The Employees' Provident Fund Scheme, 1952 Form - 6A

Paragarph 43
Employees' Pension Scheme, 1995

Annual statement of contribution for the currency period 1st March to 28th February

Name & Address of the Statutory rate of contribution 12.00 %

Establishment
No. of members voluntarily contributing at a higher rate:
Code No. of Establishment
Sr. Name of the Member Wages retaining Amount of Employer Contribution Refund of Rate of Remarks
Account No.
No. (in BLOCK letters) allowances (if any) & Workers Advance higher
DA including cash contribution Pension voluntary
value of food deducted EPF between Fund contribution
10% & Total
concession paid from the 8-1/3% (if any)
during the currency wages 8-1/3%
period.
2 6
1 3 4 5 7 8 9 10
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Grand Total Rs.
Form - 6A
Sr. Name of the Member Wages retaining Amount of Employer Contribution Refund of Rate of Remarks
Account No.
No. (in BLOCK letters) allowances (if any) Workers Advance higher
& DA including contribution EPF Pension voluntary
cash value of food deducted between Fund contribution
Total
concession paid from the 10% & 8-1/3% (if any)
during the wages 8-1/3%
currency period.
2
1 3 4 5 6 7 8 9 10

25
26
27
28
Remarks
29
30
31
32
33
34
10
35
36
Grand Total Rs. 0.00

Admn. Charges
Amount of Remittance Cols 5, 6, 7 Rs.
at 1-10% of Wages Contributions ( ) Aggregate( )
Sl.
Month EPF Contributions Pension Fund EDLI Admin
No. DLI Contribution A/c. Admin Charges A/c.
including refund of Contributions A/c Charges A/c.
No.21 2 (0.65%) (i) Total No.of contribution cards
advances A/c.1 No:10 22(0.001%)
enclosed(Form 3A revised)
1
2
3 (ii)Certified that form 3A duly
4 completed of all the members
listed in the statement are
5
enclosed, except those already
6 sent during the course of the
7 currency period for the final
8 settlement of the concerned
9 member's account vide Remarks
10 furnished against the names of
11 the respective members above
12
Date: Signature of the Employer with office seal.
7 Rs.

bution cards
evised)

3A duly
members
nt are
ose already
se of the
he final
ncerned
vide Remarks
e names of
bers above
ce seal.