CODE LANGUAGE FOR FIGURE TO WORD

pf
25508

0
0
25 Twenty Five Thousand
5 Five Hundred
8 Eight
0

Rs. Twenty Five Thousand Five Hundred Eight Only

esi
41,142

0
41 Forty One Thousand
1 One Hundred
42 Forty Two

Rs. Forty One Thousand One Hundred Forty Two Only

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47

One
Two
Three
Four
Five
Six
Seven
Eight
Nine
Ten
Eleven
Twelve
Thirteen
Fourteen
Fifteen
Sixteen
Seventeen
Eighteen
Nineteen
Twenty
Twenty One
Twenty Two
Twenty Three
Twenty Four
Twenty Five
Twenty Six
Twenty Seven
Twenty Eight
Twenty Nine
Thirty
Thirty One
Thirty Two
Thirty Three
Thirty Four
Thirty Five
Thirty Six
Thirty Seven
Thirty Eight
Thirty Nine
Forty
Forty One
Forty Two
Forty Three
Forty Four
Forty Five
Forty Six
Forty Seven

48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99

Forty Eight
Forty Nine
Fifty
Fifty One
Fifty Two
Fifty Three
Fifty Four
Fifty Five
Fifty Six
Fifty Seven
Fifty Eight
Fifty Nine
Sixty
Sixty One
Sixty Two
Sixty Three
Sixty Four
Sixty Five
Sixty Six
Sixty Seven
Sixty Eight
Sixty Nine
Seventy
Seventy One
Seventy Two
Seventy Three
Seventy Four
Seventy Five
Seventy Six
Seventy Seven
Seventy Eight
Seventy Nine
Eighty
Eighty One
Eighty Two
Eighty Three
Eighty Four
Eighty Five
Eighty Six
Eighty Seven
Eighty Eight
Eighty Nine
Ninety
Ninety One
Ninety Two
Ninety Three
Ninety Four
Ninety Five
Ninety Six
Ninety Seven
Ninety Eight
Ninety Nine

Seventeen

Twenty One
Twenty Two
Twenty Three
Twenty Four
Twenty Five
Twenty Six
Twenty Seven
Twenty Eight
Twenty Nine
Thirty One
Thirty Two
Thirty Three
Thirty Four
Thirty Five
Thirty Seven
Thirty Eight
Thirty Nine

Forty Three
Forty Four

Forty Seven

Forty Eight
Forty Nine

Fifty Three

Fifty Seven

Sixty Three

Sixty Seven
Sixty Eight

Seventy One
Seventy Two
Seventy Three
Seventy Four
Seventy Five
Seventy Six
Seventy Seven
Seventy Eight
Seventy Nine
Eighty One
Eighty Two
Eighty Three
Eighty Four
Eighty Five
Eighty Seven
Eighty Eight
Eighty Nine
Ninety One
Ninety Two
Ninety Three
Ninety Four
Ninety Five
Ninety Seven
Ninety Eight
Ninety Nine

COMBINE CHALLAN OF A/C NO. 1, 2, 10, 21, & 22

EMPLOYEE'S PROVIDENT FUND ORGANISATION
( USE SEPERATE CHALLAN FOR EACH MONTH )
ESTABLISHMENT CODE NO.:

ACCOUNT GROUP NO.

DUES FOR THE MONTH OF

Total No. of Subscribers

Total No. of Subscribers

A/C -1

S. PARTICULARS

Employee Share
Employer Share

1
1

2
2

1
1

0
0

26
99600

DATE OF PAYMENT

26
99600

A/C -10

A/C NO. 1

CHEQUE

PAID BY CHEQUE / CASH

A/C NO. 2

A/C NO. 10

A/C -21

A/C NO. 21

26
99600

A/C NO. 22

TOTAL

AMOUNT ( IN RUPEES )

No.
1 Employer's Share of Cont.

