1. KINDLY ENSURE TO FILL THE FORM CORRECTLY IN ALL RESPECTS OTHERWISE PROVIDENT
FUND OFFICE WILL NOT ACCEPT THIS FORM
GUIDELINES TO FILL THE FORM 10 C – PENSION WITHDRAWAL
 YOUR PENSION WITHDRAWAL FORMALITIES WILL START AFTER TWO MONTHS
FROM YOUR DATE OF LEAVING SERVICES
1) Name : Your Full name (in Block Letter)
B) Name of the Claimant : Your Full name (in Block Letter)
2) Date of Birth : Birth date in (DD / MM / YYYY format)
3) Father Name : Your Father’s Name
B) Husband’s Name : Applicable for Female employees.
Please attach Marriage Certificate
4) Name & Address of the Establishment : Name of the entity
Keep the address column blank
5) Code No & Account No : Keep it blank. (Will be updated by us)
6) Reason for Leaving Services : Mention “Resigned” only
B) Date of Leaving : Your last working day
7) Your Complete postal address : Your residential address with mobile
Number
8) Are you willing to accept Scheme Certificate in
Lieu of withdrawal benefit Yes / No
(Note” If you wish to take the benefit of the scheme after your retirement age or you have
completed 10 years of service then opt for Option 1 “Yes”. In that case, PF office will issue
you a certificate which has to be surrendered to PF office on retirement. Please enclose birth
certificate of your family member along with Form 10C if you opt for the Scheme Certificate
and do not sign across the Advance Stamp receipt on the last page)
If you wish to withdraw the money in full then you have to opt for Option 2 “No”)

2. 9) Particulars of Family (Spouse, Children & Nominee): Please mention the
details of your family (family means wife & children) if you have opted “Yes” at point no. 8
above
10) This column is applicable for the deceased members which is to be filled by the nominee
11) Mode of Remittance : Your bank account number with complete
address
12) Are you availing Pension under EPS-95: Keep it blank
13) Please append your signature / left thumb impression at the relevant places mentioned on
the form
14) Advance Stamp Receipt : If you wish to withdraw the accumulation please affix a revenue
stamp and your signatures across it is mandatory
Note: Pension withdrawal is not applicable for employees whose service period less than 6
months