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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 : ____________________.

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