank/cancelled cheque so that the payment may be sent through electronic mode in the claimant’s account.
(d) Form 5(IF) for claiming the benefits under the Employees’ Deposit Linked Insurance Scheme, in case:
(i) The member had died while in service,
(ii) The establishment under which the member was working at the time of death was un-exempted under the EDLI Scheme as on his date of death.
(e) Form 10D for claiming the Pension benefits, in case: (i) The claimant is a family member (Spouse/child below 25 years age as on date of death of member) (ii) Nominee for Pension, in case the member had no family and had nominated such nominee for Pension (iii) Dependent Parents, in case the member had no family at the time of his/her death and had not nominated any one for Pension.
(f) Form 10C for withdrawal Benefit, in case the member had died after 58 years of age and had not completed 10 years of service as on date of crossing 58 years age.