- Labour Law
- Specimen
- Form 2: Nomination and Declaration form for PF and EPS.
- Neha Verma
October 01, 2026
Form 2: Nomination and Declaration form for PF and EPS.
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Form 2: Nomination and Declaration form for PF and EPS.
FORM 2 REVISED)
NOMINATION AND DECLARATION FORM FOR UNEXEMPTED/EXEMPTED ESTABLISHMENTS
Declaration and Nomination Form under the Employees Provident Funds and Employees Pension Schemes
(Paragraph 33 and 61 (1) of the Employees Provident Fund Scheme 1952 and Paragraph 18 of the Employees Pension Scheme 1995)
1. Name (IN BLOCK LETTERS) :
Name Father’s / Husband’s Name Surname
2. Date of Birth : 3. Account No.
4. *Sex : MALE/FEMALE: 5. Marital Status
6. Address Permanent / Temporary :
PART – A (EPF)
I hereby nominate the person(s)/cancel the nomination made by me previously and nominate the person(s) mentioned below to receive the amount standing to my credit in the Employees Provident Fund, in the event of my death.
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Name of the Nominee (s) |
Address |
Nominee’s relationship with the member |
Date of Birth |
Total amount or share of accumulations in Provident Funds to be paid to each nominee |
If the nominee is minor name and address of the guardian who may receive the amount during the minority of the nominee |
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1 *Certified that I have no family as defined in para 2 (g) of the Employees Provident Fund Scheme 1952 and should I acquire a family hereafter the above nomination should be deemed as cancelled.
2. * Certified that my father/mother is/are dependent upon me.
Strike out whichever is not applicable Signature/or thumb impression of the subscriber
PART – (EPS)
Para 18
I hereby furnish below particulars of the members of my family who would be eligible to receive Widow/Children Pension in the event of my premature death in service.
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Sr. No |
Name & Address of the Family Member |
Age |
Relationship with the member |
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(1) |
(2) |
(3) |
(4) |
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Certified that I have no family as defined in para 2 (vii) of the Employees’s Family Pension Scheme 1995 and should I acquire a family hereafter I shall furnish Particulars there on in the above form.
I hereby nominate the following person for receiving the monthly widow pension (admissible under para 16 2 (a) (i) & (ii) in the event of my death without leaving any eligible family member for receiving pension.
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Name and Address of the nominee |
Date of Birth |
Relationship with member |
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Date
Signature or thumb impression of the subscriber
CERTIFICATE BY EMPLOYER
Certified that the above declaration and nomination has been signed / thumb impressed before me by Shri / Smt./ Miss employed in my establishment after he/she has read the entries / the entries have been read over to him/her by me and got confirmed by him/her.
Date : Signature of the employer or other authorised officer of the establishment
Name & address of the Factory /Establishment
Place : Date :
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Author Bio
Neha Verma
Curious about how law, governance and business come together to shape better organisations. Focused on continuous learning, practical exposure and developing a strategic... View Full Profile
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