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CAPGEMINI INDIA PVT.LTD.

EMPLOYEES’ PROVIDENT FUND


Plant .2, Block C, Godrej IT Park,
Godrej & Boyce compound, LBS Marg
Vikhroli (West), Mumbai - 400079

PROVIDENT FUND WITHDRAWAL FORM

Form to be used by a member of the Provident Fund for claiming the Provident Fund dues

Name of Member
(block letter)
(Last) (First) (Middle)
Father’s Name ___________________________________

Husband’s Name _______________________________________


(for married women only)
Name and Address of the Capgemini India Private Limited
Establishment Plant .2, Block C, Godrej IT Park,
Godrej & Boyce compound,
LBS Marg, Vikhroli (West),
Mumbai – 400079

Emp ID :-
Provident Fund Account Number
PU/PUN/31643/EXEM/
Date of Joining Service ___________________________________

Date of Leaving Service ____________________________________

Reason for Leaving Service ____________________________________

Full Postal Address


(in Block Letter)

Mobile no:

E-mail id:

Mode of Remittance: S. B. Account No. :


Name of the Bank :
Branch :
By account payee cheque to be sent direct to Address of the :
the Bank for credit to my SB A/c under
intimation to me (Advanced Stamped Receipt Branch
furnished below)

Signature of Member
CAPGEMINI INDIA PVT.LTD.
EMPLOYEES’
PROVIDENT FUND SEP- Plant
.2, Block C, Godrej IT Park, Godrej &
Boyce compound, LBS Marg
Vikhroli (West), Mumbai -
400079

Declaration of Non-Employment

I declare that I have not been employed in any factory / establishment to which the
Employee’s Provident Fund & Miscellaneous Provisions Act & Scheme, 1952 applies for
a continuous period not less than 2 months immediately preceding the date of my
application for final withdrawal of my Provident Fund money.

Date:
Signature of Member

ADVANCED STAMPED RECEIPT

Received a sum of Rs. (Rupees

only) from CAPGEMINI

CONSULTING INDIA PVT.LTD. EMPLOYEES’ PROVIDENT FUND by

deposit in my Savings Bank Account towards the settlement of my Provident Fund

account.

Affix Rs.1/-
Revenue
Stamp

Signature of Member
Instructions to follow:
 An employee has to note that if he/she leaves organisation & join any next
organisation has to apply for the transfer of PF/Pension & not for withdrawal
of PF/Pension.
 If member has not completed 5 yrs of Membership of PF Fund & opt for
withdrawal then entire PF withdrawal amount will be taxable.
 PF No. : PU/PUN/EXEM/31643/ -
 Reason of leaving service should be mentioned as follow :
o Resignation
o Higher Studies
o Going Abroad
 For getting the PF settlement amount through NEFT employee have to
furnish the details of HDFC Saving Bank account. In case of bank details
other than HDFC, PF amount will be disbursed to employee by drawing a/c
payee cheque & same will be courier to address mentioned in PF withdrawal
form.
 Employee has to sign advance receipt after affixing Rs. 1/- revenue stamp.
You do not have to fill any amount in Advance receipt.
 PF Withdrawal forms have to submit after 60 days from last working day
along with Pension withdrawal Form 10C.
 In case of retirement & Member going abroad, member can submit PF
withdrawal Form & Form 10C on last working day.
 You can submit/courier PF Withdrawal form to below mentioned address:

Capgemini India Private Limited Employees Provident Fund


M7, 2nd Floor, HR – 32, Plant 2, Block “C”, Godrej IT Park,
Godrej & Boyce Compound, LBS Marg, Vikhroli (West),
Mumbai – 400 079. India.

Documents Required for PF Withdrawal:

1) Mandatory documents:

 PF withdrawal Form.
 Declaration of Non-Employment, as per s p e c i f i e d format.
 Cancelled cheque.
 Bank Statement or Bank Passbook copy

2) Additional Documents:

 Visa copy i f going abroad for employment


 Education certificate/Fees receipt if pursuing higher studies without taking any
further employment
 Identity Proof if submitting PF withdrawal Form after 12 mo nt hs from Date of
Leaving

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