Joint Option

ANNEXURE-B
(For serving Members)

To
The Regional P.F. Commissioner,
Employees’ Provident Fund Organisation
Ministry of Labour & Employment
Govt. of India, Regional Office
Bhavishya Nidhi Bhavan
24, Patto Plaza Complex
PANJIM – GOA
Sub:Joint option under Para 11(3) (Now deleted) & Para 11(4) of Employees’ Pension Scheme, 1995
based upon the hon’ble Supreme Court’s Order in SLP No.8658-8659 of 2019 dated 04.11.2022
Sir,
1. With reference to the above, I hereby opt for higher pension (Pension on full salary i.e. the
salary on which EPF is deducted) under Para 11(3) OF THE EPS, 1995 & Para 11(4)since
my joining in GSL w.e.f._____________________
2. I being the member of EPF 1995, authorize EPFO to divert 8.33%ofthe salary exceeding
Rs.5000/- or 6500/-or 15000/- to the Pension Fund from the effective date (i.e.
w.e.f.________) with up to date interest as declared under EPF scheme,1952,from time to
time.
3. I also do hereby agree to contribute @ 1.16% on my salary (Pay +DA) exceeding

Rs.15000/-p.m. from my/employer share of contribution, w,e,f 01/09/2014 onwards subject
to final directives of Hon’ble Supreme Court of India in this regards.
4. I also understood all the terms and conditions governing the Higher Pension option of EPF –
1995 and I am willing to abide by all the terms & conditions. I understand that the Joint
option form shall be subject to acceptance by EPFO as per Rules. I further understand that
the Option exercised is irrevocable at any later date, and no claim for change of option shall
be entertained or considered under any circumstances.
5. I understand that the option exercised herein is subject to EPFO instructions and court
directions issues from time to time in this regard.
Yours faithfully,
Signature / Right Or Left Hand/

Thumb Impression of the Employee________________________________
Name Designation
EPF No GA/GOA/0009706/000____ UAN No
Aadhaar No E.No.
Place of posting
Declaration by the Employer
Accepted and recommended for affording necessary higher contribution from the employer’s
share of Provident Fund holding, diverting to Employees Pension Scheme. GSL shall comply with
all statutory provision in this regard.
_______________________
SIGNATURE(with office Seal)
PERMISSION UNDER PARA26(6) OF EPF & MP ACT,52
I___________________________S/o_____________________P.F. AccountNo.
GA/GOA/0009706/000____, Employee of Goa Shipyard Ltd. is drawing more than Rs.5000/-
w.e.f. 16.11.1995 / Rs.6500/- w.e.f.01.06.2001 / Rs.15000/- w.e.f.01.09.2014. I therefore request
your good office that I may be permitted to contribute to the fund on my actual pay
w.e.f.16.11.1995 or ____________(DOJ).
SIGNATURE OF THE APPLICANT
UNDERTAKING ON BEHALF OF THE EMPLOYER
I________________________________ an authorized signatory of Goa Shipyard Ltd.

undertake that in the event of allowing aforesaid applicant to contribute on actual pay which is
more than Rs.5000/--w.e.f.16.11.1995 and Rs.6500/- w.e.f.01.06.2001 and Rs. 15000/-
w.e.f.01.09.2014, GSL shall comply with all statutory levies of the said act and the scheme
framed thereunder and the directives of Hon’ble Supreme court of India in this regards.
SIGNATURE (with office seal)

____________________________________________________________________________
FOR USE OF COMMISSIONER OFFICE

Dated:
I ________________________________ Regional Provident Fund Commissioner, Goa in

exercise of powers conferred under Para 26(6) of the EPF, & MP. Act,1952 hereby permit the
member to contribute to the fund on wages exceeding Rs.5000/- w.e.f.16.11.1995 and Rs.6500/-
w.e.f.01.06.2001 and Rs.15000/- w.e.f.01.09.2014.
REGIONAL P.F. COMMISSIONER

M/s.________________________
Copy:-
1) Employees Personal File
(For EPFO pensioner)
Application by Pensioners for revision of pension under the Employees’ Pension Scheme 1995
on actual (higher) wages exceeding the wage limit of Rs. 5000/- or Rs.6500/- or Rs.15000/- per
month.
1 Name of pensioner
2 PPO No. with EPFO Branch address
3 EPF A/c No. GA/GOA/0009706/000____
4 Name of pension disbursing Bank &
Branch with IFSC Code
5 Bank A/c No.
6 Mobile No.
7 Aadhaar No.
8 UAN No.
Declaration by Pensioner
I___________________ am a pensioner under the Employees’ Pension Scheme, 1995 drawing

monthly pension with effect from _____________________. I am a retired employee of Goa
Shipyard Ltd. Retired on ____________________________ and was drawing salary more than
Rs. 5000/- or Rs.6500/- or Rs.15000/- per month and my employer had deposited 12% of my
actual salary (above the statutory wage ceiling) as employer’s share of the EPF contribution.
I understand that I am eligible for pension on my actual salary and therefore I may be permitted
to remit the amount due to the Pension Fund to become eligible for pension on my actual salary
and I undertake to remit the amount (including up to date interest) and additional contribution @
1.16% as calculated by the office of the Regional Provident Fund Commissioner, subject to final
directives of the Hon’ble Supreme court of India in this regards.
I understand that the joint option form shall be subject to acceptance by EPFO as per Rules.
I understand that the option exercised herein is subject to EPFO instructions and Court directions
issued from time to time in this regard.
Place: Signature
Date: Name :_________________________
Address :_______________________
Undertaking by the Employer
I ______________________________________________(Name& Designation) being the
authorized signatory of Goa Shipyard Ltd. do hereby certify that Mr./Mrs.
________________________________ who is the holder of PPO No. ____________________
was an employee of this establishment with PF A/c No. _________________________ . During
his/her service, we as the employer’s have contributed the employer’s share of provident fund
contribution on his actual salary, without break, as per the terms of paragraph 26(6) of the
Employees’ Provident Funds Scheme. Certified details of monthly contribution alongwith other
documents in respect of the said individual w.e.f.16.11.1995 or the date of joining /to the date of
exit is forwarded herewith for further necessary action by the Regional Provident Fund
Commissioner.
I certify that the particulars furnished are correct as per the records available.
Place :
Date : (Signature with official seal)

Joint Option

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ANNEXURE-B

(For serving Members)

3. I also do hereby agree to contribute @ 1.16% on my salary (Pay +DA) exceeding

Signature / Right Or Left Hand/

Declaration by the Employer

SIGNATURE OF THE APPLICANT

UNDERTAKING ON BEHALF OF THE EMPLOYER

I________________________________ an authorized signatory of Goa Shipyard Ltd.

SIGNATURE (with office seal)

FOR USE OF COMMISSIONER OFFICE

I ________________________________ Regional Provident Fund Commissioner, Goa in

REGIONAL P.F. COMMISSIONER

I___________________ am a pensioner under the Employees’ Pension Scheme, 1995 drawing

Date : (Signature with official seal)

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