On Stamp Paper worth Rs

On Stamp Paper worth Rs.100/-AFFIDAVIT CUM IDEMNITY BOND

I ---------------------------S/o -----------------------, Residing at-----------------------------(Permanent address---------------) solemnly affirm and state an oath as under:1) I state that have worked in M/s.--------from-----to-------- and holding Account No. MH/--------/--------- with the Regional Provident Commissioner, Maharashtra.2) I hereby undertake and indemnity to central Board of Trustee, Employees Provident Fund Organisation for any claim later if found false, for any loss incurred out of this transaction.

3) I declare that I have not withdrawn my PF accumulation/withdrawal benefit till date.

This Affidavit-cum-indemnity bond has been executed by me and state that the facts mentioned herein before are true and correct to the best of my knowledge and belief.

Solemnly affirm and signed before me at this date of -----------

DEPONENT

(NAME)