It is observed that most of the death cases submitted by the establishment are returned for non-submission of proper documents with the death claim by the establishment.
Therefore establishment is requested to check the enclosed documents herewith before submission of Death claims as per the Checklist for the various types of death claims.

BACHELOR DEATH CASE CLAIM TO BE SUBMITTED BY PARENTS (FOR DEATH CASES OF UNMARRIED PERSONS (BACHELORS/ SPINSTER)

The following Documents are to be submitted:

• The  Composite Death Claim Form No. 20, 10D & 5(IF) should be submitted by both the parents duly submitting the position of dependency certificate stating dependency on the deceased member and should state the member was not having any family.

• Original Composite Death Claim Form No. 20, 10D & 5(IF) should be submitted by the member/nominee of the deceased member duly attested by the employer with filed all columns properly filled.

• The original Death Certificate of the deceased member should be submitted by the nominee/parent.

• The surviving family members certificates  (SFMC)/List of surviving members/UAN  should be submitted by the nominee of the deceased member duly attested by the employer.

• Three (3) copies of photos of the parents duly attested with the seal of the employer on the back side of the photos.

• Previous employment/Non-employment certificate duly declaring by the nominee/parents of deceased member clearly stating that the member was working/not working anywhere else other than the present establishment in which he was working in last place and NO-DUES or pending for payable to them and in future if so, no any claim is preferable for payment under the EPF Scheme 1952.

• Aadhar and Bank details of the parents of the deceased member and Aadhar card copy of the member should be attested by the employer and a separate account should be opened in the same bank and branch of the parents. (Pension Disbursing banks are SBI, ICICI, AXIS & HDFC, PND & BOI)

• If Death While in service certificate should be submitted by the deceased nominee duly attested by the employer.

• Non-contributory period (NCP Days) of service certificate from date of joining to date leaving should be submitted by the nominee of the member duly attested by the employer, if no such break in service the employer should submit NO-BREAK in service certificate.

• Joint Declaration Form should be submitted by the claimant along with the Aadhar copy and supporting documents of the deceased member duly attested by the employer for correction of member profile, if required.3A Wages for the last 12 months prior to the death of the member (if pre ECR period).

• Form No 5 & 10 duly furnish the information such as PF No., name, father name, date of birth, date of joining, etc. in Form 5 and name, father’s name, date of leaving, etc. in form 10. Descriptive Roll should be submitted for each pensioner if the member’s death is while in service. The form should be signed by each pensioner and should be attested by the employer.

DEATH CASE CLAIMS TO BE SUBMITTED BY A FAMILY MEMBER/NOMINEE (FOR DEATH CASES OF MARRIED PERSONS)

The following Documents are to be submitted:

• Original Composite Death Claim Form No. 20, 10D & 5(IF) should be submitted by the family member/nominee of the deceased member duly attested by the employer with filed all columns properly

• The original Death Certificate of the deceased member should be submitted by the Family member/nominee.

• The surviving family members certificates (SFMC)/ List of surviving Member (lSM) should be submitted by the Family member/nominee of the deceased member duly attested by the employer.

• Three (3) copies of photos of each Family member/nominee duly attested with a seal of the employer on the back side of the photos.

• Non employment certificate duly declaring by the Family member/nominee of deceased member clearly stating that the member was not working anywhere else other than the present establishment in which they work in last place and NO- DUES or pending for payable to them and in future if so, no any claim is preferable for payment under the EPF Scheme 1952.

• Aadhar and Bank details of the Family member/nominee of the deceased member, Aadhar card copy of member, and Birth Certificate/School Certificate of children of the deceased member should be attested by the employer and a separate account should be opened by the same bank and branch of the Family member/nominee. (Pension Disbursing banks are SBI, CANARA BANK, ICICI, AXIS & HDFC)

• If Death While in service certificate should be submitted by the deceased Family member/nominee duly attested by the employer.

• Non-contributory period (NCP Days) of service certificate from date of joining to date leaving should be submitted by the
  • Family member/nominee of the member duly attested by the employer, if no such break in service the employer should submit
  • NO-BREAK in service certificate.
• Joint Declaration Form should be submitted by the claimant along with the Aadhar copy and supporting documents of the deceased member duly attested by the employer for correction of member profile, if required.3A Wages for the last 12 months prior to the death of the member (if pre ECR period).

• Form No 5 & 10 duly furnish the information such as PF No., name, father name, date of birth, date of joining, etc. in Form5 and name, father name, date of leaving, etc. in form 10.

• Descriptive Roll should be submitted for each pensioner. The form should be signed by each pensioner and should be attested by the employer.

Checklist:- 👇