( On Rs. 100/- Stamp paper)

INDEMINITY BOND

I Shri / Smt. -------------------------------------------------------------- Age yrs.

residing at -------------------------------------------------------------------------------------

Solemnly affirm that

1. I was working in M/s --------------------------------- from -------- to --------------- and I was member of P.F. bearing A/c No. ----- --------------. 2. I left the service on -----------------------.

3. I have not withdrawn the P.F. dues due to ----------------------------------- till today.

4. I have opened my Bank A/c with --------------------------- A/c No. ------------------ On -------------and still it is not closed.

5. I indemnify to the Central Board of Trustees, Employees Provident Fund Organization against any loss and wrong payment which may be sustained by Payment of P.F. and E.P.F. dues to me.

This affidavit- cum – Indemnity Bond signed by me before 1st class Magistrate on this -------------------- day of -----------------year.