UAN Joint Declaration Form

UAN Joint Declaration Form
Submit a joint declaration for Universal Account Number correction or update. Please fill out all relevant fields accurately.
Employee Full Name
First NameLast Name
Employee Email Address
example@example.com
Employee Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Universal Account Number (UAN)
Date of Birth
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
Employee Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Employer/Organization Name
Employer Contact Email
example@example.com
Reason for Joint Declaration
Details to be Corrected (Old vs New)
Rows Field Old Value New Value
Name
Date of Birth
Gender
Father's/Husband's Name
Supporting Document Upload (if any)
Cancelof
Employee Signature
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Employer/Authorized Person Signature
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Should be Empty: