Professional Documents
Culture Documents
Form - 5
S. No Account No.
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.
Form - 10
S. No Account No.
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
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
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)
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.
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
TOTAL
0.00 Only)
Form - 3A
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
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
Form - 6A
Sr. No.
Account No.
Total
Refund of Advance
Remarks
(if any) 7 8 9 10
0.00
0.00
0.00
0.00
0.00