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The Employees' Provident Fund Scheme, 1952

Paragarph 36 (2) (a) and (b)

Form - 5

Employees' Pension Scheme, 1995


Paragarph 20 (4) Return of Employees' qualifying for membership of the Employees' Provident Fund, Employees' Pension Scheme & Employees' Deposit Linked Insurance Fund for the first time during the month of To be sent to the Commissioner with Form 2 Name & Address of the Factory/ Establishment : Code No. of Factory/ Establishment : Total Period of Previous Service Date of (excluding period Sex Eligibility for of breaks) as on Service the date of joining the Fund

S. No Account No.

Name of the Member (in BLOCK letters)

Father's Name or Husband's Name in case of married women

Age/ Date of Birth

Remarks

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Signature of the employer or other authorised officer and stamp of the Factory / Establishment Note: Please furnish details of the membership in remarks column if the employee was a member of Employees' Provident Fund and Employees' Family Pension scheme before joining yourself/ factory. i.e. Account No. and/ or the name and particulars of the last employer.

The Employees' Provident Fund Scheme, 1952


Paragarph 36 (2) (a) and (b)

Form - 10

Employees' Pension Scheme, 1995


Paragarph 20 (4) Return of Members leaving service during the month of : Name & Address of the Factory/ Establishment : Code No. of Factory/ Establishment :

S. No Account No.

Name of the Member (in BLOCK letters)

Father's Name or Husband's Name in case of married women

Date of Leaving Service

Reason for Leaving Service

Remarks

1 2 3 4 5 6 7 8 9 10 11 12

Signature of the employer or other authorised officer and stamp of the Factory / Establishment Please state whether the member is (a) retiring according to para 69 (1) (a) or (b) of the scheme; (b) leaving India for permanent settlement abroad; (c) retrenched; (d) ordinarily dismissed for serious and willful misconduct; (e) discharged; (f) resigning from or leaving service; (g) taking up employment elsewhere (the name and address of the new employer should be stated) ; (h) dead. (1) A request for deduction from the account of a member dismissed for serious and willful misconduct should be reported by the following certified that the member mentioned at Sr. No. was dismissed from the service for willful misconduct. I recommend that the employer's Shri. contribution for should be forfeited from his account in the fund. A copy of order of dismissal is enclosed. (2) In case of discharge from service, the following certificate should be filled. Certified that the member mentioned in Sr. No. Shri. under the Industrial Disputes Act, 1947

was paid/ unpaid retrenchment compensation of Rs.

FORM 12-A (REVISED)

THE EMPLOYEES' PROVIDENT FUNDS & MISC. PROVISION ACT, 1952 EMPLOYEES' PENSION SCHEME [PRARGRAPH 20(4)]
Only for Un-Exempted Establishments

Name and address of the Establishment Currency period from 1st April to 31st March

(To be filled in by EPFO) Establishment Status

Statement of Contributions for the month of Code No. Particulars Wages on which Contributions are Payable Statutory Rate of Contribution Amount of Contribution 3 Recovered Payable by the from the Employer Worker % Amount of Admin Charges Due 5 Amount of Admin Charges Due 6 Group Code Date of Remittace (Enclose Triplicate Copies of Challan)

Amount of Contributions Remitted 4 Worker's Employer's Share Share

1 E.P.F. A/c No. 01 Pension Fund A/c No. 10 D.L.I. A/c No. 21 Total No. of Employees (a) Contract (b) Rest (c) Total Details of Subscribers Number as per last month's return +) Number of Subscribers vide Form No. 5 -) Number of Subscribers vide Form No. 10 Net total

NIL NIL

NIL NIL Name and address of the Bank in which amount is remitted:

NIL

NIL

E.P.F.

Pension Scheme

E.D.L.I.