3657

2 Employee's Share of Cont.

11952

8295

498

11952
1096

3 A.D.M. Charges

12450

10

1106

4 INSP. Charges

5 PENAL DAMAGES

6 MISC. PAYMENT(PAST)

ACCUMULATIONS ONLY

TOTAL
Amount in words (Rs.) :

15609

1096

8295

498

10

25508

Rs. Twenty Five Thousand Five Hundred Eight Only

NAME OF ESTABLISHMENT:
ADDRESS

FOR BANK USE ONLY

Amount Received Rs.
..
For Cheques only
..
Date of Presentation
.

NAME OF DEPOSITOR

Date of Realisation

Branch Name

SIGNATURE OF THE DEPOSITOR

Branch Code No.:

( TO BE FILLED BY EMPLOYER )
NAME OF THE BANK

CHEQUE NO.

DATE

07.01.2011

HEQUE
Y

3.67169

TOTAL

12
8.32831

12450
11952
1106
0
0
0
25508

..
..
.

1.2011

FORM 12-A (REVISED)

Only for Un-Exempted Establishment

(To be filled by the EPFO)

Employee's Provident Fund and Provisions Act. 1952

Employee's Pension Scheme
[Paragraph 20(4)]

Name and Address of the Establishment

Establishment Status
Currency Period from Ist April 2009

Code No.
Particulars

to 31 March, 2010

Statement of Contributions for the month of

Wages on which

Amount of Contribution
3

Contibutions are Recovered

payment
from the
2
worker's

Payable
by the
Employer

Amount of Contribution
remitted
4
Worker's
Share

Employer's
Share

M
0

M
3

Y
2

Y
0

Y
1

Y
0

Amount of
Administrative
charges due
5

Amount of
Administrative
remitted
6

Group Code

Date of Submitted
(enclose Triplicate
copies of Challan)
7

E.P.F. A/c No. 01

85151

10218

3126

10218

3126

937

937

Pension Fund A/c

No. 10

85151

NIL

7092

NIL

7092

NIL

NIL

D.L.I. A/c No. 21

85151

NIL

426

NIL

426

Total No. of Employees's

(a) Contract
(b) Rest
( C ) Total
Details of Subcribers
No. of Subcribers as per last month
(No. of New Subcribers vide form 5)
No. of Subcribers left service (vide from 10)
(Nett.) Total Number of subscribers

Name and Address of the Bank in which

25

the amount is remitted

Pension Fund
E.P.F.
25
25
0
0
1
1
24
24

E.D.L.I.
25
0
1
24

Signature of the Employer

with official Seal

FORM - 5

Employee's Provident Fund Scheme, 1952

[ Paragraph 36 (2) (b) ]

Return of Employees qualifying for membership of the Employee Provident Fund for the fist time during the month of
[To be send th the Commissioner with form2]
MARCH-2010
Name and address of the Factory/Establishment

Code No. of the Factoty / Establishment

S. No.

Account No.

Name of the Member

(in block capital)

Total Period of

Father's name[or
husband's name in
case of married
woment]

Age

Date of
Previous Service
Sex Eligibilty for (Excluding period of Remarks
membership breaks as on the date
of joining the fund

NIL

Date

12.04.2010

Signature of the manager or authorised officer

of the Factory / Establishment

Stamp of the Factory / Establishment

FORM-10

Employee's Provident Fund Scheme, 1952

[ Paragraph 36 (2) (b) ]
Return of members leaving service during the month of

MARCH-2010

Name and address of the Factory/Establishment

Code No. of the Factoty / Establishment

S. No.

Account No.

Name of the Member (in

block capital)

Father's name[or husband's

name in case of married
woment]
4

Date of
leaving
service
5

Reason of
leaving service

Remarks

Date
12.04.2010

Signature of the manager or authorised officer

of the Factory / Establishment

Please sate whether the member is a (a) rationing to para 69(i)[a0 or 69[b] of the scheme [b] leaving india for
permanent abroad[b] renewment [b] ordinery despised for serous and welfare misconduct dischage [e] regisgend
from of leaving service[f] taking up employment elsewhere the name and address of the new employer should be
sated, [h] dead.
Note: A request for the deduction from the account of member dismissed for serios and wilful misconduct
should be supplied by the following certificate.