Signature of Employer with Office Seal

COMBINED CHALLAN - A/C. NO. 1, 2, 10, 21 & 22 EMPLOYER'S PROVIDENT FUND ORGANIZATION
(USE SEPARATE CHALLANS FOR EACH MONTH) ESTABLISHMENT CODE NO.: DUES FOR THE MONTH OF : ACCOUNT GROUP NO.: M Employee Share DATE OF PAYMENT Employer Share Total No. of Subscribers: A/c 1 Total Wages Due: S. NO. 1 2 3 4 5 6 PARTICULARS EMPLOYER'S SHARE OF CONTRIBUTION EMPLOYEE'S SHARE OF CONTRIBUTION ADMINISTRATIVE CHARGES INSPECTION CHARGES PENAL DAMAGES MISCELLANEOUS PAYMENT TOTAL 0.00 (Amount in words Rupees NAME OF THE ESTABLISHMENT ADDRESS NAME OF THE DEPOSITOR SIGNAGURE OF THE DEPOSITOR (For Bank use Only) Amount Received Rs. For Cheques Only: Date of Presentation: Date of Realisation: Branch Name: Branch Code No. (TO BE FILLED IN BY EMPLOYER) Name of the Bank : Cheque No. : Date : 0.00 0.00 0.00 0.00 A/C NO. 1 A/C NO. 2 A/C NO. 10 A/C NO. 21 AMOUNT (in Rupees) A/C NO. 22 A/c 10 A/c 21 M Y Y Y Y D D M M PAID BY CHEQUE/ CASH

ORIGINAL DUPLICATE TRIPLICATE QUADRUPICATE

TOTAL

0.00 Only)

The Employees' Provident Fund Scheme, 1952


Paragarph 35 & 42

Form - 3A

Employees' Pension Scheme, 1995


Paragarph 19 Contribution card for currency period from 1st April 1 2 3 Account No. Name/ Surname Father's/ Husband's Name to 31st March 4 5 6 Name & Address of the Factory/ Establishment Statutory rate of contribution Voluntary higher rate of employee's contribution if any Period of non Refund of Wages 5 From 6a To 6b Remarks 7

Worker's Share Month 1 April May June July August September October November December January February March Other Total Amount of Wages 2 EPF 3 EPF Difference between 12% & 10% (if any) 4a

CONTRIBUTIONS Employer's Share Pension Fund (EPS) Contribution 8-1/3% 4b Total 4c

0.00

0.00

0.00

0.00

0.00

0.00

Certified that the total difference between the total of the contributin shown under col (3) and (4) of the table of reverse and that arrived at on the total wages shown in col (2) at the prescribed rate is solely due to the rounding off contribution to the nearest rupees under the rules. (a) Date of Leaving Service (b) Reason for leaving service Certified that the total amount of contribution (both shares) indicated in this card i.e. Rs. has already been remitted in full in EPF A/c No. 1 and Pension Fund A/c No. 10 Only

Certified that the difference between the total of the contribution shown under cols. 3, 4a and 4b of the above table and that arrived at on the total wages shown in col. 2 at the prescribed rate is solely due to rounding off of contribution to the nearest rupee under the rules.

Signature of the employer or other authorised officer and stamp of the Factory / Establishment

The Employees' Provident Fund Scheme, 1952


Paragarph 43

Form - 6A

Employees' Pension Scheme, 1995


Annual statement of contribution for the currency period 1st April Name & Address of the Establishment Code No. of Establishment Wages retaining Amount of allowances (if any) Workers & DA including cash contribution value of food deducted concession paid from the during the currency wages period. 4 5 to 31st March Statutory rate of contribution 12.00 %

No. of members voluntarily contributing at a higher rate:

Sr. No.

Account No.

Name of the Member (in BLOCK letters)

EPF between 10% & 8-1/3% 6

Pension Fund 8-1/3%

Total

Refund of Advance

Rate of higher voluntary


contribution

Remarks

(if any) 7 8 9 10

Grand Total Rs.

0.00

0.00

0.00

0.00

0.00